US Census Research Articles

Residential Structural Racism and Prevalence of Chronic Health Conditions

Studies elucidating determinants of residential neighborhood-level health inequities are needed. To quantify associations of structural racism indicators with neighborhood prevalence of chronic kidney disease (CKD), diabetes, and hypertension. This cross-sectional study used public data (2012-2018) and deidentified electronic health records (2017-2018) to describe the burden of structural racism and the prevalence of CKD, diabetes, and hypertension in 150 residential neighborhoods in Durham County, North Carolina, from US census block groups and quantified their associations using bayesian models accounting for spatial correlations and residents' age. Data were analyzed from January 2021 to May 2023. Global (neighborhood percentage of White residents, economic-racial segregation, and area deprivation) and discrete (neighborhood child care centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance coverage, and police shootings) indicators of structural racism. Outcomes of interest were neighborhood prevalence of CKD, diabetes, and hypertension. A total of 150 neighborhoods with a median (IQR) of 1708 (1109-2489) residents; median (IQR) of 2% (0%-6%) Asian residents, 30% (16%-56%) Black residents, 10% (4%-20%) Hispanic or Latino residents, 0% (0%-1%) Indigenous residents, and 44% (18%-70%) White residents; and median (IQR) residential income of $54 531 ($37 729.25-$78 895.25) were included in analyses. In models evaluating global indicators, greater burden of structural racism was associated with greater prevalence of CKD, diabetes, and hypertension (eg, per 1-SD decrease in neighborhood White population percentage: CKD prevalence ratio [PR], 1.27; 95% highest density interval [HDI], 1.18-1.35; diabetes PR, 1.43; 95% HDI, 1.37-1.52; hypertension PR, 1.19; 95% HDI, 1.14-1.25). Similarly in models evaluating discrete indicators, greater burden of structural racism was associated with greater neighborhood prevalence of CKD, diabetes, and hypertension (eg, per 1-SD increase in reported violent crime: CKD PR, 1.15; 95% HDI, 1.07-1.23; diabetes PR, 1.20; 95% HDI, 1.13-1.28; hypertension PR, 1.08; 95% HDI, 1.02-1.14). This cross-sectional study found several global and discrete structural racism indicators associated with increased prevalence of health conditions in residential neighborhoods. Although inferences from this cross-sectional and ecological study warrant caution, they may help guide the development of future community health interventions.

THE EARLY LIFE CONTEXTS OF THE HEALTH AND RETIREMENT STUDY HCAP SAMPLE: NEW INSIGHTS INTO DEMENTIA RISK FACTORS

Abstract There’s increasing interest in identifying potentially modifiable early-life socioenvironmental factors associated with late-life cognitive decline and dementia. To date, much research points to the importance of the number of years spent in education and age. We sought to extend evidence for potential modifiable targets by examining life history data available to date for women and men in the 2016 HRS-HCAP sample (N = 2645; Mean Age = 76; 61% women). The life history data were drawn from three HRS public cross-wave files: the 2015-2017 Life History Mail Surveys, the 1992-2018 Childhood Family and Childhood Health file, and the 1992-2020 Geographical Mobility File. Among the early factors examined were the US Census region of birth and school location at age 10; childhood physical and mental health conditions; childhood family SES; early learning and sensory/motor problems, early life activity engagement (cognitive, physical, social), college majors, and post-education work. The HRS-HCAP algorithm classifications (Dementia, MCI, vs Normal Cognition) served as outcomes. In addition to quantity of education and age/cohort, significant effects (all ps < .001) were revealed for childhood geographical locations, childhood mental health, and early-life access to and engagement in enriching activities. Over time, whereas the impact of changes such as increased access to post-secondary education and enriching high school activities are observed, other modifiable factors emerge. Tracking the impacts on cognitive aging of historical changes and disparities in the life course contexts of people in the HRS-HCAP subsample opens a new window into relevant social-environmental factors to target for intervention

OVERVIEW OF THE NEBRASKA GERIATRIC BEHAVIORAL HEALTH WORKFORCE SURVEY

Abstract According to the US Census, more than 16% of Nebraska’s population is 65 and older. Many older Nebraskans reside in rural communities. Although clinicians in existing state-wide workforce surveys endorse working with older adults, it is unclear how frequently they are involved in geriatric mental health. To identify the needs of those who are providing mental health services to older Nebraskans, the Behavioral Health Education Center of Nebraska (BHECN) conducted an online survey of eligible licensed practitioners from August to December 2022. This presentation highlights the background characteristics of 193 respondents, nearly 40% of whom came from rural areas. Two-thirds identified either as licensed mental health therapists (38%), licensed clinical social workers (26%), or licensed psychologists (14%). More than a quarter did not provide direct clinical services to older adults. On average, respondents estimated devoting 18% of their time working with older adults. Respondents listed insurance restrictions, lower reimbursement rates, and limited specialized geriatric mental health training opportunities as major reasons that had kept them from serving older clients more frequently. These findings support BHECN’s ongoing efforts to further develop training and support, and advocate for potential policy changes to enhance the state’s geriatric behavioral and mental health workforce.

ASSOCIATION BETWEEN COUNTY TEMPERATURE AND VISION IMPAIRMENT IN A NATIONALLY REPRESENTATIVE SAMPLE OF OLDER ADULTS

Abstract Several small studies have associated exposure to elevated average temperature with specific vision problems. However, no large-scale studies have examined the relationship between vision impairment and average area temperature in the general population. We conducted a cross-sectional analysis of a large nationally presentative sample of older adults to further explore this relationship through secondary analysis of the American Community Survey (ACS). Data from six consecutive years of the cross-sectional survey were analyzed (2012-2017). The subsample analyzed included community-dwelling and institutionalized older adults aged 65 and older in the coterminous US who lived in the same state in which they were born (n =1,707,333). The question on severe vision impairment was “Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?”. Average annual temperature data from the National Oceanic and Atmospheric Administration was combined into a 100-year average and mapped to corresponding US Census Bureau’s public use microdata areas (PUMAs) from the ACS. Higher average temperature consistently correlated with increased odds of severe vision impairment across all cohorts (i.e. age, sex, race, income, and educational attainment cohorts). Among all participants, the odds of severe vision impairment increased by 9.2% for every 5°F (2.8°C) elevation in annual average temperature (OR 1.092; 95% CI 1.088-1.097). If the association is found to be causal, the predicted rise in global temperatures could impact the number of older Americans affected by severe vision impairment and the associated health and economic burden.

RACIAL REPRESENTATIVENESS AND AFFORDABLE HOUSING DISPARITIES: A NATIONAL STUDY OF NURSING ASSISTANTS

Abstract Occupational racial representation is increasingly recognized as a health equity issue. In the US, racial unrepresentativeness in the healthcare workforce, including nursing homes (NHs), is a pervasive aspect of economic inequality: racially minoritized women are disproportionately overrepresented among nursing assistants (NAs) in NHs, and racially minoritized NAs commonly live in poverty and lack affordable housing. Despite evidence of associations between occupational racial representation and affordable housing, there is limited research on these associations among NAs in NHs. We examined how state-level racial representativeness of NAs in NHs relates to housing affordability using data from the PHI Workforce Data Center, LTCFocus, and US Census. Racial representativeness was calculated as the difference between the percentage of racial group (Black, White) in NA workforce in the state and the percentage of racial group in state working-age population. Multivariable linear regression was used to examine associations between housing affordability and racial representation. The national sample included 527,480 NAs. Results showed overrepresentation of Black NAs (M=17.5%, SD=.166) and underrepresentation of White NAs (M=-18.2%, SD=.127) in most states. Controlling for NH primary payer source and NA education level, lack of affordable housing was associated with higher representation of Black NAs in the workforce (b=1.78, p<.001, R2=.66) and lower representation of White NAs in the workforce (b=-1.45, p<.001, R2=.61). These findings indicate racial disparities in NA access to affordable housing and highlight the need for additional research on these associations and related outcomes to develop equity-centered strategies in the NH workforce that will address housing affordability.

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.

Political Partisanship and Belief in Misinformation: Operationalizing Theory of Planned Behavior to Predict Intentions to Quit Social Media

This study uses the theory of planned behavior to predict individuals’ intentions to quit social media. Attitude, subjective norms, and perceived behavioral control significantly predicted intentions to quit social media, accounting for 68 percent of variance among participants (N = 525) representing the US census data. Political partisanship and belief in misinformation also slightly increased the predictability of the TPB, suggesting that they can be used as moderators or antecedents of subjective norms in the future.

Underrepresentation of racial and ethnic minority groups in gynecologic oncology: An analysis of over 250 trials

ObjectiveTo describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. MethodsGynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. Results2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013–2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years – REMGs made up 19.6% of trial participants in 2007–2009 compared to 38.1% in 2016–2018 (p < 0.0001). ConclusionLess than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials.

Examination of Incidence of Sexually Transmitted Infections in the Ending the HIV Epidemic Priority Counties of the United States, 2005-2019.

The incidence of sexually transmitted infections (STIs) has been increasing in the United States, and this trend has continued alongside expanding/changing human immunodeficiency virus (HIV) prevention strategies, moving from reliance solely on behavioral interventions like condoms to biomedical methods like oral and injectable antiretroviral preexposure prophylaxis (PrEP). In 2019, the Ending the HIV Epidemic (EHE) initiative was released to prioritize resource allocation to the 50 jurisdictions in the United States with the highest HIV incidence, providing an opportunity to monitor STI incidence in a national group of discrete, geographic units and identify trends and differences across jurisdictions. Using existing data from the US CDC and Census Bureau, a retrospective analysis was conducted to examine the incidence of STIs in 49 of the 50 EHE priority counties between 2005 and 2019. This timeframe was divided into 2 periods representing a before and after entry into the biomedical era of HIV prevention: P1 (2005-2011) and P2 (2012-2019). A total of 49 EHE counties were included in this analysis, representing 27.4% of the total US population. Entry into the biomedical HIV prevention era was associated with an increase in STI incidence in 28 EHE counties and a decrease in 14 EHE counties. The greatest percent increase in total STI incidence was in the District of Columbia (+12.1%; incidence rate ratio = 1.121 [1.115, 1.127]; P < 0.001) and the greatest percent decrease was identified in Orleans Parish, LA (-8.7%; incidence rate ratio = 0.913 [0.908, 0.919]; P < 0.001). Rising STI rates in the biomedical era of HIV prevention represent missed opportunities for comprehensive sexual and preventive healthcare. County-level data provide actionable insight for reducing STI incidence. The EHE counties that have experienced decreases in STI incidence while being in the biomedical era may provide models of best practice, which may be scaled in other jurisdictions.

Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families

Little is known about the association of severe COVID-19 and post-COVID-19 conditions with household finances. To examine associations between COVID-19 outcomes, pandemic-related economic hardship, and prepandemic socioeconomic status among families in the US. This cohort study used data from the Panel Study of Income Dynamics (PSID), a nationally representative, longitudinal study. Data included 6932 families active in the PSID in both 2019 and 2021. Ordinal exposure categories were defined based on whether the reference person or spouse or partner reported a positive COVID-19 diagnosis and (1) persistent COVID-19 symptoms, (2) previous severe COVID-19, or (3) previous moderate, mild, or asymptomatic COVID-19. Families with no history of COVID-19 served as the reference group. Outcomes included whether a resident family member was laid off or furloughed, lost earnings, or had any financial difficulties due to the COVID-19 pandemic. In this cohort study of 6932 families (772 Hispanic families [weighted, 13.5%; 95% CI, 12.4%-14.6%], 2725 non-Hispanic Black families [weighted, 13.1%; 95% CI, 12.3%-14.1%], and 3242 non-Hispanic White families [weighted, 66.8%; 95% CI, 65.2%-68.3%]), close to 1 in 4 (2222 [weighted, 27.0%; 95% CI, 25.6%-28.6%]) reported income below 200% of the US Census Bureau poverty threshold. In survey-weighted regression models adjusted for prepandemic sociodemographic characteristics and experiences of economic hardship, the odds of reporting pandemic-related economic hardship were 2.0 to 3.7 times higher among families headed by an adult with persistent COVID-19 symptoms (laid off or furloughed: adjusted odds ratio [AOR], 1.98 [95% CI, 1.37-2.85]; lost earnings: AOR, 2.86 [95% CI, 2.06-3.97]; financial difficulties: AOR, 3.72 [95% CI, 2.62-5.27]) and 1.7 to 2.0 times higher among families headed by an adult with previous severe COVID-19 (laid off or furloughed: AOR, 1.69 [95% CI, 1.13-2.53]; lost earnings: AOR, 1.99 [95% CI, 1.37-2.90]; financial difficulties: AOR, 1.87 [95% CI, 1.25-2.80]) compared with families with no history of COVID-19. Families headed by an adult with persistent COVID-19 symptoms had increased odds of reporting financial difficulties due to the pandemic regardless of prepandemic socioeconomic status (families with lower income: AOR, 3.71 [95% CI, 1.94-7.10]; families with higher income: AOR, 3.74 [95% CI, 2.48-5.63]). Previous severe COVID-19 was significantly associated with financial difficulties among families with lower income (AOR, 2.59 [95% CI, 1.26-5.31]) but was not significantly associated with financial difficulties among those with high income (OR, 1.56 [95% CI, 0.95-2.56]). This cohort study suggests that persistent COVID-19 symptoms and, to a lesser extent, previous severe COVID-19 were associated with increased odds of pandemic-related economic hardship in a cohort of US families. The economic consequences of COVID-19 varied according to socioeconomic status; families with lower income before the pandemic were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.

Population-based evaluation of disparities in stomach cancer by nativity among Asian and Hispanic populations in California, 2011-2015.

Stomach cancer incidence presents significant racial/ethnic disparities among racial/ethnic minority groups in the United States, particularly among Asian and Hispanic immigrant populations. However, population-based evaluation of disparities by nativity has been scarce because of the lack of nativity-specific population denominators, especially for disaggregated Asian subgroups. Population-based stomach cancer incidence and tumor characteristics by detailed race/ethnicity and nativity were examined. Annual age-adjusted incidence rates were calculated by race/ethnicity, sex, and nativity and tumor characteristics, such as stage and anatomic subsite, were evaluated using the 2011-2015 California Cancer Registry data. For Hispanic and Asian populations, nativity-specific population counts were estimated using the US Census and the American Community Survey Public Use Microdata Sample data. During 2011-2015 in California, 14,198 patients were diagnosed with stomach cancer. Annual age-adjusted incidence rates were higher among foreign-born individuals than their US-born counterparts. The difference was modest among Hispanics (∼1.3-fold) but larger (∼2- to 3-fold) among Chinese, Japanese, and Korean Americans. The highest incidence was observed for foreign-born Korean and Japanese Americans (33 and 33 per 100,000 for men; 15 and 12 per 100,000 for women, respectively). The proportion of localized stage disease was highest among foreign-born Korean Americans (44%); a similar proportion was observed among US-born Korean Americans, although numbers were limited. For other Asians and Hispanics, the localized stage proportion was generally lower among foreign-born than US-born individuals and lowest among foreign-born Japanese Americans (23%). Nativity-specific investigation with disaggregated racial/ethnic groups identified substantial stomach cancer disparities among foreign-born immigrant populations.

Illustrated, Incitive, and Indecent: Comic Censorship and the Effort to Stem Youth Corruption

Today, one would be hard-pressed to find a child, teen, or adult in the United States who has not been exposed to comic culture in some sense—a cultural element we share with those Americans from almost a century ago. Comic magazines (hereby referred to as comics) were a staple of American youth culture from the late-1930s to the mid-1950s. According to Paul Lopes, a 1944 study found that nearly every American between six and seven years old read comics, and Shawna Kidman estimates that prior to the comic book crash beginning in 1954, there were around 70 million American comic readers—a number which not only exceeded the US Census Bureau’s estimate of nearly 60 million Americans under age 20, but made up roughly 40% of the American population.1 In other words, around two in five Americans were comic readers at the time. In fact, comics were so popular that to promote literacy among soldiers, the US military even used specialized editions of popular comics, such as Action Comics’ Superman stories, which contained simplified language and quizzes titled “How well did you read?”2 It is clear that the medium was recognized to have engaged readers in all different parts of life, but if comics were so well read among Americans youths and adults alike, why did their popularity decline?

Association of neighborhood opportunity and pediatric hospitalization rates in the United States.

We examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.02 hospitalizations per 1000). Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased (p < .001 for each), from 26.56 per 1000 (95% confidence interval [CI] 26.41-26.71) in very low COI areas to 14.76 per 1000 (95% CI 14.66-14.87) in very high COI areas (incidence rate ratio 1.8; 95% CI 1.78-1.81). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in 18 US states. These data underscore the importance of social context and community-engaged solutions for health systems aiming to eliminate care inequities.

Estimating network flow and travel behavior using day-to-day system-level data: A computational graph approach

To estimate network flow and travel behavior under recurrent traffic conditions, we leverage computational graphs and multi-source system-level data and solve a single-level optimization problem consistent with stochastic user equilibrium under logit assignment (SUELOGIT). Our model learns time-specific O-D matrices and utility functions and network flow parameters such as link flows, path flows, and travel times. To increase the model’s representational capacity for reproducing observed link flows and travel times, the parameters of the link performance functions are assumed link-specific. More importantly, the utility function in the route choice model is enriched with (i) link-specific parameters to capture the effect of unobserved attributes on route choices and (ii) period-specific parameters weighting the observed features in the utility function to capture the heterogeneity of travelers preferences among periods of the day. Experiments on synthetic data show that the parameters of the models can be consistently recovered and that the solution of the model satisfies the SUELOGIT conditions with high accuracy. The estimation procedure is also robust to random noise in both the observed traffic flow and travel time, and it requires very few hyperparameter tuning. Subsequently, the algorithm is deployed at a large scale using real-world multi-source data in Fresno, CA, with hourly data collected during the morning and afternoon peak periods of October 2019. The utility function includes link-specific effects and attributes such as travel time, the standard deviation of travel time, the number of traffic incidents, and socio-demographic information obtained from the US Census. We obtain estimates for the total trips and travelers’ utility function by hour of the day and for the average values of the link performance parameters that are reasonable and informative on the demand and supply characteristics of the transportation network.

Disparities in access to healthcare services in a regional neonatal transport network

IntroductionThe disproportionate distribution of healthcare resources in the U.S. leads to an annual estimated 68,000 critically-ill newborns transported to regional centers for intensive care. As described in the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, patients with limited access to healthcare experience multiple healthcare settings in their journey to specialty care. Little is known about community resources for transported neonatal patients in the Pacific Northwest region. MethodsTransport data from January 2014–December 2019 identified referral zip codes for transfers to a regional neonatal intensive care unit (NICU). Using the SEIPS 3.0 framework to explore the journey of families experiencing neonatal complications, we linked referral zip codes to data on healthcare and resource access including: Health Transportation Shortage Index (HTSI); US Census Small Area Income and Poverty Estimates; public transportation availability; Health Professional Shortage Area (HPSA) and number of Federally Qualified Health Centers. Results1834 neonatal transports from 75 zip codes were analyzed. Forty percent of patients were transferred from a HPSA, one-quarter from areas with limited public transit availability (28%) and household internet access (24%). Almost all infants transferred from a high HTSI area (96%) were transported by air. ConclusionMany patients were referred from communities with high poverty and limited services. Improving patient outcomes requires population and policy level recommendations and care coordination between healthcare organizations and community services. Considering the patient family perspective within the SEIPS 3.0 framework will ensure patient centered care and an inclusive experience for families transitioning through healthcare settings.

Interstate Mobility of People With Diagnosed HIV in the United States, 2011-2019.

Assessing mobility among people with HIV is an important consideration when measuring HIV incidence, prevalence, and the care continuum in the United States. Our aims were to measure mobility among people with HIV compared with the general population and to examine factors associated with migration among people with HIV. We calculated state-to-state move-in and move-out migration rates for 2011 through 2019 using National HIV Surveillance System data for people with HIV and using US Census data for the general population. For people with HIV, we also assessed the association between migration and HIV care outcomes. From 2011 through 2019, the US general population had stable migration, whereas migration rates among people with HIV fluctuated and were higher than among the general population. Among people with HIV, migration rates in 2019 were higher among people assigned male sex at birth versus female sex at birth, among people aged ≤24 years versus ≥25 years, among people with HIV infection attributed to male-to-male sexual contact versus other transmission categories, and among non-Hispanic Other people (ie, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or multiple races) versus Hispanic, non-Hispanic Black, and non-Hispanic White people. Receipt of HIV medical care (90.3% vs 75.5%) and achieving viral suppression (72.1% vs 65.3%) were higher among people with HIV who migrated versus those who did not. People with HIV in the United States are more mobile than the general population. Determining the mobility of people with HIV can help with strategic allocation of HIV prevention and care resources.

Marital status associated with excess ADRD mortality among Californians during the COVID‐19 pandemic

AbstractBackgroundSocial support shapes the health of older adults with Alzheimer’s disease and related dementias (ADRD), and marital status is linked to ADRD risk and all‐cause mortality. During the Covid‐19 pandemic, older adults with ADRD may have been particularly reliant on key social ties such as spouses. We estimated excess ADRD mortality by marital status among older Californians during the pandemic.MethodUsing California monthly mortality data from January 2016 to February 2020, we built autoregressive integrated moving average time series models to estimate the number of expected deaths with ADRD as a final or contributing cause between March 2020 and December 2022, stratified by marital status and age group. We obtained population estimates from the US Census’ American Community Survey. We calculated cumulative and monthly excess deaths per 100,000 living individuals and relative risk ratios (by dividing the number of observed deaths by the number expected). We simulated models 10,000 times to estimate 95% prediction intervals (PIs) for cumulative measures of excess.ResultAmong older Californians who died with ADRD during the study period, 7% were 65‐74, 26% were 75‐84, and 67% were 85+ (Table 1). Compared to people who were divorced, never married, or widowed, married people experienced the lowest spikes in per capita excess mortality associated with ADRD during the 2020 winter surge, regardless of age group (Figure 1). Among people who were 75 years and older, married people had the fewest estimated cumulative excess deaths per 100,000 population (1385, 95%PI: (1033, 1746)) compared to divorced (3217 (2294, 4155)), never married (2621 (1777, 3471)), and widowed people (2156 (770, 3560) (Table 1), although prediction intervals overlapped.ConclusionBeing married may have protected against excess ADRD mortality during the pandemic among older Californians. The link between marital status and ADRD mortality risk likely reflects several mechanisms: social and emotional support; instrumental support to adhere to safety protocols during contagious outbreaks; caregiving and practical assistance with the activities of daily living; access to a broader social network that may include adult children; and advocacy to ensure appropriate medical care and support.

The urban community college: An overview

AbstractUrban community colleges have been studied primarily from a case study perspective, often highlighted by doctoral students conducting research at their institutions. Little of this scholarship, however, has been translated into the base of literature, as less than 5% of the citations in the largest search engines are focused on urban community colleges. The article begins by exploring what “urban” means, primarily using the complex and evolving definition from the US Census Bureau. Then it explores this case study research on urban community colleges' mission, organization, students, and faculty. The article concludes with a strong recommendation for identifying and making available rigorous data to guide a more systematic approach to studying urban community colleges.

Chinese Naturalization, Voting, and Other Impossible Acts

Abstract: Historians have taken as a defining characteristic of Chinese experience in the United States their inability to naturalize until the repeal of Chinese Exclusion in 1943. It is certainly true that treaty agreements, court rulings, and discriminatory legislation conspired to prevent the existence of Chinese American citizens. But scholars may have taken for granted Chinese migrants' alien status and disenfranchisement more than they themselves did. In 1900, the US census recorded that 6.7 percent of the Chinese population had naturalized. These naturalized Chinese accomplished a seemingly impossible task and in so doing they exposed broader truths about the uncertain nature of citizenship in the postbellum era.

Analysis and Prediction of Poverty Rate along with Other Economic Factors in the United States

Poverty is an everlasting issue that affects everyone on the globe, and it is of crucial importance to lift people out of poverty. It is part of the UN SDGs and a macroeconomic goal of most countries. Thus, it is important to understand patterns and make predictions of poverty rate. In this paper, data from the US Census Bureau and The Balance are used to form timeseries analysis. In addition to poverty rate alone, unemployment rate and inflation rate are used to generate dynamic regression model for more complete and accurate predictions. The result of modeling and prediction shows that poverty rate in the United States will most likely increase in the following years to around 15 to 16 precent and then gradually decrease. It is also likely that it will fluctuate around 12%. Overall, the result is a sign that potential measures should be taken to mitigate the possible effects of a predicted increasing poverty rate.