US Citizens Research Articles

Counting regulations and measuring regulatory impact: a call for nuance

The effect of regulation on virtually every aspect of the lives of US citizens has led to an understandable impulse to measure this total impact. It has led to various attempts to count the total number of regulations and regulatory requirements, and to total the costs and benefits of regulation. And these counting mechanisms have played prominent roles in discussions over statutory changes designed to reform the process by which we write regulations. However, counting regulations in a meaningful way and measuring their cumulative economic impact is an astonishingly difficult task. For this reason, there have been a wide variety of methods that scholars and advocates have employed in the effort to do so. This article is an attempt to catalog the most prominent methods of counting regulations and measuring regulatory impact in the United States, describe their strengths and weaknesses, and suggest alternative approaches to attack this important question. We suggest both using large language models and detailed analysis of Paperwork Reduction Act data and, at the opposite extreme, doing more qualitative work on the consequences of regulation on individuals, firms, and industries.

Perinatal Health Insurance And Health Care Use By Immigration Status In 6 US States, 2020-22.

Some noncitizens in the US are not eligible for public health insurance, potentially reducing access to preconception, prenatal, and postpartum care. We compared insurance coverage and health care use from the preconception period to the postpartum period by immigration status, using representative survey data collected from six US states between 2020 and 2022. Respondents were surveyed at two to six months postpartum and at twelve to fourteen months postpartum. Immigration status was classified in three categories: US citizen, permanent resident, and people who were neither citizens nor permanent residents. Compared with US citizens, fewer permanent residents had late postpartum insurance coverage, but coverage rates were otherwise similar. Coverage was lower among noncitizens/non-permanent residents compared with US citizens at every time point except pregnancy, with the largest differences at preconception (50.5percent and 90.5percent, respectively) and late postpartum (53.2percent and 95.1percent, respectively). Fewer permanent residents had health care visits before pregnancy compared with US citizens, but health care use was otherwise similar. Noncitizens/non-permanent residents had substantially lower rates of preconception health care, early and adequate prenatal care, postpartum visits, and having a usual source of care at one year postpartum. Expansion of public insurance to cover immigrants is needed to reduce large inequities in perinatal health insurance and health care use by immigration status.

Are Certain Types of Microtargeting More Acceptable? Comparing US, German, and Dutch Citizens’ Attitudes

Much of the research on political microtargeting has focused on growing public concerns about its use in elections, fuelling calls for greater regulation or even a ban on the practice. We contend that a more nuanced understanding of public attitudes toward microtargeting is required before further regulation is considered. Drawing on advertising psychology research and the results of academic analyses into microtargeting, we argue that individual concern, and by corollary, acceptance of microtargeting will vary based on socio-demographic characteristics and political orientations, and the type of personal data used. We hypothesise that microtargeting that relies on observable or publicly accessible personal information will be more accepted by voters than that which uses unobserved and inferred traits. We test these expectations and the expected variance of public acceptance by individual characteristics using comparative survey data from the US, Germany, and the Netherlands. We find that across countries and socio-demographic groups, not all microtargeting is considered equally problematic. For example, whereas the use of age and gender is generally deemed acceptable, the use of sexual orientation is not, and right-leaning individuals are more accepting than those who lean left. Additionally, overall, the US is more accepting of microtargeting than Germany or the Netherlands. Thus, we find that not all microtargeting is considered equally problematic across countries and socio-demographic groups. We conclude by calling for a more contextualised debate about the benefits and costs of political microtargeting and its use of “sensitive” data before the expansion of current regulation.

Unveiling Cervical Cancer Inequities Among Georgia Immigrant Latinas: A Robust Qualitative Examination of the Facilitators and Barriers to Prevention, with Emphasis on the Impact of Community-Based Organizations.

This qualitative study delves into the facilitators and barriers surrounding cervical cancer prevention among Latina women in Georgia, with a specific focus on the impact of community-based organizations (CBOs). Employing semi-structured interviews with healthcare providers and representatives from CBOs, faith-based organizations, and other key stakeholders, the study uncovers key themes and subthemes shaping cervical cancer disparities. Themes such as challenges in cross-cultural healthcare access, difficulties due to lack of US citizenship, and limited mobility emerge as significant barriers, while community and family support stand out as crucial facilitators to cancer prevention. Additionally, the study examines community intervention methods from CBOs to target cervical cancer disparity, highlighting the importance of public awareness campaigns, building trust within the Latina community, and providing medical support tailored to immigrant populations. Through this comprehensive examination, the study not only offers invaluable insights into the intricate web of issues surrounding cervical cancer prevention but also endeavors to serve as a catalyst for targeted interventions and evidence-based policies aimed at ameliorating cervical cancer disparities among immigrant Latinas in Georgia and beyond.

Effects of Citizenship Status on International Medical Graduate Specialty Choice and Practice Location.

The number of both US citizen and noncitizen international medical graduates (IMGs) practicing in the United States has grown substantially over the last two decades, but little is known about how these groups differ in clinical specialty and practice location. To evaluate the effects of citizenship status on IMG specialty choice (primary care vs nonprimary care) and practice location (rural and health professional shortage areas [HPSAs]). To analyze the retrospective, cross sectional data between 2010 and 2019, we estimated a series of multivariate logistic regressions with year fixed effects after assessing trends in new physician specialty choice and practice location. Survey of Residents Completing Training in New York, the largest publicly available annual survey of graduating residents and fellows in the US. 15,133 new physicians who accepted a job offer in our study period, including 8,177 US medical graduates (USMGs), 2,753 US citizen IMGs, 1,057 permanent resident IMGs, and 3,146 noncitizen non-permanent resident (NCNP) IMGs. IMG and Citizenship status. Whether a new physician chose to practice primary care; whether a new primary care physician chose to work in a rural area; whether a new primary care physician chose to work in a HPSA. Compared to 2010, there were 20% fewer NCNP IMGs entering primary care in 2019. Our logistic analysis found that US citizen IMGs were five times, permanent resident IMGs seven times, and NCNP IMGs nine times more likely to enter primary care compared to USMGs. Among new primary care physicians, NCNP IMGs were more likely to work in a rural area compared to USMGs while US citizen IMGs and permanent resident IMGs acted similarly to USMGs. NCNP IMGs were five times more likely to work in a HPSA while US citizen IMGs and permanent resident IMGs were less likely, compared to USMGs. There was a declining proportion of NCNP IMGs entering primary care; citizenship status affected IMGs' specialty and practice location choices with NCNP IMGs more likely to choose primary care and work in rural areas and HPSAs.

Transparent Citizenship: The Racialization of Privacy in Post–World War II Japanese American Fiction

Abstract Written in the wake of the Japanese incarceration and the emergence of new Cold War discourses around race, privacy, and democracy, Hisaye Yamamoto’s and John Okada’s works mark a shift from the specific targeting of Japanese Americans as individuals whose citizenship was contingent upon enforced transparency to the broader suspicion of the more generalized “Oriental” as a figure whose opacity becomes an excuse for racialized surveillance and policing in the name of national security. As formerly interned or imprisoned individuals, Yamamoto’s and Okada’s protagonists begin their stories already understanding the contingency of their right to privacy and the expectations of transparency that attend their reentry into the mainstream of US society. This article argues that Yamamoto’s and Okada’s depictions of this transparent citizenship not only critique the limitations and burdens of proof that it places on racialized (and otherwise minoritized) individuals, but also articulate ways to think differently about citizenship itself. What if US citizenship were understood as a formation that did not fetishize the role of individual agency in the process of self-determination? What if the goal of transparency was not to expose or condemn the individual but to better illuminate the parts that individuals play in the construction of our society, and the complexity of their connections to others? And how might transparent citizenship be reconceptualized to empower, rather than infantilize, citizens vis-à-vis the state, by giving us information we might need to imagine and remake the power dynamics of this relationship?

More than “A Matter of Deciding To”: Citizenship, Border Positionality, and Irresolution in Louise Erdrich’s The Night Watchman

Abstract This article considers Indigenous refusal to state-imposed US citizenship through a reading of Louise Erdrich’s The Night Watchman (2020). The novel follows the Turtle Mountain Band of Chippewa’s struggle to remain a federally recognized tribe during the US government’s move toward tribal termination in the 1950s. While the characters’ appeal to the US government could be construed simply as a plea for state recognition, the novel’s insistence on Chippewa kinship structures as a simultaneous and legitimate expression of the characters’ political identities suggests otherwise. Taking up conversations in Indigenous studies pertaining to the limits of state recognition and the possibilities of generative forms of refusal, the article expands upon Mohawk scholar Audra Simpson’s (2014) model of refusal with an emphasis on irresolution. This irresolution is manifested in the novel’s narrative form—which refuses closure. The article uses the term border positionalities to describe the unresolved and unsettled tension between the characters’ Indigenous and settler political identities. It contends that the incommensurability of these social and political identities makes Erdrich’s novel an important text for reading citizenship as an ongoing site of struggle for Indigenous people.

Kenyan Female Immigrants’ Creation of a Virtual Enclave: The Influence of Age and Immigration Status

ABSTRACTMuch of the research on ethnic enclaves in the United States has focussed on physical, geographic spaces or brick‐and‐mortar establishments that foster community building and provide shared resources for immigrant groups, such as those from Latin America, Asia and Europe. These studies often highlight the benefits and challenges enclaves provide, with only a limited discussion of how immigrant women use these spaces. Using survey data drawn from Kenyan women residing in the United States, this study aimed to answer two research questions: (1) Does membership in social media groups comprised of Kenyan female immigrants vary (e.g. by age, immigration status)? (2) Do age and immigration/citizenship status influence Kenyan female immigrants' reasons for joining social media groups? The bivariate results show that older women and those who migrated to the United States for school or through the Green Card lottery programme were likelier to join Tumaini and other immigrant‐specific social media groups. Regarding factors influencing their reasons for joining these groups, the regression results revealed that US citizens and permanent residents were less likely to join the group for solidarity/support. Furthermore, those who migrated for school or to join family members were likelier to join the Tumaini group for support/solidarity. This finding suggests that older women, being more likely to belong to physical social groups, have a relatively stronger attachment to such groups. Consequently, their willingness to join the Tumaini group, despite it being an online community, may be stronger than that of their younger counterparts.

Complicated Pleural Infection is Associated With Prolonged Recovery and Reduced Functional Ability.

Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients' recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery. We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire. Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781). Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.

Demographic Differences in the Radiology Residency Match, 2022 to 2024

PurposeRanking preferences by residency programs in the Match could shape the diversity of selective specialties. We investigated demographic characteristics of applicants and matched residents in radiology and other specialties to identify changes in representation. MethodsSurvey data from the National Resident Matching Program were obtained for applicants to radiology (diagnostic radiology, interventional radiology, and combined diagnostic radiology and nuclear medicine) and nonradiology programs in the 2022 to 2024 Main Residency Matches. Demographics among applicants preferring a specialty, and matched residents were compared using χ2 tests. ResultsRadiology had a 73.9% match rate (3,486 of 4,718 applicants). Women represented 29.0% of radiology applicants compared with 52.0% in other specialties. In radiology, only US citizenship had higher representation among matched residents compared with applicants (+4.0%, 95% confidence interval [CI], 2.8%-5.3%) (P = .001). Other demographics were not significantly different between applicants and matched residents in radiology overall. A higher representation of women was observed in matched residents compared with applicants in diagnostic radiology (+2.4%, 95% CI, 0.2%-4.6%) (P = .031) but not interventional radiology (+0.2%, 95% CI, −5.1% to 5.5%) (P = .944). In nonradiology specialties, female gender, nonheterosexual orientation, White race, US citizenship, first-generation medical graduate, and nonurban childhood were associated with higher match rates. ConclusionUS citizenship but not other demographic variables was associated with higher rates of matching into radiology. Women are underrepresented among radiology applicants and have slightly higher match rates in diagnostic radiology but not interventional radiology.

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018.

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

Association between lipid accumulation products and gallstones: an analysis of the National Health and Nutrition Examination Survey 2017–2020

AimsThe aim of the research was to look into the connection between the occurrence of gallstones in adult US citizens and lipid accumulation products (LAP).MethodsWe conducted a cross-sectional study of 3,582 U.S. adults with relevant indicators collected from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) database. Multifactorial logistic regression was used to investigate the linear relationship between LAP and gallstone incidence, while smoothed curve fitting was used to describe the nonlinear relationship, and subgroup and interaction analyses were used to evaluate the potential differences between groups.ResultsAmong the 3582 participants aged ≥ 20 years included, there was a positive association between LAP and gallstones. Following adjustments for all covariates, the likelihood of getting gallstones rose by 29% for each unit rise in log2-LAP (OR = 1.29, 95% CI: 1.13‒1.49). Compared to those in the lowest tertile, those in the highest LAP tertile had a significantly higher risk of developing gallstones (OR = 1.97, 95% CI: 1.31‒2.95). Subgroup analyses indicated that the association between LAP and gallstones was not affected by the stratification of the variables examined.ConclusionGallstones and LAP exhibited a positive association in our investigation, indicating that LAP may be utilized as a clinical indicator to determine the occurrence of gallstones.

A Cross-Cultural Comparison of Cat–Human Relationships in the United States and Japan

ABSTRACT Across the world, more and more cats are being kept in captive spaces such as homes, animal shelters, and cat cafés. There is a growing need to understand whether cross-cultural differences influence human–animal interactions in these human-controlled environments. Cats are one of the world’s most popular companion animals, and both the US and Japan have high rates of cat ownership. However, cultural differences may account for differences in how people feel about cats and how humans and cats behave toward one another. The research aim was to examine whether differences exist between the US and Japan across multiple facets of the human–cat relationship. Study 1 examined each country’s attitude toward pet cats. Results indicate US citizens have significantly more positive attitudes toward pet cats than Japanese citizens. Study 2 examined owner attachment to their cat and pet cat social behavior. Results indicate owners in both countries were highly attached to their cats. In the US, but not Japan, owner attachment level predicted pet cat sociability toward the owner. Study 3 examined cat social behavior in cat cafés. The results of studies 2 and 3 indicate that pet cats and café cats in the US spend a greater proportion of time in proximity to people compared with pet and café cats in Japan. In all, differences and similarities were seen between the US and Japan. In humans, differences in childhood cat experiences and lower rates of cat ownership may impact attitudes toward cats. In pet cats, owner characteristics, the size of the cat’s environment, cat care practices, and attitudes toward cats may impact cat social behavior. Future exploration in this area can benefit our understanding of cross-cultural human–animal interactions and how to apply these findings to improve captive-cat welfare.

Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?

Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents. Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program. 108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score. This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.

Gender, germs, and governors: political masculinities and leadership in the US during the COVID-19 pandemic

This article describes how the concept of political masculinities helps explain public responses to US governors’ COVID-19 policies. We draw upon governors’ approval ratings, using a paired comparison of similar states with male and female governors, illustrating these findings with examples of citizens’ opinions on governors’ performance from local newspapers and social media. While the approval ratings data suggest citizens made few gender-based distinctions when appraising their governors’ performance, our media analysis shows citizens used gendered language to describe their governors’ leadership skills, evaluating governors during COVID-19 on stereotypically masculine traits. Also, regarding the “male-as-protector” element of normative political masculinity, both the approval ratings and local media data show that citizens held male—but not female—governors responsible for increased COVID-19 rates. These findings suggest that US citizens continued to regard their male and female governors through the lens of traditional (normative) political masculinities during the pandemic’s first year.

Mixed Methods Evaluation of a Youth-Friendly Clinic for Young People Living with HIV Transitioning from Pediatric Care.

(1) Background: Adolescents and young adults face challenges when transitioning to adult care due to emerging adulthood and changing providers and insurance. Young people living with HIV (YPLHIV) have additional obstacles with mental health and stigma. During transition, only 55% of YPLHIV are retained in care, and 65% are virally suppressed. To address these challenges, the Adolescent and Young Adult Health Care Transition Clinic (AYAHCTC) was created at Vanderbilt University Medical Center in 2017. This mixed methods study evaluates the initial cohort and solicits YPLHIVs' perspectives on transition barriers and facilitators. (2) Methods: Quantitative analyses (n = 21) characterized patients' demographics, clinical engagement, and retention. Qualitative interviews (n = 5) captured patients' transition experiences. (3) Results: This study, conducted in the Southeastern USA, included a cohort where 47.6% were born abroad, with all participants being US citizens by birth or naturalization. Patients' mean age at first visit was 19.6 years. The average AYAHCTC duration was 2.21 years. First-year engagement and retention were 100% and 95.5%, respectively. Viral suppression rates improved from 66.7% at the first visit to 81.0% at the last visit. Eleven patients transitioned out of AYAHCTC. Qualitative analyses indicate that barriers to transition include leaving trusted providers, reduced parental guidance, developing autonomy, and perceived loss of confidentiality in adult clinic environment. Transition was facilitated by youth-friendly services, clear communication, and strong relationships with AYAHCTC providers. (4) Conclusions: YPLHIV positively viewed AYAHCTC experiences. Future directions include optimizing services to build YPLHIVs' independence, supporting YPLHIV experiencing stigma, assuaging concerns about switching providers, collaborating with adult clinics to maintain confidentiality, and designing interventions focused on adherence during transition.

Predictors for success and failure in international medical graduates: a systematic review of observational studies

BackgroundInternational Medical Graduates (IMG) are an essential part of the international physician workforce, and exploring the predictors of success and failure for IMGs could help inform international and national physician labour workforce selection and planning. The objective of this study was to explore predictors for success for selection of IMGs into high stakes postgraduate training positions and practice and not necessarily for informing IMGs.MethodsWe searched 11 databases, including Medline, Embase and LILACS, from inception to February 2022 for studies that explored the predictors of success and failure in IMGs. We reported baseline probability, effect size in relative risk (RR), odds ratio (OR) or hazard ratio (HR) and absolute probability change for success and failure across six groups of outcomes, including success in qualifying exams, or certificate exams, successful matching into residency, retention in practice, disciplinary actions, and outcomes of IMG clinical practice.ResultsTwenty-five studies (375,549 participants) reported the association of 93 predictors of success and failure for IMGs. Female sex, English fluency, graduation recency, higher scores in USMLE step 2 and participation in a skill assessment program were associated with success in qualifying exams. Female sex, English fluency, previous internship and results of qualifying exams were associated with success in certification exams. Retention to work in Canada was associated with several factors, including male sex, graduating within the past five years, and completing residency over fellowships. In the UK, IMGs and candidates who attempted PLAB part 1, ≥ 4 times vs. first attempters, and candidates who attempted PLAB part 2, ≥ 3 times vs. first attempters were more likely to be censured in future practice. Patients treated by IMGs had significantly lower mortalities than those treated by US graduates, and patients of IMGs had lower mortalities [OR: 0.82 (95% CI: 0.62, 0.99)] than patients of US citizens who trained abroad.ConclusionsThis study informed factors associated with the success and failure of IMGs and is the first systematic review on this topic, which can inform IMG selection and future studies.Systematic review registrationPROSPERO: CRD42021252678.

Health disparity viewed from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers, for tailored prevention measures, and for inter-agency population data harmonization.

152 Background: We searched public datasets released by CDC to answer the question ”Can we have a bird’s-eye view of health disparity in cancer care in the US?” By looking into historic data, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also signs of missing data. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. Since the 2022 AACR report on cancer in Asian Americans raised concerns, we then looked into the “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count liver cancer deaths (ICD10: C22) 2018-2021 among 6 Asian minority groups with population data from 2021 Census ACS data. 2020 GLOBOCAN estimated liver cancer mortality data were also compared. With anecdotal stories suggesting immigrants may seek end-of-life care in the birth country to access culture-concordant services, we looked into how cancer deaths abroad was reported. Results: Gastrointestinal (GI) cancers emerged as an area of cancer health disparity from USCS data. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to 1/4 of US cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have poor outcomes. Black non-hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in US under-50 population. Liver cancer mortality of US East Asian alone groups shown in the table were lower than GLOBOCAN estimated ASR of 16.1, with the greatest discrepancy in the Chinese (9.1 vs 17.2). Difference between the Vietnamese and Asian Indians may reflect that liver cancer is #1 cause of death in Vietnam, or HepB infection is low in India. Census data excluded expat US citizens, and consulate reports of death abroad have neither cause of death nor race/ethnicity data. Conclusions: We identified gastrointestinal cancers as a focus for cancer health disparity advocacy. Divergent risks for liver cancer in Asian Americans call for tailored prevention measures. Cross-agency death abroad data harmonisation to include race/ethnicity information will complete views of cancer mortality data in US. [Table: see text]

Migration policy and the supply of foreign physicians: Evidence from the Conrad 30 waiver program

In the United States, rural and low-income communities have difficulty attracting and retaining physicians, potentially adversely impacting health outcomes. With a limited supply of physicians completing medical school at US universities, foreign-born and educated physicians provide a potential source of supply in underserved areas. Although nearly a quarter of medical residents in US hospitals received their medical degrees abroad, the terms of the commonly used J-1 visa require a return to the home country for two years, which may limit the capacity of international medical graduates (IMGs) to pursue employment in the US market. Our analysis examines the extent to which reducing visa barriers impacts the supply of physicians at state and local levels, particularly in areas designated as medically underserved. The Conrad 30 Visa Waiver program gives states the opportunity to attract foreign IMGs to practice in underserved areas by waiving the two-year home residency requirement for those with J-1 visas and providing a path to obtaining US citizenship. Changes in the federal limit on the number of waivers per state, combined with variations in the state-level restrictions on eligible specialties and geographies in which physicians can work, provide evidence of the role of visa restrictions in limiting the supply of doctors. We find that the expansion of the cap on visa waivers increased the supply of IMGs in states impacted by the cap lift. There is little evidence of reductions in US-trained doctors in states where IMGs increases were the largest, suggesting little evidence for crowding out. Health Professional Shortage Areas (HPSAs) in states with fewer restrictions on the program had relatively more IMGs but no fewer US-trained doctors. Importantly, HPSAs in states with less restriction to the program also had relatively lower early mortality rates and lower COVID-19 death rates.

Assistance Programs to Medical Licensure for IMGs Living in the US

Background: International Medical Graduates who are not US citizens (non-USIMGs) have the potential to provide culturally and linguistically competent care for diverse patient populations in underserved areas, relieving US physician shortages. However, the migration experiences of physicians who start the process of US medical licensure after arriving make it less likely they will practice medicine in the US. The objective of this research was to identify and assess the number of programs and the range and type of support currently available to this population. Methods: A scoping review was conducted of non-profit physician career assistance programs for non-USIMGs already in the US when they begin the US medical licensure process. For-profit companies are excluded because they are generally prohibitively expensive for non-USIMGs. The keywords “physician reentry” were entered into Google, identifying individual programs as well as databases, which were searched using the same keywords. Program websites and email outreach were used to review services provided by identified programs. Inclusion criteria were that programs provide physician career assistance, provide services to physicians who have never been licensed to practice medicine in the US, and have a nonprofit model. Results: Seventeen non-profit programs were identified that provide a combination of educational guidance, courses, and clinical experience to non-USIMGs seeking US medical licensure. They have supported at least 276 non-USIMGs to match to residency programs. Discussion: Career assistance non-profit programs like these have the potential to help remediate the physician shortage while increasing diversity in the medical profession and addressing issues of equity.