Associations between county-level voter turnout, county-level felony voter disenfranchisement, and sexually transmitted infections among women in the Southern United States

Couple-level determinants of syphilis infection among heterosexual married couples of reproductive age in Guangdong Province, China: A population-based cross-sectional study

Background

Syphilis remains a major public health problem worldwide, and its prevention requires knowledge of factors that go beyond the individual-level. However, most syphilis-related studies have focused on individual-level and regional-level factors, neglecting couple-level factors. Thus, this study aimed to explore couple-level determinants of syphilis infection among heterosexual married couples.

Methods

This population-based cross-sectional study used data from heterosexual married couples who participated in the National Free Preconception Health Examination Project in Guangdong Province, China during 2014-2019. The syphilis infection was tested by the rapid plasma reagin test. Couple-level data were obtained by combining information provided by the man and woman living in the same household. Multivariate logistic models were employed to explore the couple-level determinants of syphilis infection by gender after adjusting for potential confounders.

Results

A total of 1,755,156 couples were recruited in this analysis. The seroprevalence was 0.25% (95%CI: 0.24-0.25%) and 0.26% (95%CI: 0.25-0.27%) among men and women, respectively. The median age was 28.0 (interquartile range, IQR: 25.0-31.0) years, and the median duration of marriage was 0.2 (IQR: 0.0-2.5) years. After adjusting for individual and regional-level variables, duration of marriage was a protective factor for syphilis infection in men (adjusted odds ratios, AOR: 0.97; 95% CI: 0.96-0.98) and women (AOR: 0.95, 95% CI: 0.94-0.96). The age gap and the difference in education level between the husband and wife were associated with syphilis infection, but these associations were somewhat different between men and women. Condom use was negatively associated with syphilis infection in men (AOR: 0.77; 95% CI: 0.70-0.84) and women (AOR: 0.77, 95% CI: 0.71-0.84). Our results also showed that couple mobility and the number of children were not statistically significant determinants of syphilis infection among heterosexual married couples.

Conclusion

This study contributes to a more comprehensive understanding of syphilis outcomes in individuals in the context of marriage in China. Several couple-level factors are indeed associated with syphilis infection, but these associations differ between men and women. Couple-based strategies that engage both women and men and efforts to promote condom use among heterosexual married couples need to be developed and further evaluated for syphilis prevention.

Use of Race in Kidney Research and Medicine: Concepts, Principles, and Practice

Black Americans and other racially and ethnically minoritized individuals are disproportionately burdened by higher morbidity and mortality from kidney disease when compared with their White peers. Yet, kidney researchers and clinicians have struggled to fully explain or rectify causes of these inequalities. Many studies have sought to identify hypothesized genetic and/or ancestral origins of biologic or behavioral deficits as singular explanations for racial and ethnic inequalities in kidney health. However, these approaches reinforce essentialist beliefs that racial groups are inherently biologically and behaviorally different. These approaches also often conflate the complex interactions of individual-level biologic differences with aggregated population-level disparities that are due to structural racism (i.e., sociopolitical policies and practices that created and perpetuate harmful health outcomes through inequities of opportunities and resources). We review foundational misconceptions about race, racism, genetics, and ancestry that shape research and clinical practice with a focus on kidney disease and related health outcomes. We also provide recommendations on how to embed key equity-enhancing concepts, terms, and principles into research, clinical practice, and medical publishing standards.

Emergency Absentee Voting for Hospitalized Patients and Voting During COVID-19: A 50-State Study

Introduction: Voters facing illness or disability are disproportionately under-represented in terms of voter turnout. Earlier research has indicated that enfranchisement of these populations may reinforce the implementation of policies improving health outcomes and equity. Due to the confluence of the coronavirus 2019 (COVID-19) pandemic and the 2020 election, we aimed to assess emergency absentee voting processes, which allow voters hospitalized after regular absentee deadlines to still obtain an absentee ballot, and election changes due to COVID-19 in all 50 states. Methods: We performed a cross-sectional study collecting 34 variables pertaining to emergency voting processes and COVID-19-related election changes, including deadlines, methods of submission for applications and ballots, and specialized services for patients. Data were obtained from, in order of priority, state boards of elections websites, poll worker manuals, application forms, and state legislation. We verified all data through direct correspondence with state boards of elections. Results: Emergency absentee voting processes are in place in 39 states, with the remaining states having universal vote-by-mail (n = 5) or extended regular absentee voting deadlines (n = 6). The emergency absentee period most commonly began within 24 hours following the normal absentee application deadline, which was often seven days before an election (n = 11). Unique aspects of emergency voting processes included patients designating an “authorized agent” to deliver their applications and ballots (n = 38), electronic ballot delivery (n = 5), and in-person teams that deliver ballots directly to patients (n = 18). Documented barriers in these processes nationwide include unavailable online information (n = 11), restrictions mandating agents to be family members (n = 7), physician affidavits or signatures (n = 9), and notary or witness signature requirements (n = 15). For the November 2020 presidential election, 12 states expanded absentee eligibility to allow COVID-19 as a reason to request an absentee ballot, and 18 states mailed absentee ballot applications or absentee ballots to all registered voters. Conclusion: While 39 states operate emergency absentee voting processes for hospitalized voters, there are considerable areas for improvement and heterogeneity in guidelines for these protocols. For future election cycles, information on emergency voting and broader election reforms due to COVID-19 may be useful for emergency providers and patients alike to improve the democratic participation of voters experiencing illness.

Racism and Kidney Health: Turning Equity Into a Reality

Kidney disease continues to manifest stark racial inequities in the United States, revealing the entrenchment of racism and bias within multiple facets of society, including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and "colorblind" approaches as well as their pitfalls, offering in their place suggestions to embed antiracism and an "equity lens" into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, using equity-focused race consciousness, and centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed antiracism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.