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Qian H, Wehby GL. Revisiting the effects of state earned income tax credits on infant health: a quasi-experimental study using contiguous border counties approach. BMC Public Health 2023; 23:2422. [PMID: 38053105 PMCID: PMC10698941 DOI: 10.1186/s12889-023-17166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND To examine the effects of refundable state earned income tax credits (EITC) on infant health. METHODS We use the restricted-access U.S. birth certificate data with county codes from 1989 to 2018. Birth outcomes include birth weight, low birth weight, gestational weeks, preterm birth, and the fetal growth rate. The analytical sample includes single mothers with high school education or less. Two specifications of two-way fixed effects models are employed. The first specification accounts for shared time trends across all states/counties. The second specification estimates effects based on EITC changes within contiguous counties across state borders which accounts for contemporaneous events specific to each contiguous county pair. Models are estimated pooling and stratifying by parity subgroups. RESULTS Under the first specification, refundable state EITC is associated with improved birth outcomes. Pooling all parity, a 10%-point increase in refundable EITC is associated with an 8-gram increase in birth weight (95% CI: 2.9,14.6). The effect increases by parity. In contrast, the estimates from the second model are much smaller and statistically non-significant, both pooling and stratifying by parity. CONCLUSIONS Comparing contiguous counties across state borders, there is no evidence that refundable state EITC affects birth outcomes. However, the estimates still do not rule out moderate to large benefits for third or higher born infants.
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Affiliation(s)
- Haobing Qian
- Department of Family and Community Medicine, University of California, San Francisco, USA.
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
- Department of Economics, University of Iowa, Iowa City, IA, USA
- Preventive & Community Dentistry, University of Iowa, Iowa City, IA, USA
- Public Policy Center, University of Iowa, Iowa City, IA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Anderson NW, Eisenberg D, Zimmerman FJ. Structural Racism and Well-Being Among Young People in the U.S. Am J Prev Med 2023; 65:1078-1091. [PMID: 37385571 DOI: 10.1016/j.amepre.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Structural racism has clear and pernicious effects on population health. However, there is a limited understanding of how structural racism impacts young people's well-being. The objective of this ecologic cross-sectional study was to assess the relationship between structural racism and well-being for 2,009 U.S. counties from 2010 to 2019. METHODS Population-based data on demographics, health, and other variables related to young people's ability to thrive are used to construct a previously validated composite index that serves as a proxy of young people's well-being. The index is regressed on several forms of structural racism (segregation, economic, and educational) both independently and jointly while accounting for county-fixed effects, time trends, and state-specific trends as well as weighting for child population. Data were analyzed from November 2021 through March 2023. RESULTS Higher levels of structural racism are associated with lower well-being. A 1-SD increase in Black-White child poverty disparity is associated with a -0.034 (95% CI= -0.019, -0.050) SD change in index score. When accounting for multiple structural racism measures, associations remain statistically significant. In joint models, only estimates for economic racism measures remain significant when additionally controlling for demographic, socioeconomic, and adult health measures (β= -0.015; 95% CI= -0.001, -0.029). These negative associations are heavily concentrated in counties where Black and Latinx children are overrepresented. CONCLUSIONS Structural racism-particularly of the kind that produces racialized poverty outcomes-has a meaningful adverse association with child and adolescent well-being, which may produce lifelong effects. Studies of structural racism among adults should consider a lifecourse perspective.
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Affiliation(s)
- Nathaniel W Anderson
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Frederick J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Urban Planning, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
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Karasek D, Batra A, Baer RJ, Butcher BDC, Feuer S, Fuchs JD, Kuppermann M, Gomez AM, Prather AA, Pantell M, Rogers E, Snowden JM, Torres J, Rand L, Jelliffe-Pawlowski L, Hamad R. Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births. BMC Public Health 2023; 23:2180. [PMID: 37936102 PMCID: PMC10629068 DOI: 10.1186/s12889-023-16920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes. METHODS We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007-2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia. RESULTS Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA. CONCLUSION This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.
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Affiliation(s)
- Deborah Karasek
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA.
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA.
| | - Akansha Batra
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
- Department of Pediatrics, University of California, San Diego, San Diego, USA
| | | | - Sky Feuer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Jonathan D Fuchs
- Department of Public Health, Population Health Division, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, USA
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco, USA
| | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Elizabeth Rogers
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA
| | - Jacqueline Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Rita Hamad
- Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Cambridge, USA
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Berkowitz SA, Dave G, Venkataramani AS. Potential gaps in income support policies for those in poor health: The case of the earned income tax credit-A cross sectional analysis. SSM Popul Health 2023; 23:101429. [PMID: 37252288 PMCID: PMC10209707 DOI: 10.1016/j.ssmph.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background The federal Earned Income Tax Credit (EITC) is the primary income support program for low-income workers in the U.S., but its design may hinder its effectiveness when poor health limits, but does not preclude, work. Methods Cross-sectional analysis of nationally-representative U.S. Census Current Population Survey (CPS) data covering 2019. Working-age adults eligible to receive federal EITC were included in this study. Poor health, as indicated by self-report of at least one problem with hearing, vision, cognitive function, mobility, dressing and bathing, or independence, was the exposure. The main outcome was federal EITC benefit category, categorized as no benefit, phase-in (income too low for the maximum benefit), plateau (maximum benefit), phase-out (income above threshold for maximum benefit), or earnings too high to receive any benefit. We estimated EITC benefit category probabilities by health status using multinomial logistic regression. We further examined whether other government benefits provided additional income support to those in poor health. Results 41,659 participants (representing 87.1 million individuals) were included. 2,724 participants (representing 5.6 million individuals) reported poor health. In analyses standardized over age, gender, race, and ethnicity, those in poor health, compared with those not in poor health, were more likely to be in the no benefit (2.40% vs. 0.30%, risk difference 2.10 percentage points [95%CI 1.75 to 2.46 percentage points]), and phase-in (9.28% vs. 2.74%, risk difference 6.54 percentage points [95%CI 5.82 to 7.26 percentage points]) categories. Differences in resources by health status persisted even after accounting for other government benefits. Conclusions EITC program design creates an important gap in income support for those for whom poor health limits work, which is not closed by other programs. Filling this gap is an important public health goal.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gaurav Dave
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Atheendar S. Venkataramani
- Division of Health Policy, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
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Hamad R, Yeb J, Jackson K, Gosliner W, Fernald LCH. Potential mechanisms linking poverty alleviation and health: an analysis of benefit spending among recipients of the U.S. earned income tax credit. BMC Public Health 2023; 23:1385. [PMID: 37468839 DOI: 10.1186/s12889-023-16296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The earned income tax credit (EITC) is the largest U.S. poverty alleviation program for low-income families, disbursed annually as a lump-sum tax refund. Despite its well-documented health impacts, the mechanisms through which the EITC affects health are not well understood. The objective of this analysis was to examine self-reported spending patterns of tax refunds among EITC recipients to clarify potential pathways through which income may affect health. METHODS We first examined spending patterns among 2020-2021 Assessing California Communities' Experiences with Safety Net Supports (ACCESS) study participants (N = 241) and then stratified the analysis by key demographic subgroups. RESULTS More than half of EITC recipients reported spending their tax refunds on bills and debt (52.3%), followed by 49.4% on housing, and 37.8% on vehicles. Only 3.3% reported spending on healthcare. (Note: respondents could list more than one possible spending category.) Participants ages 30 + were more likely to spend on bills and debt relative to those ages 18-29 (57.6% versus 39.4%, respectively). Other subgroup analyses did not yield significant findings. CONCLUSIONS Our findings suggest that EITC recipients primarily use their refunds on bills and debt, as well as on household and vehicle expenses. This supports the idea of the EITC as a safety net policy which addresses key social determinants of health.
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Affiliation(s)
- Rita Hamad
- Department of Social & Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA.
| | - Joseph Yeb
- School of Public Health, Tufts University, Boston, MA, USA
| | - Kaitlyn Jackson
- Department of Social & Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
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Junior JA, Lee LK, Fleegler EW, Monuteaux MC, Niescierenko ML, Stewart AM. Association of State-Level Tax Policy and Infant Mortality in the United States, 1996-2019. JAMA Netw Open 2023; 6:e239646. [PMID: 37093600 PMCID: PMC10126872 DOI: 10.1001/jamanetworkopen.2023.9646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Importance Infant mortality in the United States is highest among peer nations; it is also inequitable, with the highest rates among Black infants. The association between tax policy and infant mortality is not well understood. Objective To examine the association between state-level tax policy and state-level infant mortality in the US. Design, Setting, and Participants This state-level, population-based cross-sectional study investigated the association between tax policy and infant mortality in the US from 1996 through 2019. All US infant births and deaths were included, with data obtained from the National Center for Health Statistics. Data were analyzed from November 28, 2021, to July 9, 2022. Exposures State-level tax policy was operationalized as tax revenue per capita and tax progressivity. The Suits index was used to measure tax progressivity, with higher progressivity indicating increased tax rates for wealthier individuals. Main Outcomes and Measures The association between tax policy and infant mortality rates was analyzed using a multivariable, negative binomial, generalized estimating equations model. Since 6 years of tax progressivity data were available (1995, 2002, 2009, 2012, 2014, and 2018), 300 state-years were included. Adjusted incidence rate ratios (aIRRs) were calculated controlling for year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups. Results There were 148 336 infant deaths in the US from 1996 through 2019, including 27 861 Hispanic infants, 1882 non-Hispanic American Indian or Alaska Native infants, 5792 non-Hispanic Asian or Pacific Islander infants, 41 560 non-Hispanic Black infants, and 68 666 non-Hispanic White infants. The overall infant mortality rate was 6.29 deaths per 1000 live births. Each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate (aIRR, 0.97; 95% CI, 0.95-0.99). An increase of 0.10 in the Suits index (ie, increased tax progressivity) was associated with a 4.6% decrease in the infant mortality rate (aIRR, 0.95; 95% CI, 0.91-0.99). Increased tax progressivity was associated with decreased non-Hispanic White infant mortality (aIRR, 0.95; 95% CI, 0.91-0.99), and increased tax revenue was associated with increased non-Hispanic Black infant mortality (aIRR, 1.04; 95% CI, 1.01-1.08). Conclusions and Relevance In this cross-sectional study, an increase in tax revenue and the Suits index of tax progressivity were both associated with decreased infant mortality. These associations varied by race and ethnicity. Tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.
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Affiliation(s)
- Jean A Junior
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michelle L Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Amanda M Stewart
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Batra A, Jackson K, Hamad R. Effects Of The 2021 Expanded Child Tax Credit On Adults' Mental Health: A Quasi-Experimental Study. Health Aff (Millwood) 2023; 42:74-82. [PMID: 36623218 PMCID: PMC10089297 DOI: 10.1377/hlthaff.2022.00733] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The US Congress temporarily expanded the Child Tax Credit (CTC) during the COVID-19 pandemic to provide economic assistance for families with children. Although formerly the CTC provided $2,000 per child for mostly middle-income parents, during July-December 2021 it provided up to $3,600 per child. Eligibility criteria were also expanded to reach more economically disadvantaged families. There has been little research evaluating the effect of the policy expansion on mental health. Using data from the Census Bureau's Household Pulse Survey and a quasi-experimental study design, we examined the effects of the expanded CTC on mental health and related outcomes among low-income adults with children, and by racial and ethnic subgroup. We found fewer depressive and anxiety symptoms among low-income adults. Adults of Black, Hispanic, and other racial and ethnic backgrounds demonstrated greater reductions in anxiety symptoms compared to non-Hispanic White adults with children. There were no changes in mental health care use. These findings are important for Congress and state legislators to weigh as they consider making the expanded CTC and other similar tax credits permanent to support economically disadvantaged families.
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Affiliation(s)
- Akansha Batra
- Akansha Batra, University of California San Francisco, San Francisco, California
| | | | - Rita Hamad
- Rita Hamad , University of California San Francisco
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Hamad R, Gosliner W, Brown EM, Hoskote M, Jackson K, Esparza EM, Fernald LCH. Understanding Take-Up Of The Earned Income Tax Credit Among Californians With Low Income. Health Aff (Millwood) 2022; 41:1715-1724. [PMID: 36469822 DOI: 10.1377/hlthaff.2022.00713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Earned Income Tax Credit (EITC) is the largest poverty alleviation program for families with children in the US, and it has well-documented health effects. However, not all eligible families receive benefits. The Assessing California Communities' Experiences with Safety Net Supports (ACCESS) Study interviewed 411 EITC-eligible Californians with young children to understand low take-up of the federal EITC and California's supplemental CalEITC. Interviews were conducted in English and Spanish in 2020 and 2021 to gather information on sociodemographic characteristics, tax filing, and EITC receipt (verified via tax forms). Among those eligible for the EITC or CalEITC, 9 percent of participants did not file taxes; among those who did file taxes, about 84 percent received the EITC, and 83 percent received the CalEITC. Lower likelihood of federal EITC receipt among those eligible and filing taxes was associated with being younger, not speaking English, and not having prior knowledge of the EITC. Lower likelihood of CalEITC receipt among those eligible and filing taxes was associated with not speaking English. These findings can inform policies and community interventions to increase EITC take-up and thereby help address health equity.
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Affiliation(s)
- Rita Hamad
- Rita Hamad, University of California San Francisco, San Francisco, California
| | - Wendi Gosliner
- Wendi Gosliner, University of California Agriculture and Natural Resources, Oakland, California
| | - Erika M Brown
- Erika M. Brown, University of California San Francisco
| | - Mekhala Hoskote
- Mekhala Hoskote, University of California Berkeley, Berkeley, California, and University of California San Francisco
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Hamad R, Galea S. The Role of Health Care Systems in Bolstering the Social Safety Net to Address Health Inequities in the Wake of the COVID-19 Pandemic. JAMA 2022; 328:17-18. [PMID: 35704339 DOI: 10.1001/jama.2022.10160] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, University of California, San Francisco
| | - Sandro Galea
- Office of the Dean, School of Public Health, Boston University, Boston, Massachusetts
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