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Schwartz GL, Wang G, Kim MH, Glymour MM, White JS, Collin D, Hamad R. Individual and regional differences in the effects of school racial segregation on Black students' health. SSM Popul Health 2024; 26:101681. [PMID: 38840850 PMCID: PMC11152755 DOI: 10.1016/j.ssmph.2024.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background School racial segregation in the US has risen steadily since the 1990s, propelled by Supreme Court decisions rolling back the legacy of Brown v. Board. Quasi-experimental research has shown this resegregation harms Black students' health. However, whether individual or family characteristics (e.g., higher family incomes) are protective against segregation's health harms-or whether segregation is more damaging in regions of the US with fewer public sector investments-remains unclear. We leverage the quasi-random timing of school districts being released from Brown-era integration plans to examine heterogeneity in the association between resegregation and Black students' health. Methods & findings We took an instrumental variables approach, using the timing of integration order releases as an instrument for school segregation and analyzing a pre-specified list of theoretically-motivated modifiers in the Panel Study of Income Dynamics. In sensitivity analyses, we fit OLS models that directly adjusted for relevant covariates. Results suggest resegregation may have been particularly harmful in the South, where districts resegregated more quickly after order releases. We find little evidence that the effects of school segregation differed across family income, gender, or age. Conclusion The end of court-ordered integration threatens the health of Black communities-especially in the US South. Modestly higher incomes do not appear protective against school segregation's harms. Research using larger samples and alternative measures of school segregation-e.g., between districts, instead of within districts-may further our understanding of segregation's health effects, especially in Northern states.
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Affiliation(s)
- Gabriel L. Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Urban Health Collaborative & Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19147, USA
| | - Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Daniel Collin
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Yeboah P, Daliri DB, Abdin AY, Appiah-Brempong E, Pitsch W, Panyin AB, Adusei EBA, Razouk A, Nasim MJ, Jacob C. Knowledge into the Practice against COVID-19: A Cross-Sectional Study from Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412902. [PMID: 34948512 PMCID: PMC8702109 DOI: 10.3390/ijerph182412902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has affected populations globally, including Ghana. Knowledge of the COVID-19 disease, and the application of preventive public health interventions are pivotal to its control. Besides a lockdown, measures taken against the spread of the virus include the wearing of face masks, social distancing, regular hand washing with soap and, more recently, vaccination against the virus. In order to establish a possible link between the knowledge of the disease and compliance with preventive measures, including vaccination, a cross-sectional study employing an interview-structured questionnaire was conducted in six regions of Ghana (n = 1560). An adequate level of knowledge of COVID-19 (69.9%) was reported. The linear multiple regression analysis further explicated the differences in the knowledge of COVID-19 among the respondents by their knowledge of cholera and influenza (adjusted R-Square = 0.643). Despite this profound knowledge of the illness, two thirds of the respondents were unwilling to follow basic preventive measures and only 35.3% were willing to be vaccinated. Amazingly, neither knowledge of COVID-19 nor the socio-demographic characteristics had any meaningful influence on the practice of preventive measures. Personal attitude leading to efficient public compliance with preventive measures, therefore, is a critical issue demanding special attention and effective interventions by the government and locals with authority to curb the spread of the pandemic which surpasses the traditional channels of public health communication. This includes a roll-out of persuasion, possibly including public figures and influencers, and in any case, a balanced and open discussion addressing the acceptance of the COVID-19 vaccine in order to avoid new variants and comparable problems currently facing many countries of Western Europe. Indeed, a profound hesitancy against vaccination may turn African countries such as Ghana for many years into hotspots of new viral variants.
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Affiliation(s)
- Prince Yeboah
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (P.Y.); (A.Y.A.); (A.R.); (M.J.N.)
| | | | - Ahmad Yaman Abdin
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (P.Y.); (A.Y.A.); (A.R.); (M.J.N.)
| | - Emmanuel Appiah-Brempong
- Department of Health Promotion & Education, School of Public Health, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana;
| | - Werner Pitsch
- Department for Economics and Sociology of Sports, Faculty of Economics and Empirical Human Sciences, Institute of Sport Sciences, Saarland University, 66123 Saarbruecken, Germany;
| | - Anto Berko Panyin
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Correspondence: or (A.B.P.); (C.J.); Tel.: +233-205-410-2277 (A.B.P.); +49-681-302-3129 (C.J.)
| | - Emmanuel Bentil Asare Adusei
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy & Pharmaceutical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana;
| | - Afraa Razouk
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (P.Y.); (A.Y.A.); (A.R.); (M.J.N.)
| | - Muhammad Jawad Nasim
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (P.Y.); (A.Y.A.); (A.R.); (M.J.N.)
| | - Claus Jacob
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (P.Y.); (A.Y.A.); (A.R.); (M.J.N.)
- Correspondence: or (A.B.P.); (C.J.); Tel.: +233-205-410-2277 (A.B.P.); +49-681-302-3129 (C.J.)
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