Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic

Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.

School Discipline and Racial Disparities in Early Adulthood

Despite interest in the contributions of school discipline to the creation of racial inequality, previous research has been unable to identify how students who receive suspensions in school differ from unsuspended classmates on key young adult outcomes. We utilize novel data to document the links between high school discipline and important young adult outcomes related to criminal justice contact, social safety net program participation, post-secondary education, and the labor market. We show that the link between school discipline and young adult outcomes tends to be stronger for Black students than for White students, and that approximately 30 percent of the Black-White disparities in young adult criminal justice outcomes, SNAP receipt, and college completion can be traced back to inequalities in exposure to school discipline.

Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014

BACKGROUND

Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States.

METHODS

We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored.

RESULTS

More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts.

CONCLUSIONS

During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.).

Measurement of multiple nicotine dependence domains among cigarette, non-cigarette and poly-tobacco users: Insights from item response theory

BACKGROUND

Nicotine dependence (ND) is a key construct that organizes physiological and behavioral symptoms associated with persistent nicotine intake. Measurement of ND has focused primarily on cigarette smokers. Thus, validation of brief instruments that apply to a broad spectrum of tobacco product users is needed.

METHODS

We examined multiple domains of ND in a longitudinal national study of the United States population, the United States National Epidemiological Survey of Alcohol and Related Conditions (NESARC). We used methods based in item response theory to identify and validate increasingly brief measures of ND that included symptoms to assess ND similarly among cigarette, cigar, smokeless, and poly tobacco users.

RESULTS

Confirmatory factor analytic models supported a single, primary dimension underlying symptoms of ND across tobacco use groups. Differential Item Functioning (DIF) analysis generated little support for systematic differences in response to symptoms of ND across tobacco use groups. We established significant concurrent and predictive validity of brief 3- and 5-symptom indices for measuring ND.

CONCLUSIONS

Measuring ND across tobacco use groups with a common set of symptoms facilitates evaluation of tobacco use in an evolving marketplace of tobacco and nicotine products.

The impact of the promise of scholarships and altering school structure on college plans, preparation, and enrollment

The Washington State Achiever (WSA) program was a large-scale educational intervention of scholarships, mentoring, and school redesign designed to encourage students from moderate and low income families to attend college in Washington State. Using a quasi-experimental design based on pre- and post-intervention surveys of high school seniors in program and non-program schools, we find a significant WSA effect on educational outcomes, net of the demographic and socioeconomic composition of students across schools. Across the three intervention high schools, the program is strongly significant in one school, significant after a lag in another school, and not significant in a third. We speculate about the potential reasons for the differential program effect across high schools.

The 9th grade shock and the high school dropout crisis

Retrospective questions on educational attainment in national surveys and censuses tend to over-estimate high school graduation rates by 15-20% points relative to administrative records. Administrative data on educational enrollment are, however, only available at the aggregate level (state, school district, and school levels) and the recording of inter-school transfers are generally incomplete. With access to linked individual-level administrative records from a very large "West Coast metropolitan school district" we track patterns of high school attrition and on-time high school graduation of individual students. Even with adjustments for the omission of out-of-district transfers (estimates of omission are presented), the results of this study show that failure in high school, as indexed by retention and attrition, are almost as common as on-time high school graduation. In addition to the usual risk factors of disadvantaged background, we find that the "9th grade shock"-an unpredicted decline in academic performance upon entering high school-is a key mechanism behind the continuing crisis of high school attrition.

Colorectal cancer following tamoxifen therapy for breast cancer (United States)

BACKGROUND

An analysis combining data from several clinical trials has raised concern that tamoxifen therapy may increase the risk of a subsequent colorectal malignancy. We conducted a nested case-control study to test this hypothesis.

METHODS

A cohort of women diagnosed with breast cancer in 1978-1992 was identified from the western Washington population-based cancer registry. Cases included women who subsequently developed colorectal cancer prior to 1995. Controls were a random sample of the cohort who did not develop a second primary malignancy, matched to cases on age, stage, and year of initial cancer diagnosis. Tamoxifen use was ascertained by medical record abstraction and physician questionnaires.

RESULTS

Thirty-six percent of the 122 cases for whom information could be obtained received tamoxifen versus 38% of 194 controls. Relative to non-users and adjusted for receipt of other therapies, there was no increased risk of colorectal cancer associated with tamoxifen use in general (matched odds ratio [mOR] = 0.9, 95% CI 0.6-1.6), longer durations of use (for > or =37 months, mOR = 0.8, 95% CI 0.4-1.9), higher cumulative doses of therapy (for > or =15 g, mOR = 0.8, 95% CI 0.4-1.6), or use that started at least 5 years prior to the end of study follow-up (mOR = 1.1, 95% CI 0.3-3.7).

CONCLUSIONS

We found no overall increased risk for colorectal cancer among tamoxifen users.