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LeMasters K, Ross RK, Edwards JK, Lee H, Robinson WR, Brinkley-Rubinstein L, Delamater P, Pence BW. Mass Probation: Effects of Sentencing Severity on Mental Health for Black and White Individuals. Epidemiology 2024; 35:74-83. [PMID: 38032802 PMCID: PMC10683971 DOI: 10.1097/ede.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Incarceration is associated with negative impacts on mental health. Probation, a form of community supervision, has been lauded as an alternative. However, the effect of probation versus incarceration on mental health is unclear. Our objective was to estimate the impact on mental health of reducing sentencing severity at individuals' first adult criminal-legal encounter. METHODS We used the US National Longitudinal Survey on Youth 1997, a nationally representative dataset of youth followed into their mid-thirties. Restricting to those with an adult encounter (arrest, charge alone or no sentence, probation, incarceration), we used parametric g-computation to estimate the difference in mental health at age 30 (Mental Health Inventory-5) if (1) everyone who received incarceration for their first encounter had received probation and (2) everyone who received probation had received no sentence. RESULTS Among 1835 individuals with adult encounters, 19% were non-Hispanic Black and 65% were non-Hispanic White. Median age at first encounter was 20. Under hypothetical interventions to reduce sentencing, we did not see better mental health overall (Intervention 1, incarceration to probation: RD = -0.01; CI = -0.02, 0.01; Intervention 2, probation to no sentence: RD = 0.00; CI = -0.01, 0.01) or when stratified by race. CONCLUSION Among those with criminal-legal encounters, hypothetical interventions to reduce sentencing, including incremental sentencing reductions, were not associated with improved mental health. Future work should consider the effects of preventing individuals' first criminal-legal encounter.
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Affiliation(s)
- Katherine LeMasters
- From the Department of Epidemiology, Gillings School of Global Public Health
- Center for Health Equity Research, Department of Social Medicine, School of Medicine
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rachael K. Ross
- From the Department of Epidemiology, Gillings School of Global Public Health
| | - Jessie K. Edwards
- From the Department of Epidemiology, Gillings School of Global Public Health
| | - Hedwig Lee
- Department of Sociology, Washington University in St. Louis, St. Louis, MO
- Department of Sociology, Duke University, Durham, NC
| | - Whitney R. Robinson
- Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | | | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W. Pence
- From the Department of Epidemiology, Gillings School of Global Public Health
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LeMasters K, Delamater P, Brinkley-Rubinstein L, Edwards JK, Robinson WR, Pence B. Mass probation: Temporal and geographic correlation of county-level probation rates & mental health in North Carolina. SSM Ment Health 2023; 3:100189. [PMID: 36936811 PMCID: PMC10022749 DOI: 10.1016/j.ssmmh.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
High community incarceration rates are associated with worse community mental health. However, it remains unknown whether higher rates of probation, a form of criminal legal community supervision, are similarly associated with worse community mental health. Our objective was to evaluate temporal and geographic correlations of county-level probation and mental health rates separately and to assess the association between county-level probation and mental health rates, measured by self-inflicted injury and suicide. We performed ecological analyses using North Carolina administrative data (2009-2019) and used repeated cross-section, multivariable spatial error models. From 2009 to 2019, probation rates trended downward while self-inflicted injury and suicide remained stable. We found positive spatial autocorrelation suggesting that there are spatial determinants of probation and self-harm, though less so for suicide. Hot spot analyses showed local variation with high self-harm and suicide rates being clustered in rural Western North Carolina and high probation rates being clustered in rural Eastern North Carolina. Probation was positively associated with self-inflicted injury and suicide. For example, in 2018, a 1 percentage point increase in probation was associated with a 0.05 percentage point increase in self-harm in 2019 (95% CI: 0.03, 0.06), meaning that in a county of 100,000 people, an increase in 1000 county residents being on probation would be associated with an increase in 50 self-harm injuries. High county-level probation rates may exert collateral damage on the mental health of those living in areas with much of the population under state control. These findings emphasize that the criminal legal system is not separate from communities and that future public health research and advocacy must consider these collateral consequences of probation on communities.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Paul Delamater
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
- Department of Geography, University of North Carolina at Chapel Hill, United States
| | - Lauren Brinkley-Rubinstein
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States
| | - Jesse K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Whitney R. Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
- Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, United States
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
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Dudley MZ, Barnett EE, Paulenich A, Omer SB, Schuh H, Proveaux TM, Buttenheim AM, Klein NP, Delamater P, McFadden SM, Patel KM, Salmon DA. Characterization of parental intention to vaccinate elementary school aged children in the state of California. Vaccine 2023; 41:630-635. [PMID: 36543683 PMCID: PMC9762501 DOI: 10.1016/j.vaccine.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
In October 2021, Emergency Use Authorization of Coronavirus Disease 2019 (COVID-19) vaccines was granted for children aged 5-11. To ensure vaccine uptake in children upon approval, California will implement a state-wide executive order mandating COVID-19 vaccination for school children following full US FDA approval. This study uses survey data collected between November 6th, 2020 and December 14th, 2020 (n = 2091) to identify how sociodemographic characteristics and attitudes towards childhood vaccines among California parents were associated with their intentions to vaccinate their child against COVID-19. About one quarter (26 %) of surveyed California parents did not intend to vaccinate their child, suggesting skepticism towards the COVID-19 vaccine for children and the potential for pushback to a COVID-19 vaccine school-entry mandate. However, 17 % were unsure of their decision, suggesting the potential for public health messaging to make a positive impact on COVID-19 vaccine confidence and uptake. This study identifies characteristics of hesitant parents in California to prioritize for research and outreach. These data also provide a baseline for parental attitudes towards vaccinating children against COVID-19 in California, which will be useful for characterizing changes in attitudes towards childhood COVID-19 vaccination over time.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Erin E Barnett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alex Paulenich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Saad B Omer
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Institute for Global Health, New Haven, CT, United States; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Yale School of Nursing, Orange, CT, United States
| | - Holly Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M Proveaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Paul Delamater
- Department of Geography and Carolina Population Center, The University of North Carolina, Chapel Hill, NC, United States
| | - SarahAnn M McFadden
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Institute for Global Health, New Haven, CT, United States; School of Nursing, Pacific Lutheran University, Tacoma, WA, United States
| | - Kavin M Patel
- Yale School of Medicine, New Haven, CT, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health Behavior Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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4
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LeMasters K, Renson A, Edwards JK, Robinson WR, Brinkley-Rubinstein L, Delamater P, Pence B. Inequities in life course criminal legal system sanctions: measuring cumulative involvement. Ann Epidemiol 2022; 76:83-90. [PMID: 36273701 PMCID: PMC10075343 DOI: 10.1016/j.annepidem.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The impact of incarceration on health is well known. Yet, most studies measure incarceration alone and miss additional exposure to the criminal legal system over time. We evaluated adult criminal legal sanctions - inclusive of arrests, charges, probation, incarceration - from ages 18-35 and inequities by juvenile sanctions and race. METHODS Using the National Longitudinal Survey on Youth 1997, a nationally representative data set of adolescents followed into their mid-thirties (1997-2017), we calculated the mean cumulative count, or the average number of criminal legal events per person per study visit, stratified by juvenile sanctions and race. RESULTS Of 7024 participants, 1679 experienced 3,075 encounters. There were seven arrests, 30 charges, nine probation encounters, and 13 incarceration events /100 participants by age 35. Juvenile sanctions were most common for Black individuals. Among those experiencing juvenile sanctions, Black and White individuals had similar numbers of encounters, but Black individuals had more arrests and incarceration stays. For those without juvenile encounters, Black individuals had more encounters than White individuals. CONCLUSIONS Research on health effects of criminal legal sanctions must consider encounters beyond incarceration and focus on life course trajectories and racial inequities.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Audrey Renson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jesse K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Lauren Brinkley-Rubinstein
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul Delamater
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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5
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Johnson K, Biddell CB, Hecht HK, Lich KH, Swann J, Delamater P, Mayorga M, Ivy J, Smith RL, Patel MD. Organizational decision‐making during COVID‐19: A qualitative analysis of the organizational decision‐making system in the United States during COVID‐19. Contingencies & Crisis Mgmt 2022. [DOI: 10.1111/1468-5973.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Karl Johnson
- Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Hillary K. Hecht
- Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Kristen H. Lich
- Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Julie Swann
- Department of Industrial and Systems Engineering North Carolina State University Raleigh North Carolina USA
| | - Paul Delamater
- Department of Geography University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Maria Mayorga
- Department of Industrial and Systems Engineering North Carolina State University Raleigh North Carolina USA
| | - Julie Ivy
- Department of Industrial and Systems Engineering North Carolina State University Raleigh North Carolina USA
| | - Raymond L. Smith
- Department of Engineering, College of Engineering and Technology East Carolina University Greenville North Carolina USA
| | - Mehul D. Patel
- Department of Emergency Medicine, School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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Johnson K, Biddell CB, Hassmiller Lich K, Swann J, Delamater P, Mayorga M, Ivy J, Smith RL, Patel MD. Use of Modeling to Inform Decision Making in North Carolina during the COVID-19 Pandemic: A Qualitative Study. MDM Policy Pract 2022; 7:23814683221116362. [PMID: 35923388 PMCID: PMC9340948 DOI: 10.1177/23814683221116362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The COVID-19 pandemic has popularized computer-based decision-support models, which are commonly used to inform decision making amidst complexity. Understanding what organizational decision makers prefer from these models is needed to inform model development during this and future crises. Methods. We recruited and interviewed decision makers from North Carolina across 9 sectors to understand organizational decision-making processes during the first year of the COVID-19 pandemic (N = 44). For this study, we identified and analyzed a subset of responses from interviewees (n = 19) who reported using modeling to inform decision making. We used conventional content analysis to analyze themes from this convenience sample with respect to the source of models and their applications, the value of modeling and recommended applications, and hesitancies toward the use of models. Results. Models were used to compare trends in disease spread across localities, estimate the effects of social distancing policies, and allocate scarce resources, with some interviewees depending on multiple models. Decision makers desired more granular models, capable of projecting disease spread within subpopulations and estimating where local outbreaks could occur, and incorporating a broad set of outcomes, such as social well-being. Hesitancies to the use of modeling included doubts that models could reflect nuances of human behavior, concerns about the quality of data used in models, and the limited amount of modeling specific to the local context. Conclusions. Decision makers perceived modeling as valuable for informing organizational decisions yet described varied ability and willingness to use models for this purpose. These data present an opportunity to educate organizational decision makers on the merits of decision-support modeling and to inform modeling teams on how to build more responsive models that address the needs of organizational decision makers.
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Affiliation(s)
- Karl Johnson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie Swann
- Department of Industrial and Systems Engineering, North Carolina State University, Atlanta, GA, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Atlanta, GA, USA
| | - Julie Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, Atlanta, GA, USA
| | - Raymond L. Smith
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, USA
| | - Mehul D. Patel
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fliss MD, Baumgartner FR, Delamater P, Marshall SW, Poole C, Robinson W. Public health critical race praxis at the intersection of traffic stops and injury epidemiology. Inj Epidemiol 2022; 9:9. [PMID: 35313990 PMCID: PMC8939166 DOI: 10.1186/s40621-022-00375-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/11/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Law enforcement traffic stops are one of the most common entryways to the US justice system. Conventional frameworks suggest traffic stops promote public safety by reducing dangerous driving practices and non-vehicular crime with little to no collateral damage to individuals and communities. Critical frameworks interrogate these assumptions, identifying significant individual and community harms that disparately impact Black, Indigenous, and People of Color (BIPOC) and low-income communities. METHODS The Public Health Critical Race Praxis (PHCRP) and multi-level frameworks from community anti-racist training were combined into a structured diagram to guide intervention and research teams in contrasting conventional and critical perspectives on traffic stops. The diagram divides law enforcement and drivers/residents as two separate agent types that interact during traffic stops. These two agent types have different conventional and critical histories, priorities, and perspectives at multiple levels, including individual, interpersonal, institutional, and cultural levels. Conventional solutions (identifying explicitly racist officers, "meet-a-cop" programs, police interaction training for drivers) are born from conventional frameworks (rewarding crime prevention regardless of cost, the war on drugs saves lives, driver behavior perfectionism). While conventional perspectives focus on individual and interpersonal levels, critical perspectives more deeply acknowledge dynamics at institutional and cultural levels. Critical solutions may be hard to discover without critical frameworks, including that law enforcement creates measurable collateral damage and disparate social control effects; neighborhood patrol priorities can be set without community self-determination or accountability and may trump individual and interpersonal dynamics; and the war on drugs is highly racialized and disproportionally enforced through traffic stop programs. CONCLUSIONS Traffic stop enforcement and crash prevention programs that do not deeply and critically consider these dynamics at multiple levels, not just law enforcement-driver interactions at the individual and interpersonal levels, may be at increased risk of propagating histories of BIPOC discrimination. In contrast, public health and transportation researchers and practitioners engaged in crash and injury prevention strategies that employ law enforcement should critically consider disparate history and impacts of law enforcement in BIPOC communities. PHCRP, anti-racism frameworks, and the included diagram may assist them in organizing critical thinking about research studies, interventions, and impacts.
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Affiliation(s)
- Michael Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500 CB# 7505, 137 E Franklin St,, Chapel Hill, NC, 27599, USA.
| | - Frank R Baumgartner
- Department of Political Science, University of North Carolina, 235 E Cameron Ave, Chapel Hill, NC, 27514, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina, Carolina Hall, CB# 3220, Chapel Hill, NC, 27599, USA.,Carolina Population Center, University of North Carolina, 123 W Franklin St, Chapel Hill, NC, 27516, USA
| | - Steve W Marshall
- Department of Epidemiology, University of North Carolina, 170 Rosenau Hall, CB #7400
- 135 Dauer Drive, Chapel Hill, NC, 27599, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Charles Poole
- Department of Epidemiology, University of North Carolina, 170 Rosenau Hall, CB #7400
- 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Whitney Robinson
- Department of Obstetrics and Gynecology, Duke University, 40 Duke Medicine Circle Clinic 1J, Durham, NC, 27710, USA
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Rosenstrom ET, Mele J, Ivy JS, Mayorga ME, Patel MD, Lich KH, Johnson K, Delamater P, Keskinocak P, Boyce R, Smith R, Swann JL. Can vaccine prioritization reduce disparities in COVID-19 burden for historically marginalized populations? PNAS Nexus 2022; 1:pgab004. [PMID: 36712803 PMCID: PMC9801966 DOI: 10.1093/pnasnexus/pgab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/19/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023]
Abstract
SARS-CoV-2 vaccination strategies were designed to reduce COVID-19 mortality, morbidity, and health inequities. To assess the impact of vaccination strategies on disparities in COVID-19 burden among historically marginalized populations (HMPs), e.g. Black race and Hispanic ethnicity, we used an agent-based simulation model, populated with census-tract data from North Carolina. We projected COVID-19 deaths, hospitalizations, and cases from 2020 July 1 to 2021 December 31, and estimated racial/ethnic disparities in COVID-19 outcomes. We modeled 2-stage vaccination prioritization scenarios applied to sub-groups including essential workers, older adults (65+), adults with high-risk health conditions, HMPs, or people in low-income tracts. Additionally, we estimated the effects of maximal uptake (100% for HMP vs. 100% for everyone), and distribution to only susceptible people. We found strategies prioritizing essential workers, then older adults led to the largest mortality and case reductions compared to no prioritization. Under baseline uptake scenarios, the age-adjusted mortality for HMPs was higher (e.g. 33.3%-34.1% higher for the Black population and 13.3%-17.0% for the Hispanic population) compared to the White population. The burden on HMPs decreased only when uptake was increased to 100% in HMPs; however, the Black population still had the highest relative mortality rate even when targeted distribution strategies were employed. If prioritization schemes were not paired with increased uptake in HMPs, disparities did not improve. The vaccination strategies publicly outlined were insufficient, exacerbating disparities between racial and ethnic groups. Strategies targeted to increase vaccine uptake among HMPs are needed to ensure equitable distribution and minimize disparities in outcomes.
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Affiliation(s)
- Erik T Rosenstrom
- Department of Industrial and Systems Engineering, North Carolina State University, 915 Partners Way, Campus Box 7906, Raleigh, NC 27606, USA
| | - Jessica Mele
- Department of Industrial and Systems Engineering, North Carolina State University, 915 Partners Way, Campus Box 7906, Raleigh, NC 27606, USA
| | - Julie S Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, 915 Partners Way, Campus Box 7906, Raleigh, NC 27606, USA
| | - Maria E Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, 915 Partners Way, Campus Box 7906, Raleigh, NC 27606, USA
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karl Johnson
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Pinar Keskinocak
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Ross Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Raymond Smith
- Department of Engineering, East Carolina University, Greenville, NC 27834, USA
| | - Julie L Swann
- To whom correspondence should be addressed: NC State University; 915 Partners Way; Campus Box 7906, Raleigh, NC 27695. Tel; +(919-515-6423);
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Rosenstrom E, Mele J, Ivy J, Mayorga M, Patel M, Lich KH, Delamater P, Smith R, Swann JL. Vaccinating Children Against COVID-19 is Essential Prior to the Removal of Non-Pharmaceutical Interventions. medRxiv 2021:2021.12.08.21267496. [PMID: 34909784 PMCID: PMC8669851 DOI: 10.1101/2021.12.08.21267496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVESS To evaluate the joint impact of childhood vaccination rates and masking policies, in schools and workplaces, on community transmission and severe outcomes due to COVID-19. STUDY DESIGN We utilized a stochastic, agent-based simulation of North Carolina, to evaluate the impact of 24 health policy decisions on overall incidence of disease, COVID-19 related hospitalization, and mortality from July 1, 2021-July 1, 2023. RESULTS Universal mask removal in schools in January 2022 could lead to a 38.1-47%, 27.6-36.2%, and 15.9-19.7% increase in cumulative infections for ages 5-9, 10-19, and the total population, respectively, depending on the rate of vaccination of children relative to the adult population. Additionally, without increased vaccination uptake in the adult population, a 25% increase in child vaccination uptake from 50% to 75% uptake and from 75% to 100% uptake relative to the adult population, leads to a 22% and 18% or 28% and 33% decrease in peak hospitalizations in 2022 across scenarios when masks are removed either January 1st or March 8th 2022, respectively. Increasing vaccination uptake for the entire eligible population can reduce peak hospitalizations in 2022 by an average of 89% and 92% across all masking scenarios compared to the scenarios where no children are vaccinated. CONCLUSIONS High vaccination uptake among both children and adults is necessary to mitigate the increase in infections from mask removal in schools and workplaces.
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Affiliation(s)
- Erik Rosenstrom
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America
| | - Jessica Mele
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America
| | - Julie Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America
| | - Maria Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America
| | - Mehul Patel
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Raymond Smith
- Department of Engineering, East Carolina University, Greenville, NC United States of America
| | - Julie L. Swann
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America
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10
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Lacko A, Delamater P, Gordon-Larsen P, Wen Ng S. Geographic patterns and socioeconomic differences in the nutritional quality of household packaged food purchases in the United States. Health Place 2021; 69:102567. [PMID: 33930729 DOI: 10.1016/j.healthplace.2021.102567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear whether dietary quality varies by geography in the US. PURPOSE Assess patterns in packaged food purchases (PFPs). METHODS We characterized variation in PFP quality from 2008 to 2018 by 1) examining geographic clustering and 2) using regression analysis to control for household characteristics. RESULTS Lower quality purchases clustered in the Southeast and Appalachia, whereas higher quality purchases clustered in the West and Northeast. Spatial patterns were similar for low socioeconomic households but not high socioeconomic households. Geographic differences in quality remained after controlling for demographic composition. CONCLUSION This analysis should inform research into systemic drivers of PFP quality.
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Affiliation(s)
- Allison Lacko
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
| | - Paul Delamater
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Geography, College of Arts and Sciences at the University of North Carolina at Chapel Hill, United States.
| | - Penny Gordon-Larsen
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
| | - Shu Wen Ng
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
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11
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Zelner J, Trangucci R, Naraharisetti R, Cao A, Malosh R, Broen K, Masters N, Delamater P. Racial Disparities in Coronavirus Disease 2019 (COVID-19) Mortality Are Driven by Unequal Infection Risks. Clin Infect Dis 2021; 72:e88-e95. [PMID: 33221832 PMCID: PMC7717213 DOI: 10.1093/cid/ciaa1723] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/09/2020] [Indexed: 01/20/2023] Open
Abstract
Background As of 1 November 2020, there have been >230 000 deaths and 9 million confirmed and probable cases attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States. However, this overwhelming toll has not been distributed equally, with geographic, race/ethnic, age, and socioeconomic disparities in exposure and mortality defining features of the US coronavirus disease 2019 (COVID-19) epidemic. Methods We used individual-level COVID-19 incidence and mortality data from the state of Michigan to estimate age-specific incidence and mortality rates by race/ethnic group. Data were analyzed using hierarchical Bayesian regression models, and model results were validated using posterior predictive checks. Results In crude and age-standardized analyses we found rates of incidence and mortality more than twice as high than for Whites for all groups except Native Americans. Blacks experienced the greatest burden of confirmed and probable COVID-19 (age-standardized incidence, 1626/100 000 population) and mortality (age-standardized mortality rate, 244/100 000). These rates reflect large disparities, as Blacks experienced age-standardized incidence and mortality rates 5.5 (95% posterior credible interval [CrI], 5.4–5.6) and 6.7 (95% CrI, 6.4–7.1) times higher than Whites, respectively. We found that the bulk of the disparity in mortality between Blacks and Whites is driven by dramatically higher rates of COVID-19 infection across all age groups, particularly among older adults, rather than age-specific variation in case-fatality rates. Conclusions This work suggests that well-documented racial disparities in COVID-19 mortality in hard-hit settings, such as Michigan, are driven primarily by variation in household, community, and workplace exposure rather than case-fatality rates.
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Affiliation(s)
- Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rob Trangucci
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ramya Naraharisetti
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alex Cao
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelly Broen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nina Masters
- Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Masters N, Zelner J, Delamater P, Boulton M. Identifying spatial heterogeneity in vaccination coverage in Michigan from 2008–2018: Evaluating the impact of a 2015 policy change on measles risk. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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13
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Fliss MD, Baumgartner F, Delamater P, Marshall S, Poole C, Robinson W. Re-prioritizing traffic stops to reduce motor vehicle crash outcomes and racial disparities. Inj Epidemiol 2020; 7:3. [PMID: 32127046 PMCID: PMC6970293 DOI: 10.1186/s40621-019-0227-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Law enforcement traffic stops are one of the most common entryways to the US justice system. Conventional frameworks suggest traffic stops promote public safety by reducing dangerous driving practices and non-vehicular crime. Law enforcement agencies have wide latitude in enforcement, including prioritization of stop types: (1) safety (e.g. moving violation) stops, (2) investigatory stops, or (3) economic (regulatory and equipment) stops. In order to prevent traffic crash fatalities and reduce racial disparities, the police department of Fayetteville, North Carolina significantly re-prioritized safety stops. METHODS Annual traffic stop, motor vehicle crash, and crime data from 2002 to 2016 were combined to examine intervention (2013-2016) effects. Fayetteville was compared against synthetic control agencies built from 8 similar North Carolina agencies by weighted matching on pre-intervention period trends and comparison against post-intervention trends. RESULTS On average over the intervention period as compared to synthetic controls, Fayetteville increased both the number of safety stops + 121% (95% confidence interval + 17%, + 318%) and the relative proportion of safety stops (+ 47%). Traffic crash and injury outcomes were reduced, including traffic fatalities - 28% (- 64%, + 43%), injurious crashes - 23% (- 49%, + 16%), and total crashes - 13% (- 48%, + 21%). Disparity measures were reduced, including Black percent of traffic stops - 7% (- 9%, - 5%) and Black vs. White traffic stop rate ratio - 21% (- 29%, - 13%). In contrast to the Ferguson Effect hypothesis, the relative de-prioritization of investigatory stops was not associated with an increase in non-traffic crime outcomes, which were reduced or unchanged, including index crimes - 10% (- 25%, + 8%) and violent crimes - 2% (- 33%, + 43%). Confidence intervals were estimated using a different technique and, given small samples, may be asymmetrical. CONCLUSIONS The re-prioritization of traffic stop types by law enforcement agencies may have positive public health consequences both for motor vehicle injury and racial disparity outcomes while having little impact on non-traffic crime.
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Affiliation(s)
- Mike Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, 521 S Greensboro St, Carrboro, NC, 27510, USA.
| | - Frank Baumgartner
- Department of Political Science, University of North Carolina, Chapel Hill, 235 E Cameron Ave, Chapel Hill, NC, 27514, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina, Chapel Hill, Carolina Hall, CB# 3220, Chapel Hill, NC, 27599, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA
| | - Steve Marshall
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, 521 S Greensboro St, Carrboro, NC, 27510, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB #7400
- 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Charles Poole
- Department of Epidemiology, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB #7400
- 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Whitney Robinson
- Carolina Population Center, University of North Carolina, Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB #7400
- 135 Dauer Drive, Chapel Hill, NC, 27599, USA
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14
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Mohanty S, Delamater P, Feemster K, Buttenheim AM. 8 months to 5 days: what happened when Pennsylvania changed the vaccination regulations for provisional enrollment? Hum Vaccin Immunother 2019; 16:1166-1170. [PMID: 31567048 DOI: 10.1080/21645515.2019.1673120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In March 2017, the Pennsylvania Department of Health reduced the time allowed to demonstrate compliance with school-entry vaccination requirements from eight months to five days. We describe changes in provisional enrollment, vaccine exemptions, and vaccine coverage rates before and after the new regulation. Across Pennsylvania, provisional enrollment decreased from 11.1% in 2016/17 to 2.5% in 2017/18 (77% relative decrease). Personal belief exemptions continued a modest upward trend, similar to previous years, and medical exemptions remained steady. Among kindergartners, coverage with ≥ 2 doses of MMR vaccine and 2 doses of Varicella vaccine increased; similar increases were seen for the MCV and Tdap vaccines among 7th graders. However, improvements in coverage and reductions in provisional enrollment were not consistent across counties. Provisional enrollment in Philadelphia County during the 2017/18 school year (10.4%) did not substantially decrease. The statewide reduction in provisional enrollment suggests that the new regulations accomplished the goal of increasing the proportion of students who are up-to-date on required vaccines at the beginning of the school year without a significant increase in vaccine exemptions. However, the persistence of high provisional enrollment in some counties points to additional barriers to this goal in some schools and regions.
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Affiliation(s)
- Salini Mohanty
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Paul Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Feemster
- Immunization Program and Acute Communicable Diseases, Philadelphia Department of Public Health, Philadelphia, PA, USA.,Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Boyce RM, Delamater P, Muhindo R, Matte M, Ntaro M, Verity R, Mulogo E. Accessible metrics of access: Novel tools to measure immunization coverage in rural sub-Saharan Africa. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13066.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Immunization rates in most sub-Saharan African countries fall far below stated targets. Measuring access in resource-limited settings, however, is challenging, especially with the data available at the district level, which is the primary administrative division for most immunization programs. Despite calls to improve routine data collection and use, there remains a lack of structured methods and practical tools to target underserved populations. Herein, we describe a prospective study that aims to develop, pilot, and validate a set of user-friendly tools to identify geographic areas with limited access to immunization services and by extension, low immunization coverage. The approach will leverage routinely-collected data from public health facilities combined with novel methods of household mapping to perform spatial analyses using open-access platforms. In addition, we will triangulate the analyses across datasets representing common reasons for care seeking – namely, visits for vaccination, antenatal care, and malaria – to improve the accuracy of our estimates. The ultimate goal of this project is to equip front-line providers and district level program managers with novel tools that facilitate timely and accurate analysis of routinely-collected data to guide immunization efforts.
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