Positive and negative aspects of the COVID-19 pandemic among a diverse sample of US adults: an exploratory mixed-methods analysis of online survey data

BACKGROUND

The COVID-19 pandemic had a profound social and economic impact across the United States due to the lockdowns and consequent changes to everyday activities in social spaces.

METHODS

The COVID-19's Unequal Racial Burden (CURB) survey was a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults living in the U.S. For this analysis, we used data from the 1,931 participants who responded to the 6-month follow-up survey conducted between 8/16/2021-9/9/2021. As part of the follow-up survey, participants were asked "What was the worst thing about the pandemic that you experienced?" and "Was there anything positive in your life that resulted from the pandemic?" Verbatim responses were coded independently by two coders using open and axial coding techniques to identify salient themes, definitions of themes, and illustrative quotes, with reconciliation across coders. Chi-square tests were used to estimate the association between sociodemographics and salient themes.

RESULTS

Commonly reported negative themes among participants reflected disrupted lifestyle/routine (27.4%), not seeing family and friends (9.8%), and negative economic impacts (10.0%). Positive themes included improved relationships (16.9%), improved financial situation (10.1%), and positive employment changes (9.8%). Differences in themes were seen across race-ethnicity, gender, and age; for example, adults ≥ 65 years old, compared to adults 18-64, were more likely to report disrupted routine/lifestyle (37.6% vs. 24.2%, p < 0.001) as a negative aspect of the pandemic, and Spanish-speaking Latino adults were much more likely to report improved relationships compared to other racial-ethnic groups (31.1% vs. 14.8-18.6%, p = 0.03).

DISCUSSION

Positive and negative experiences during the COVID-19 pandemic varied widely and differed across race-ethnicity, gender, and age. Future public health interventions should work to mitigate negative social and economic impacts and facilitate posttraumatic growth associated with pandemics.

Disparities in fatal and non-fatal opioid-involved overdoses among middle-aged non-Hispanic Black Men and Women

The gap in fatal opioid overdose rates has been closing between non-Hispanic Black and non-Hispanic White individuals. The rising opioid-involved mortality rates among non-Hispanic Black adults has been identified by SAMHSA as a critical public health issue. However, further research is needed that utilizes comprehensive surveillance data on both fatal and non-fatal opioid-involved overdoses to better assess the changing trends and evaluate factors contributing to changing disparities. We conducted an analysis of medical examiner and hospital data for years 2016-2021 from the largest county in Illinois (Cook) to (1) evaluate disparities in non-fatal and fatal opioid-involved overdoses between middle-aged non-Hispanic Black adults and Black adults of other age groups stratified by sex, (2) to assess if disparities exist across middle-aged adults of different race-ethnicities specifically non-Hispanic White and Hispanic-Latino adults, and (3) evaluate factors contributing to the disparities. Fatal opioid overdose rates among middle-aged Black men 45-64 years old were on average 5.3 times higher than Black men of other age groups, and 6.2 times higher than middle-aged non-Black men. Similarly, fatal opioid overdose rates among middle-aged Black women were on average 5.0 times higher than Black women of other age groups, and 4.9 times higher than middle-aged non-Black women. Hospital utilization rates for opioid-involved overdoses showed similar disparities between age groups and race-ethnicities. Findings indicate that stark disparities in rates of opioid-involved overdoses among middle-aged Black men and women are likely attributed to exposure to more lethal opioids, drug variability in local markets, differences in concurrent drug exposures, and lower access to harm reduction, emergent and preventative health services.

Gender, race-ethnicity and postdoctoral hiring in STEMM fields

As postdoctoral training has become a requirement in many STEMM fields the influence of postdoc hiring on STEMM labor force inclusion and diversity has increased, yet postdoc hiring processes have received only limited attention from researchers. Drawing on status theory and data for 769 postdoctoral recruitments, we systematically analyze the relationship between gender, race-ethnicity, and postdoctoral hiring. The findings show: (1) differences by gender and race-ethnicity in application rates, and in whether an applicant is seriously considered, interviewed, and offered the postdoc position; (2) hiring disparities correlate with between-group differences in applicants' network connections, referrer prestige, and academic human capital; (3) between-group differences in network connections have the greatest power to account for hiring disparities; and (4) hiring processes may differ by applicant gender or race-ethnicity, the female representation in the STEMM field and the race of the search committee chair. We discuss competing interpretations of the results and highlight directions for future research.

Heterogeneous effects of spatially proximate firearm homicide exposure on anxiety and depression symptoms among U.S. youth

The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths' mental health and whether those impacts vary by characteristics that shape youths' risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation.

Inequities in Community Exposure to Deadly Gun Violence by Race/Ethnicity, Poverty, and Neighborhood Disadvantage among Youth in Large US Cities

Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2-18% of youth resided within 600 m of a gun homicide occurring in the past 14-365 days. These percentages were 3-25% for incidents within 800 m and 5-37% for those within a 1300-m radius. Black and Latinx youth were 3-7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5-10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.

Racial-ethnic inequities in age at death among adults with/without intellectual and developmental disability in the United States

To identify potential differences in racial-ethnic inequities in mortality between adults with/without intellectual and developmental disability, we compared patterns in age at death by race-ethnic status among adults who did/did not have intellectual and developmental disability reported on their death certificate in the United States. Data were from the 2005-2017 U.S. Multiple Cause-of-Death Mortality files. Average age at death by racial-ethnic status was compared between adults, age 18 and older, with/without different types of intellectual and developmental disability reported on their death certificate (N = 32,760,741). A multiple descent pattern was observed among adults without intellectual or developmental disability, with age at death highest among Whites, followed by Asians, Hispanics and Blacks, then American Indians. In contrast, a bifurcated pattern was observed among adults with intellectual disability, with age at death highest among Whites, but lower and similar among all racial-ethnic minority groups. The severity of racial-ethnic inequities in age at death was most pronounced among adults with cerebral palsy. Policy makers and public health experts should be aware that racial-ethnic inequities are different for adults with intellectual and developmental disability - all minorities with intellectual and developmental disability are at greater risk of premature death than their White counterparts.

Peer Victimization and Mental Health Problems: Racial-Ethnic Differences in the Buffering Role of Academic Performance

Despite research highlighting the importance of academic performance in reducing youth's bullying involvement, little attention has focused on its role in moderating the association between peer victimization and youth maladjustment, further, there have been even fewer studies examining potential racial-ethnic differences in the association. This cross-sectional study examined the function of academic performance, as a moderator, in the associations between peer victimization and youth mental health problems (i.e., internalizing, externalizing, and substance use problems) and whether and how this function varied by the youth's racial-ethnic background. Self-report data were collected from 69,244 middle and high school youth (45.96% were middle schoolers; 49.7% were females; 25.72% were Black and African American youth, 9.64% Latinx American youth, 5.95% Asian American youth, and 10.47% Bi- and Multi-racial youth, and 48.22% White American youth). Multi-level models indicated that academic performance was negatively related to internalizing problems and substance use more strongly in victimized youth than in non-victimized youth, suggesting itself as a buffering factor. Moreover, this buffering function of academic performance in victimized youth was more pronounced in some ethnic groups (i.e., Asian American) than in others (i.e., Black and Latinx American), yet, notably, it was a buffer across all ethnic groups. These findings underscore the importance of academic strength in protecting victimized youth of all ethnicities against mental health difficulties, while recognizing that additional foci on improving academic performance and addressing academic-related norms are needed for racial-ethnic minority subgroups.

Accelerometer-Measured Physical Activity and Cardiometabolic Risk Factors by Race-Ethnicity: 2003-2006 NHANES

Previous studies suggest that the magnitude of morbidity/mortality reduction may differ between race-ethnic groups despite equated dose of physical activity (PA). The purpose of this study was to compare the potential racial-ethnic differences in cardiometabolic risk factors (CMRF) across quartiles of accelerometer-derived total activity counts/day (TAC/d) among US adults. The final sample (n=4144) included adults who participated in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). CMRF included fasting glucose (FG), fasting insulin (FI), HOMA-IR, resting systolic (SBP) and diastolic blood pressure (DBP), waist circumference (WC), BMI, CRP, HDL-C, LDL-C, and triglycerides. Race-ethnic groups examined included non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican American (MA). In the highest quartile, NHW had significantly lower values of HOMA-IR, FI, SBP, BMI, WC, and HDL-C when compared to NHB. Compared to MA in the highest quartile, NHW had significantly lower values of HOMA-IR, FI, BMI, and triglycerides. Significant race-ethnic differences were found for several CMRF, especially among those who were in the top quartile of PA (e.g., the most active adults). It is probable that the protective effect of higher volumes of PA on CMRF is moderated by other non-PA factors distinct to NHB and MA.

Does the Hispanic Mortality Advantage Vary by Marital Status Among Postmenopausal Women in the Women's Health Initiative?

BACKGROUND

Literature assessing the effect of marital status on mortality has underrepresented, or altogether omitted Hispanics and the potential moderating effect of Hispanic ethnicity on these relationships. Given cultural and network dynamics, marital advantages in older Hispanic women may be greater than other groups given their family-focused, collectivist orientation.

PURPOSE

The purpose of this study was to understand whether older Hispanic women exhibited a more pronounced marital advantage as compared with non-Hispanic Whites.

METHODS

We used longitudinal data from the Women's Health Initiative (WHI) Observational Study and Clinical Trials (N = 161,808) collected initially from 1993 to 1998 and followed until 2018. Our sample excluded those respondents indicating "other" as their race-ethnicity and those missing marital status and race-ethnicity variables (N = 158,814). We used Cox-proportional hazards models to assess the association between race-ethnicity, marital status, and the interactive effect of race-ethnicity and marital status on survival.

RESULTS

After controlling for socioeconomic status (SES) and health controls, we found a Hispanic survival advantage when compared with non-Hispanic Whites and all other racial-ethnic groups with the exception of Asian/Pacific Islander women (all significant HRs < 0.78, all ps ≤ 0.001). Hispanics had a higher rate of divorce when compared with non-Hispanic Whites. The interactive effect of race-ethnicity and marital status was not significant.

CONCLUSIONS

U.S. Hispanic, postmenopausal women exhibit a mortality advantage over and above marital status despite their high rates of divorce. Implications and potential explanations are discussed.

CLINICAL TRIAL REGISTRATION

NCT00000611.

Racial-Ethnic Differences in Mental Health Stigma and Changes Over the Course of a Statewide Campaign

OBJECTIVE

The authors examined whether shifts in mental health-related stigma differed across racial-ethnic groups over the course of a California statewide antistigma campaign and whether racial-ethnic disparities were present at the beginning of the campaign and 1 year later.

METHODS

Participants had taken part in the 2013 and 2014 California Statewide Surveys (CASSs), a longitudinal, random-digit-dialing telephone survey of California adults ages ≥18 years (N=1,285). Surveys were administered in English, Spanish, Mandarin, Cantonese, Vietnamese, Khmer, and Hmong.

RESULTS

Compared with Whites, Latino and Asian respondents who preferred to take the survey in their native language had higher levels of mental health-related stigma on several domains of the 2013 CASS. Specifically, Latino and Asian respondents who completed the survey in their native language were more likely than White respondents to report social distance, prejudice, and perceptions of dangerousness toward people with mental illness. These racial-ethnic disparities persisted 1 year later on the 2014 CASS. Latino-Spanish respondents experienced significant decreases in social distance over the course of the campaign but not to a degree that eliminated disparities on the 2014 CASS. Of note, perceptions of dangerousness of people with mental illness significantly increased among Latino-Spanish respondents between the 2013 and 2014 CASSs.

CONCLUSIONS

Future research is needed to better understand which components of antistigma campaigns are effective across racial-ethnic minority groups and whether more targeted efforts are needed, especially in light of the persistent and growing racial-ethnic disparities in mental health care.

Widowhood and mortality: gender, race/ethnicity, and the role of economic resources

PURPOSE

We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources.

METHODS

Data were drawn from the Health and Retirement Study (1992-2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson-Holm-Breen analysis was conducted to examine the mediating role of economic resources across groups.

RESULTS

Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics.

CONCLUSIONS

Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.

Are You Saving for Retirement? Racial/Ethnic Differentials in Contributory Retirement Savings Plans

OBJECTIVES

How individuals and families accumulate retirement resources during working years is a key aspect of aging with implications for later life. This study examines how much, and by what mechanisms, savings in retirement plans vary by race/ethnicity.

METHOD

Using representative survey data and linked W-2 tax records, we estimate the probability of participation in employer-sponsored defined contribution (DC) retirement plans with probit regression, and contribution levels with ordinary least squares (OLS) models. We use Heckman models to adjust for potential sample selection.

RESULTS

Black and Hispanic workers have lower participation and contributions in employer-sponsored DC retirement plans than do white workers, while Asian Americans have higher levels. The bulk of racial/ethnic differences is attributed to socioeconomic position, especially education and labor market circumstances like earnings. Differentials are also associated with family circumstances, namely for black workers. After accounting for education, labor market, and family covariates, social-psychological factors appear to explain only small portions of differences, especially for black and Hispanic.

DISCUSSION

This study clarifies how racial/ethnic disparities in socioeconomic circumstances generate advantages and disadvantages in retirement wealth accumulation. Lower DC retirement plan participation and contributions among minorities in work life represent an underappreciated earlier-life channel through which racial inequalities in income and wealth in later life are generated.

Race-Ethnic Disparities in 30-Day Readmission After Stroke Among Medicare Beneficiaries in the Florida Stroke Registry

OBJECTIVE

To examine racial/ethnic disparities in 30-day all-cause readmission after stroke.

METHODS

Thirty-day all-cause readmission was compared by race/ethnicity among Medicare fee-for-service beneficiaries discharged for ischemic stroke from hospitals in the Florida Stroke Registry from 2010 to 2013. We fit a Cox proportional hazards model that censored for death and adjusted for age, sex, length of stay, discharge home, and comorbidities to assess racial/ethnic differences in readmission.

RESULTS

Among 16,952 stroke patients (54% women, 75% white, 8% black, and 15% Hispanic), 30-day all-cause readmission was 15% (17.2% for blacks, 16.7% for Hispanics, 14.4% for whites, and 14.7% for others; P = .003). There was a median of 11 days between discharge and first readmission. In adjusted analyses, there was no significant difference in readmission for blacks (hazard ratio 1.15, 95% confidence interval 0.99-1.33), Hispanics (1.00, .90-1.13), and those of other race/ethnicity (.91, .71-1.16) compared with whites. Nearly 1 in 4 readmissions were attributable to acute cerebrovascular events: 16.6% ischemic stroke or transient ischemic attack, 1.5% hemorrhagic stroke, and 5.2% cerebral artery interventions. Interventions were more common among whites and those of other race than blacks and Hispanics (P = .029). Readmission due to pneumonia or urinary tract infection was 8.2%.

CONCLUSIONS

Readmissions attributable to acute cerebrovascular events were common and generally occurred within 2 weeks of hospital discharge. Racial/ethnic disparities were present in readmissions for arterial interventions. Our results underscore the importance of postdischarge transitional care and the need for better secondary prevention strategies after ischemic stroke, particularly among minority populations.

How Does Park Use and Physical Activity Differ between Childhood and Adolescence? A Focus on Gender and Race-Ethnicity

Physical activity typically declines between childhood and adolescence. Despite urban parks being a great venue for physical activity, children change both the frequency of park use and their park use habits as they age into adolescence. However, little is known about how these differences vary by gender and how distinct race/ethnicity groups differentially change their park habits. This study analyzed the differences in park use and per capita energy expenditure between children and teenagers of different gender and race/ethnicity backgrounds. Using the System for Observing Play and Recreation in Communities (SOPARC), systematic observations were conducted in 20 New York City parks in 2017, located in low-income areas with high presence of Latino or Asian residents. A total of 9963 scans in 167 distinct target areas counted 16,602 children (5-10 years old) and 11,269 teenagers (11 or older). Using adjusted marginal means, we estimated the number of park users of each age range, gender, and race/ethnicity expected to be found in each park activity setting. Teenagers of both genders and most race/ethnicity groups were less likely to be in a park and had lower per capita energy expenditure, compared with children. The difference in park attendance was greater than the difference in per capita energy expenditure. Dissimilarities were clearly gendered and race/ethnicity dependent. Asian and Latino females showed the greatest divergence between childhood and adolescence. African American boys were the only group to show a positive age contrast in park attendance and per capita energy expenditure.

Implications of intersecting socioeconomic and racial-ethnic identities for academic achievement and well-being

The evolving study of identity development has become increasingly attentive to the ways that young people think about their socioeconomic and racial-ethnic identities. The status-based identity framework provides one way to analyze the implications of these dynamic identities, particularly as people approach young adulthood. For students from low socioeconomic status (SES) backgrounds, the experience of socioeconomic mobility can accompany an aversive sense of uncertainty about their own SES, termed status uncertainty, with potential negative implications for their academic behaviors and outcomes. A longitudinal study and experiment demonstrate some of these consequences and suggest how intersections between socioeconomic and racial-ethnic identities may be associated with well-being. This perspective on the dynamic identities of young people calls for consistent attention to the various levels of context that can be leveraged to support positive development, effective goal pursuit, and desired life trajectories.

Ain't nobody got time for dad? Racial-ethnic disproportionalities in child welfare casework practice with nonresident fathers

BACKGROUND

Given fathers' potential role in bringing about desired child welfare case outcomes, researchers have begun to identify factors that impact agency efforts to identify and involve fathers. Racial-ethnic inequality and bias are not among factors studied, despite longstanding evidence that racial-ethnic minority children make up a disproportionate share of the child welfare population.

OBJECTIVE

We set out to identify racial-ethnic patterns in initial casework activity with nonresident fathers and explore whether select factors explain racial-ethnic differentials.

PARTICIPANTS AND SETTING

Caseworkers of 1,754 children in foster care in four U.S. states were surveyed.

METHODS

Bivariate and multivariate logistic regression models were used to identify factors associated with whether agencies identified, located, and contacted nonresident fathers.

RESULTS

Agencies were less likely to identify nonresident fathers of Black, Latinx, and Multiracial children, relative to those of White children. Among fathers whom agencies identified, Black and Latinx fathers were less likely to be located. Among fathers whom agencies located, Black and Latinx fathers were less likely to be contacted. Whereas greater rates of international mobility among Latinx fathers explained agencies' disproportionately low rates of contact, no other factor explained racial-ethnic differentials.

CONCLUSION

We find evidence of historical racial-ethnic disproportionalities across the three initial stages of casework practice with nonresident fathers in U.S. child welfare systems. Though more recent data are needed, this research suggests that racial-ethnic minority foster children are more likely than White foster children to be denied the benefits of agency-father contact, whether due to societal or systemic racial inequalities.

Patient Satisfaction with Navigator Interpersonal Relationship (PSN-I): item-level psychometrics using IRT analysis

BACKGROUND

Patient navigation (PN) is a promising intervention to eliminate cancer health inequities. Patient navigators play a critical role in the navigation process. Patients' satisfaction with navigators is important in determining the effectiveness of PN programs. We applied item response theory (IRT) analysis to establish item-level psychometric properties for the Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I).

METHODS

We conducted a confirmatory factor analysis (CFA) to establish unidimensionality of the 9-item PSN-I in 751 cancer patients (68% female) between 18 and 86 years old. We fitted unidimensional IRT models-unconstrained graded response model (GRM) and Rasch model-to PSN-I data, and compared model fit using likelihood ratio (LR) test and information criteria. We obtained item parameter estimates (IPEs), item category/operating characteristic curves, and item/test information curves for the better fitting model.

RESULTS

CFA with diagonally weighted least squares confirmed that the one-factor model fit the data (RMSEA = 0.047, 95% CI = 0.033-0.060, and CFI ≈ 1). Responses to PSN-I items clustered into the 4th and 5th categories. We aggregated the first three response categories to provide stable parameter estimates for both IRT models. The GRM fit the data significantly better than the Rasch model (LR = 80.659, df = 8, p < 0.001). Akaike's information coefficient (6384.978 vs. 6320.319) and Bayesian information coefficient (6471.851 vs. 6443.771) were lower for the GRM. IPEs showed substantial variation in items' discriminating power (1.80-3.35) for GRM.

CONCLUSIONS

This IRT analysis confirms the latent structure of the PSN-I and supports its use as a valid and reliable measure of latent satisfaction with PN.

Obesity and understudied minority children: existing challenges and opportunities in epidemiology

Background

Obesity is a major public health concern in the United States and should be addressed as early as possible, in childhood. Disparities exist in obesity prevalence and its associated comorbidities by racial/ethnic group, however less is known about the smaller racial/ethnic subclasses that are often aggregated and assumed to be homogeneously at risk. As the racial and ethnic composition of the US shifts towards greater diversity, it is important that epidemiologic research addresses these new challenges.

Main body

In this short communication, we focus on Asian American children given that subgroups are historically understudied and emerging evidence among adults suggest heterogeneous associations for both obesity and cardio-metabolic outcomes. Existing limitations in this research area include: (1) identifying the appropriate measurement of adiposity in Asian American children; (2) determining high-risk cutoffs for intervention; and (3) developing strategies to ensure study robustness.

Conclusion

Data disaggregation is a necessary approach to understand potentially heterogeneous associations in childhood obesity and cardio-metabolic risk, but epidemiologic investigators must address these challenges. Ultimately, successful strategies could help better identify high risk subgroups, target interventions, and effectively reduce the burden of obesity among American youth.

Application of machine-learning to predict early spontaneous preterm birth among nulliparous non-Hispanic black and white women

PURPOSE

Spontaneous preterm birth is a leading cause of perinatal mortality in the United States, occurring disproportionately among non-Hispanic black women compared to other race-ethnicities. Clinicians lack tools to identify first-time mothers at risk for spontaneous preterm birth. This study assessed prediction of early (<32 weeks) spontaneous preterm birth among non-Hispanic black and white women by applying state-of-the-art machine-learning to multilevel data from a large birth cohort.

METHODS

Data from birth certificate and hospital discharge records for 336,214 singleton births to nulliparous women in California from 2007 to 2011 were used in cross-validated regressions, with multiple imputation for missing covariate data. Residential census tract information was overlaid for 281,733 births. Prediction was assessed with areas under the receiver operator characteristic curves (AUCs).

RESULTS

Cross-validated AUCs were low (0.62 [min = 0.60, max = 0.63] for non-Hispanic blacks and 0.63 [min = 0.61, max = 0.65] for non-Hispanic whites). Combining racial-ethnic groups improved prediction (cross-validated AUC = 0.67 [min = 0.65, max = 0.68]), approaching what others have achieved using biomarkers. Census tract-level information did not improve prediction.

CONCLUSIONS

The resolution of administrative data was inadequate to precisely predict individual risk for early spontaneous preterm birth despite the use of advanced statistical methods.

Racial variation in the effect of motherhood on women's employment: Temporary or enduring effect?

Part of the motherhood wage penalty results from mothers' loss of work experience, yet little research has investigated whether this loss is temporary or accumulates over time. Using growth curve models and data from the National Longitudinal Study of Youth (1979), I examine the extent to which motherhood reduces work experience over the life course among White, Black, and Hispanic women. Results indicate that motherhood slows the accretion of experience in full-time work for all racial-ethnic groups, having an enduring effect on women's employment. The effect is stronger among Whites and mothers with two or more children, remaining sizeable as women approach retirement age. By age 50, White and Hispanic mothers with two or more children exhibit between two to seven fewer years of experience in full-time employment. Among Blacks, only mothers with three or more children experience a significant reduction, averaging five fewer years of experience in full-time work.

Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey

Background

This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools.

Methods

A mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65–79 years. Respondent data were weighted to the study population for the cross-sectional analyses.

Results

Older seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities.

Conclusions

The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2986-0) contains supplementary material, which is available to authorized users.

Implications of language barrier on the diagnostic yield of computed tomography in pulmonary embolism

OBJECTIVES

To determine if a physician-patient language barrier impacts the diagnostic accuracy of pulmonary embolism (PE) evaluation.

METHODS

A retrospective chart review, conducted between June 2015 and December 2016, of a consecutive sample of diagnostic computed tomography pulmonary angiogram (CTPA) studies performed on adult patients. Positive and negative CTPA scans were further categorized by patient language and the positive diagnostic yield was determined for each language group. A post collection sub-analysis was performed to determine the yield when interpreter services were identified as necessary.

RESULTS

The yield for English speaking patients was 10.24% (92/898, 95% CI 8.39% to 12.36%), similar to the yield in Spanish speaking patients of 9.40% (25/266, 95% CI 6.31% to 13.37%, P=0.69). This contrasted with the yield in patients who identified as bilingual, which was significantly lower at 1.41% (1/71, 95% CI 0.07% to 6.75%) compared to both English-(P<0.02) and Spanish-only speakers (P<0.03). The yield for non-English speaking patients who requested an interpreter was 7.37% (14/190, 95% CI 4.26% to 11.77%) versus 3.23% (2/62, 95% CI 0.54% to 10.25%, P=0.25) in those who did not.

CONCLUSIONS

The diagnostic yield in English- and Spanish-only speaking patients was similar, however, the yield in those that self-identified as bilingual was significantly lower. In patient groups in which a language barrier existed and an interpreter was not utilized, there was a trend toward a lower diagnostic yield. This suggests an increased propensity to order diagnostic imaging when potential communication barriers exist.

Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in 2013

BACKGROUND

Disparities in Acute Myocardial Infarction (AMI) care and outcomes have been frequently reported in racial-ethnic minorities in the U.S. Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representations and updated quality resources is needed.

METHODS

Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%), and the comparison of these two groups constitutes the focus of the study. Mortality, 30day readmissions, medication/performance measures (PRx); aspirin, statins/anti-lipids, beta-blockers, ACEI/ARB for LV systolic dysfunction, <90min door-balloon time, and revascularization procedures were compared between hospitals, NHW and H, using Chi-squared tests (χ²), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions - independent groups.

RESULTS

No significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had 47.3% H and Hospitals A+B 14.6% (p<0.001, effect size=0.430). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private/commercial insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p<0.001) than H.

CONCLUSIONS

Equitable access to quality hospital services in three Southern California hospitals offset previously reported disparities in AMI management in Hispanics. These results may not necessarily reflect the reality of AMI care for Hispanics in other U.S. regions.

Why Do(n't) they leave?: Motherhood and women's job mobility

Although the relationship between motherhood and women's labor market exits has received a great deal of popular and empirical attention in recent years, far less is known about the relationship between motherhood and women's job changes. In this paper, I use panel data from the National Longitudinal Survey of Youth (1979) (NLSY79) and Cox regression models to examine how motherhood influences the types of job changes and employment exits women make and how this varies by racial-ethnic group. I find preschool-age children are largely immobilizing for white women, as they discourage these women from making the types of voluntary job changes that are often associated with wage growth. No such effects were found for Black or Hispanic women.

Racial-Ethnic Variation in Park Use and Physical Activity in the City of Los Angeles

Racial-ethnic disparities in physical activity present important challenges to population health. Public parks provide access to free or low-cost physical activity opportunities, but it is unclear to what extent parks are utilized by various race-ethnic groups in diverse urban settings. Here, we examine racial ethnic differences in park use and physical activity among adult residents (n = 7506) living within 1 mi of 50 parks in the city of Los Angeles. In multivariate analyses, we find few differences among race-ethnic groups in terms of their frequency of having visited the park in the past 7 days; however, we find numerous differences in how the groups used the park and in their levels of physical activity: Blacks and English-speaking Latinos were less likely than whites to report being physically active, exercising in the park, and exercising outside the park; Spanish-speaking Latinos were equally likely as whites to report exercising in park but less likely to report exercising outside the park and more likely to report using the parks for social interactions; Asians/Pacific Islanders (PI)/others were more likely than whites to report visiting the park in the past 7 days and using the parks for social interactions. Urban parks appear to be an important resource for physical activity and socialization, in particular among Spanish-speaking Latino and Asians/PI groups. Additional efforts may be needed for other racial-ethnic minorities to experience the same benefits.

Genetic Basis for Colorectal Cancer Disparities

African Americans suffer the highest burden from colorectal cancer (CRC) in the USA. Studies have suggested that healthcare access and poorer utilization of preventive services may be playing more of a role in this disparity. However, African Americans also tend to develop CRC at younger ages and are more likely to have proximal cancers. This raises the possibility of higher genetic predisposition to CRC among African Americans and this has not been well studied. In this article, we reviewed possible genetic basis underpinning biological differences in CRC burden in the USA.

Race-Ethnic Differences in the Non-marital Fertility Rates in 2006-2010

Research in the 1980s pointed to the lower marriage rates of blacks as an important factor contributing to race differences in non-marital fertility. Our analyses update and extend this prior work to investigate whether cohabitation has become an important contributor to this variation. We use data from the 2006-2010 National Survey of Family Growth (NSFG) and to identify the relative contribution of population composition (i.e. percent sexually active single and percent cohabiting) versus rates (pregnancy rates, post-conception marriage rates) to race-ethnic variation in non-marital fertility rates (N=7,428). We find that the pregnancy rate among single (not cohabiting) women is the biggest contributor to race-ethnic variation in the non-marital fertility rate and that contraceptive use patterns among racial minorities explains the majority of the race-ethnic differences in pregnancy rates.