Association of neighborhood opportunity and pediatric hospitalization rates in the United States.

We examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.02 hospitalizations per 1000). Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased (p < .001 for each), from 26.56 per 1000 (95% confidence interval [CI] 26.41-26.71) in very low COI areas to 14.76 per 1000 (95% CI 14.66-14.87) in very high COI areas (incidence rate ratio 1.8; 95% CI 1.78-1.81). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in 18 US states. These data underscore the importance of social context and community-engaged solutions for health systems aiming to eliminate care inequities.

Neighborhood Childhood Opportunity, Race/Ethnicity, and Surgical Outcomes in Children With Congenital Heart Disease.

BACKGROUND: Racial and ethnic disparities in outcomes for children with congenital heart disease (CHD) coexist with disparities in educational, environmental, and economic opportunity. OBJECTIVES: We sought to determine the associations between childhood opportunity, race/ethnicity, and pediatric CHD surgery outcomes. METHODS: Pediatric Health Information System encounters aged <18 years from 2016 to 2022 with International Classification of Diseases-10th edition codes for CHD and cardiac surgery were linked to ZIP code-level Childhood Opportunity Index (COI), a score of neighborhood educational, environmental, and socioeconomic conditions. The associations of race/ethnicity and COI with in-hospital surgical death were modeled with generalized estimating equations and formal mediation analysis. Neonatal survival after discharge was modeled by Cox proportional hazards. RESULTS: Of 54,666 encounters at 47 centers, non-Hispanic Black (Black) (OR: 1.20; P = 0.01), Asian (OR: 1.75; P < 0.001), and Other (OR: 1.50; P < 0.001) groups had increased adjusted mortality vs non-Hispanic Whites. The lowest COI quintile had increased in-hospital mortality in unadjusted and partially adjusted models (OR: 1.29; P = 0.004), but not fully adjusted models (OR: 1.14; P = 0.13). COI partially mediated the effect of race/ethnicity on in-hospital mortality between 2.6% (P = 0.64) and 16.8% (P = 0.029), depending on model specification. In neonatal multivariable survival analysis (n = 13,987; median follow-up: 0.70 years), the lowest COI quintile had poorer survival (HR: 1.21; P = 0.04). CONCLUSIONS: Children in the lowest COI quintile are at risk for poor outcomes after CHD surgery. Disproportionally increased mortality in Black, Asian, and Other populations may be partially mediated by COI. Targeted investment in low COI neighborhoods may improve outcomes after hospital discharge. Identification of unmeasured factors to explain persistent risk attributed to race/ethnicity is an important area of future exploration.

Connecting past to present: Examining different approaches to linking historical redlining to present day health inequities.

In the 1930's, the Home Owner Loan Corporation (HOLC) drafted maps to quantify variation in real estate credit risk across US city neighborhoods. The letter grades and associated risk ratings assigned to neighborhoods discriminated against those with black, lower class, or immigrant residents and benefitted affluent white neighborhoods. An emerging literature has begun linking current individual and community health effects to government redlining, but each study faces the same measurement problem: HOLC graded area boundaries and neighborhood boundaries in present-day health datasets do not match. Previous studies have taken different approaches to classify present day neighborhoods (census tracts) in terms of historical HOLC grades. This study reviews these approaches, examines empirically how different classifications fare in terms of predictive validity, and derives a predictively optimal present-day neighborhood redlining classification for neighborhood and health research.

The Association of the Childhood Opportunity Index on Pediatric Readmissions and Emergency Department Revisits.

OBJECTIVE: Reutilization following discharge is costly to families and the health care system. Singular measures of the social determinants of health (SDOH) have been shown to impact utilization; however, the SDOH are multifactorial. The Childhood Opportunity Index (COI) is a validated approach for comprehensive estimation of the SDOH. Using the COI, we aimed to describe the association between SDOH and 30-day revisit rates. METHODS: This retrospective study included children 0 to 17 years within 48 children's hospitals using the Pediatric Health Information System from 1/1/2019 to 12/31/2019. The main exposure was a child's ZIP code level COI. The primary outcome was unplanned readmissions and emergency department (ED) revisits within 30 days of discharge. Primary outcomes were summarized by COI category and compared using chi-square or Kruskal-Wallis tests. Adjusted analysis used generalized linear mixed effects models with adjustments for demographics, clinical characteristics, and hospital clustering. RESULTS: Of 728,997 hospitalizations meeting inclusion criteria, 30-day unplanned returns occurred for 96,007 children (13.2%). After adjustment, the patterns of returns were significantly associated with COI. For example, 30-day returns occurred for 19.1% (95% confidence interval [CI]: 18.2, 20.0) of children living within very low opportunity areas, with a gradient-like decrease as opportunity increased (15.5%, 95% CI: 14.5, 16.5 for very high). The relative decrease in utilization as COI increased was more pronounced for ED revisits. CONCLUSIONS: Children living in low opportunity areas had greater 30-day readmissions and ED revisits. Our results suggest that a broader approach, including policy and system-level change, is needed to effectively reduce readmissions and ED revisits.

Nonprofits: A Public Policy Tool for the Promotion of Community Subjective Well-being.

Looking to supplement common economic indicators, politicians and policymakers are increasingly interested in how to measure and improve the subjective well-being of communities. Theories about nonprofit organizations suggest that they represent a potential policy-amenable lever to increase community subjective well-being. Using longitudinal cross-lagged panel models with IRS and Twitter data, this study explores whether communities with higher numbers of nonprofits per capita exhibit greater subjective well-being in the form of more expressions of positive emotion, engagement, and relationships. We find associations, robust to sample bias concerns, between most types of nonprofit organizations and decreases in negative emotions, negative sentiments about relationships, and disengagement. We also find an association between nonprofit presence and the proportion of words tweeted in a county that indicate engagement. These findings contribute to our theoretical understanding of why nonprofit organizations matter for community-level outcomes and how they should be considered an important public policy lever.

Donations in social context.

Many nonprofit organizations rely on donations to fund their programs, and a robust literature predicts donations in large-scale quantitative studies. The focus, however, is almost exclusively on the financial characteristics of the organizations, leaving the social context underexplored. In this article, we theorize how ecological context, organizational identity, and social network ties can shape donations. We use the new Internal Revenue Service (IRS) release of e-filed nonprofit reporting forms to consider 95,518 501(c)3 nonprofits around 2015. Using lagged regression models, we find that organizations within a more favorable ecological context, those that use appeals to religion, and organizations with more volunteers report more donations. Furthermore, stressing affiliation with a geographic location is associated with more donations only under certain ecological conditions. The article concludes with a discussion of the implications of these results for nonprofit organizations and social theories regarding what influences donations to organizations.

What Village? Opportunities and Supports for Parental Involvement Outside of the Family Context.

Parental involvement research and practice has disproportionately focused on the characteristics of families that promote family-school partnerships. This study focuses instead on school and community characteristics that may elicit or support parental involvement for all families, but especially those from racial/ethnic minority groups. Using the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 enhanced with data from the American Community Survey and the IRS, multilevel models reveal that educational organizations in the community are associated with higher levels of school-based parental involvement behaviors. This association varies across diverse racial/ethnic groups, such that the link between human service organizations and parental involvement is stronger for Latina/o families than for White and Black families.

Race/ethnicity, human capital, and the selection of young children into early childhood education.

Mexican-origin families face complex ethnic and immigration-based barriers to enrollment in early childhood education programs. As such, reducing barriers to enrollment for this population requires a better understanding of how Mexican-origin families work with, against, or around both general and group-specific constraints on educational opportunities. Using the Early Childhood Longitudinal Study-Birth Cohort, this study tailored broad social theory to the experience of Mexican-origin families to examine associations between human capital considerations and early childhood education enrollment within this population. Results supported the hypothesis that human capital considerations would be associated with early childhood care and education and provide limited evidence for the expectation that this link would be stronger for Mexican-origin families.

Does Use of Emotion Increase Donations and Volunteers for Nonprofits?

Nonprofits offer services to disadvantaged populations, mobilize collective action, and advocate for civil rights. Conducting this work requires significant resources, raising the question: how do nonprofits succeed in increasing donations and volunteers amid widespread competition for these resources? Much research treats nonprofits as cold, rational entities, focusing on overhead, the "price" of donations, and efficiency in programming. We argue that nonprofits attract donors and volunteers by connecting to their emotions. We use newly available administrative IRS 990 e-filer data to analyze 90,000 nonprofit missions from 2012 to 2016. Computational text analysis measures the positive or negative affect of each nonprofit's mission statement. We then link the positive and negative sentiment expressed by nonprofits to their donations and volunteers. We differentiate between the institutional fields of nonprofits-for example, arts, education, social welfare-distinguishing nonprofits focused on social bonding from those focused on social problems. We find that expressed positive emotion is often associated with higher donations and volunteers, especially in bonding fields. But for some types of nonprofits, combining positive sentiment with negative sentiment in a mission statement is most effective in producing volunteers. Auxiliary analyses using experimental and longitudinal designs provide converging evidence that emotional language enhances charitable behavior. Understanding the role of emotion can help nonprofit organizations attract and engage volunteers and donors.

Do National Service Programs Improve Subjective Well-Being in Communities?

Since the creation of Volunteers in Service to America (VISTA) in 1964 and AmeriCorps in 1993, a stated goal of national service programs has been to strengthen the overall health of communities across the United States. But whether national service programs have such community effects remains an open question. Using longitudinal cross-lagged panel and change-score models from 2005 to 2013, this study explores whether communities with national service programs exhibit greater subjective well-being. We use novel measures of subjective well-being derived from tweeted expressions of emotions, engagement, and relationships in 1,347 U.S. counties. Results show that national service programs improve subjective well-being primarily by mitigating threats to well-being and communities that exhibit more engagement are better able to attract national service programs. Although limited in size, these persistent effects are robust to multiple threats to inference and provide important new evidence on how national service improves communities in the United States.

Revisiting Declines in Social Capital: Evidence from a New Measure.

In the late twentieth century, researchers began calling attention to declining social capital in America and the potential consequences of this trend for a healthy society. While researchers empirically assessed the decline in social capital from the mid-1900s onward, this line of research diminished when the major source of data, the General Social Survey, stopped fielding critical questions in 2004. We do not know, therefore, whether social capital, especially associational social capital, has declined, stabilized, or even increased in a twentyfirst century America. In this paper, we develop a new measure of associational social capital using a confirmatory factor analysis of six indicators from the Civic Engagement Supplement to the Current Population Survey for 2008-2011 and 2013. Our findings support previous research suggesting that associational social capital does not seem to be declining over time. However, we do find evidence of a nonlinear decrease in associating during the Great Recession years. Across the entire time period, though, membership in groups has not declined and there has been little practical change in the amount of time that individuals spend with neighbors. Our analysis of the variance of social capital also shows no general change in the national dispersion of social capital from 2008 to 2013. The paper advances the measurement of social capital and updates our understanding of its possible decline.