Prior COVID-19 infection: an underappreciated factor in vaccine hesitancy in the USA.

Despite tremendous efforts to quickly identify the 'vaccine hesitant' in the USA, what has emerged instead is a complex picture of a highly heterogeneous unvaccinated population. Although numerous factors have been implicated in influencing US COVID-19 vaccine decision-making, the role that prior coronavirus disease 2019 (COVID-19) infection may play in vaccine receipt has been largely uninvestigated. Using data from two separate US national surveys, the US COVID-19 Trends and Impact Survey and the Household Pulse Survey, we find that roughly one-quarter of unvaccinated survey respondents has had a prior COVID-19 infection. Prior COVID-19 infection halves the odds of receiving the vaccine. This information is consequential for ongoing vaccine outreach efforts.

U.S. frontline workers and COVID-19 inequities.

We overcome a lack of frontline worker status information in most COVID-19 data repositories to document the extent to which occupation has contributed to COVID-19 disparities in the United States. Using national data from over a million U.S. respondents to a Facebook-Carnegie Mellon University survey administered from September 2020 to March 2021, we estimated the likelihoods of frontline workers, compared to non-frontline workers, 1) to ever test positive for SARs-Cov-2 and 2) to test positive for SARs-Cov-2 within the past two weeks. Net of other covariates including education level, county-level political environment, and rural residence, both healthcare and non-healthcare frontline workers had higher odds of having ever tested positive for SARs-Cov-2 across the study time period. Similarly, non-healthcare frontline workers were more likely to test positive in the previous 14 days. Conversely, healthcare frontline workers were less likely to have recently tested positive. Our findings suggest that occupational exposure has played an independent role in the uneven spread of the virus. In particular, non-healthcare frontline workers have experienced sustained higher risk of testing positive for SARs-Cov-2 compared to non-frontline workers. Alongside more worker protections, future COVID-19 and other highly infectious disease response strategies must be augmented by a more robust recognition of the role that structural factors, such as the highly stratified U.S. occupational landscape, have played in the uneven toll of the COVID-19 pandemic.

Hispanic Segregation and Poor Health: It's Not Just Black and White.

Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born.

New faces in new spaces in new places: Residential attainment among newly legalized immigrants in established, new, and minor destinations.

UNLABELLED: Immigrants at the beginning of the twenty-first century are located in a more diverse set of metropolitan areas than at any point in U.S. HISTORY: Whether immigrants' residential prospects are helped or hindered in new versus established immigrant-receiving areas has been the subject of debate. Using multilevel models and data from the New Immigrant Survey (NIS), a nationally representative sample of newly legalized immigrants to the U.S., we move beyond aggregate-level analyses of residential segregation to specify the influence of destination type on individual-level immigrant residential outcomes. The findings indicate that immigrants in new and minor destinations are significantly more likely to live in tracts with relatively more non-Hispanic whites and relatively fewer immigrants and poor residents. These residential advantages persist net of individual-level controls but are largely accounted for by place-to-place differences in metropolitan composition and structure. Our exclusive focus on newly legalized immigrants means that our findings do not necessarily contradict the possibility of worse residential prospects in new areas of settlement, but rather qualifies it as not extending to the newly authorized population.

Beyond English proficiency: rethinking immigrant integration.

We develop and test a conceptual model of English language acquisition and the strength of the latter in predicting social and cultural assimilation. We present evidence that the path to English proficiency begins with exposure to English in the home country and on prior U.S. trips. English proficiency, then, has direct links to the intermediate migration outcomes of occupational status in the U.S., the amount of time in the U.S. since the most recent trip, and the co-ethnic residential context in the U.S. In turn, pre-migration characteristics and the intermediate characteristics work in tandem with English proficiency to determine social assimilation in the U.S., while cultural assimilation is primarily determined by pre-migration habits. A shift in focus to English use is desirable in studies of immigrant integration.

What's Behind the Dramatic Pre-2020 Declines in Hispanic/Latina Adolescent Childbearing? Decomposing Change by Age, Origin, and Nativity.

PURPOSE: To assess whether the large declines in adolescent childbearing among Hispanic adolescents over the period 2000-2019 have been driven by co-occurring changes in the composition of the Hispanic population and, if so, whether they have done so differentially by Hispanic subgroup. METHODS: We use birth counts from the United States vital statistics system and population denominators from the United States decennial census long form 5-percent Public Use Microdata and the American Community Survey to conduct a decomposition analysis apportioning observed declines in Hispanic adolescent childbearing to: (1) compositional shifts in nativity, age, and region-of-origin and (2) subgroup changes in childbearing rates. RESULTS: The Hispanic adolescent fertility rate fell by over 71% from 2000 to 2019, with Mexican-Origin, United States-born, and younger adolescents exhibiting the steepest declines (79%, 70%, and 80% declines, respectively). Results from the decomposition analysis show that almost 90% of the decline is due to within-group rate change, with some variability by subgroup and by decade. Only 10% of the decline was due to compositional changes, with shifts in nativity driving much of the effect. DISCUSSION: Declines in Hispanic adolescent childbearing over the last decades have occurred in spite of substantial shifts in the composition of the Hispanic population, not because of them. These findings set the stage for a more detailed examination of the drivers of change in sexual activity, contraceptive use, and abortion, all of which are proximate determinants of adolescent pregnancy and childbearing. Additionally, a focus on more distal factors is needed, including the role that changing political, societal, and economic conditions in the United States have for early fertility patterns.

Unequal burdens: assessing the determinants of elevated COVID-19 case and death rates in New York City's racial/ethnic minority neighbourhoods.

BACKGROUND: The disproportionate burden of the COVID-19 pandemic on racial/ethnic minority communities has revealed glaring inequities. However, multivariate empirical studies investigating its determinants are still limited. We document variation in COVID-19 case and death rates across different racial/ethnic neighbourhoods in New York City (NYC), the initial epicentre of the U.S. coronavirus outbreak, and conduct a multivariate ecological analysis investigating how various neighbourhood characteristics might explain any observed disparities. METHODS: Using ZIP-code-level COVID-19 case and death data from the NYC Department of Health, demographic and socioeconomic data from the American Community Survey and health data from the Centers for Disease Control's 500 Cities Project, we estimated a series of negative binomial regression models to assess the relationship between neighbourhood racial/ethnic composition (majority non-Hispanic White, majority Black, majority Hispanic and Other-type), neighbourhood poverty, affluence, proportion of essential workers, proportion with pre-existing health conditions and neighbourhood COVID-19 case and death rates. RESULTS: COVID-19 case and death rates for majority Black, Hispanic and Other-type minority communities are between 24% and 110% higher than those in majority White communities. Elevated case rates are completely accounted for by the larger presence of essential workers in minority communities but excess deaths in Black neighbourhoods remain unexplained in the final model. CONCLUSIONS: The unequal COVID-19 case burden borne by NYC's minority communities is closely tied to their representation among the ranks of essential workers. Higher levels of pre-existing health conditions are not a sufficient explanation for the elevated mortality burden observed in Black communities.

The Diverging Impacts of Segregation on Obesity Risk by Nativity and Neighborhood Poverty Among Hispanic Americans.

While racial residential segregation is frequently cited as a fundamental cause of racial health disparities, its health impacts for Hispanic Americans remain unclear. We argue that several shortcomings have limited our understanding of how segregation influences Hispanic health outcomes, most notably a failure to assess the possible diverging impacts of segregation by neighborhood poverty level and the conflation of segregation with ethnic enclaves. We use multiple years of restricted geocoded data from a nationally representative sample of the US population (2006-2013 National Health Interview Survey) to investigate the association between metropolitan-level Hispanic segregation and obesity by nativity and neighborhood poverty level. We find segregation to be protective against obesity for Hispanic immigrants who reside in low poverty neighborhoods. For Hispanic immigrants residing in higher neighborhood poverty, no association between segregation and obesity was found. Among US-born Hispanics, we observe an increased risk of obesity-but only for those in high poverty neighborhoods. No association was found for those in low and medium neighborhood poverty. Results provide evidence to indicate that the relationship between segregation and health for Hispanics is not uniform within a metropolitan area. In the case of obesity, the consequences of metropolitan Hispanic segregation can be either protective, null, or deleterious depending not only on local neighborhood context but also on nativity.

The relationship between remittances and health care provision in Mexico.

OBJECTIVES: We examined whether remittances sent from the United States to Mexico were used to access health care in Mexico. METHODS: Data were from a 2006 survey of 2 localities in the municipal city of Tepoztlán, Morelos, Mexico. We used logistic regression to determine whether household remittance expenditure on health care was associated with type of health insurance coverage. RESULTS: Individuals who lacked insurance coverage or who were covered by the Seguro Popular program were significantly more likely to reside in households that spend remittances on health care than were individuals covered by an employer-based insurance program. CONCLUSIONS: Improving the coverage and quality of care within Mexico's health care system will help ensure that remittances serve as a complement, and not a substitute, to formal access to care.

Health selection among new immigrants.

OBJECTIVES: We sought to quantify the extent of health selection (i.e., the degree to which potential immigrants migrate, or fail to migrate, on the basis of their health status) among contemporary US immigrant groups and evaluate the degree that selection explains variation in self-rated health among US legal permanent residents. METHODS: Data came from the New Immigrant Survey 2003 cohort. We estimated the extent of positive and negative health selection through a unique series of questions asking immigrants in the United States to evaluate their health and compare it to that of citizens in their country of origin. RESULTS: The extent of positive health selection differed significantly across immigrant groups and was related to compositional differences in the socioeconomic profiles of immigrant streams. CONCLUSIONS: The salience of socioeconomic status and English-language ability in explaining health differentials across immigrant groups reinforces the importance of further research on the role of these factors in contributing to the health of immigrants above and beyond the need for additional attention to the health selection process.

Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood.

This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.

What to make of it? The (Re)emergence of a biological conceptualization of race in health disparities research.

The debate over the role of race/ethnicity in determining disease susceptibility has re-emerged since it was declared that race was arbitrary biological fiction more than 50 years ago. Partly due to advancements in the Human Genome Project and related technologies, the idea that race/ethnicity does have a genetic basis is enjoying a resurgence. A rise in the use of race in genetic studies has left many researchers who are committed to a social conceptualization of race at a loss regarding how to evaluate these developments. The commentary attempts to correct the problem by providing a critical review of the state of research on race, genetics and health. This review aims to bring social health disparities researchers up-to-date on developments in the genetic literature and to facilitate a more critical engagement of research that purports to find a genetic basis to racial disparities in health.

Barrios and burbs: residential context and health-risk behaviors among Angeleno adolescents.

The increasing size of the Latino immigrant population in the United States underscores the need for a more complete understanding of the role that social context plays in influencing the health of immigrants and their children. This analysis explores the possibility that residential location influences the health-risk behaviors of Latino youth in Los Angeles County, California. The data come from the Los Angeles Family and Neighborhood Survey. We apply multivariate, multilevel Rasch models to two scales of adolescent health-risk behaviors (substance use and delinquency). The findings suggest that residence in Census tracts characterized by above-county-average levels of Latinos and above-county-average levels of poverty is associated with increased odds of health-risk behaviors for Latino adolescents, particularly for those born in the United States. The findings lend support to the contention, put forth in the segmented assimilation literature, that disadvantaged urban contexts increase the risk that U.S.-born children of immigrants will experience downward assimilation.

Black-white metropolitan segregation and self-rated health: Investigating the role of neighborhood poverty.

While black-white segregation has been consistently linked to detrimental health outcomes for blacks, whether segregation is necessarily a zero-sum arrangement in which some groups accrue health advantages at the expense of other groups and whether metropolitan segregation impacts the health of racial groups uniformly within the metropolitan area, remains unclear. Using nationally representative data from the 2008-2013 National Health Interview Survey linked to Census data, we investigate whether the association between metropolitan segregation and health is invariant within the metropolitan area or whether it is modified by neighborhood poverty for black and white Americans. In doing so, we assess the extent to which segregation involves direct health tradeoffs between blacks and whites. We conduct race-stratified multinomial and logistic regression models to assess the relationship between 1) segregation and level of neighborhood poverty and 2) segregation, neighborhood poverty, and poor health, respectively. We find that, for blacks, segregation was associated with a higher likelihood of residing in high poverty neighborhoods, net of individual-level socioeconomic characteristics. Segregation was positively associated with poor health for blacks in high poverty neighborhoods, but not for those in lower poverty neighborhoods. Hence, the self-rated health of blacks clearly suffers as a result of black-white segregation - both directly, and indirectly through exposure to high poverty neighborhoods. We do not find consistent evidence for a direct relationship between segregation and poor health for whites. However, we find some suggestive evidence that segregation may indirectly benefit whites through decreasing their exposure to high poverty environments. These findings underscore the critical role of concentrated disadvantage in the complex interconnection between metropolitan segregation and health. Weakening the link between racial segregation and concentrated poverty via local policy and planning has the potential for broad population-based health improvements and significant reductions in black-white health disparities.

Segmented assimilation, neighborhood disadvantage, and Hispanic immigrant health.

We use a subset of Hispanics from the New Immigrant Survey, a nationally representative data set on immigrants recently granted legal permanent residency (n = 2245), to examine whether the relationship between assimilation and health is modified by neighborhood disadvantage and, in doing so, carry out an empirical test of the segmented assimilation hypothesis. Results indicate that assimilation in the least disadvantaged neighborhoods can be protective against poor health. Specifically, more assimilated men and women in the lowest disadvantage neighborhoods have a lower likelihood of self-reported poorer health and being overweight, respectively; no link was found in higher disadvantage neighborhoods. Assimilation was not found to be associated with self-reported health for women or BMI for men, regardless of neighborhood disadvantage level. Overall, we find some evidence supporting the hypothesis that the effects of assimilation on health depend on the context in which immigrants experience it.

A crossover in Mexican and Mexican-American fertility rates: Evidence and explanations for an emerging paradox.

Against a backdrop of two new developments in the fertility behavior of the Mexican-Origin population in the U.S., the present discussion will update contemporary Mexican-Origin fertility patterns and address several theoretical weaknesses in the current approach to immigrant group fertility. Data come from six national surveys (three from Mexico and three from the U.S.) that cover a twenty-five year period (1975- 2000). The findings demonstrate dramatic decreases in the fertility rates in Mexico at the same time that continuous increases have been documented in the fertility rates of native-born Mexican-Americans in the U.S. at younger ages. These changes necessitate a reexamination of the idea that Mexican pronatalist values are responsible for the high fertility rates found within the Mexican-Origin population in the U.S. Instead, they point to the increasing relevance of framing the fertility behavior of the Mexican-Origin population within a racial stratification perspective that stresses the influence of U.S. social context on fertility behavior. As a step in this direction, the analysis examines fertility patterns within the Mexican-Origin population in the U.S., giving special attention to the role of nativity/generational status in contributing to within group differences.

Educational Attainment and Timing to First Union across Three Generations of Mexican Women.

We use data from Wave 3 of the Mexican Family Life Survey (N = 7276) and discrete-time regression analyses to evaluate changes in the association between educational attainment and timing to first union across three generations of women in Mexico, including a mature cohort (born between 1930 and 1949), a middle cohort (born between 1950 and 1969), and a young cohort (born between 1970 and 1979). Mirroring prior research, we find a curvilinear pattern between educational attainment and timing to first union for women born between 1930 and 1969, such that once we account for the delaying effect of school enrollment, those with the lowest (0-5 years) and highest levels of education (13+ years) are characterized by the earliest transition to a first union. For women born between 1970 and 1979, however, we find that the pattern between education and first union formation has changed. In contrast to their peers born in earlier cohorts, highly educated women in Mexico are now postponing first union formation relative to the least educated. We draw on competing theories of educational attainment and timing to first union to help clarify these patterns in the context of Mexico.

The molecular reinscription of race: a comment on "Genetic bio-ancestry and social construction of racial classification in social surveys in the contemporary United States".

In an article in the February 2014 issue of Demography, Guo et al. claimed that their research "establishes geographic genetic bio-ancestry as a component of racial classification" (p. 141). In doing so, they argued that their work has "a larger theoretical significance on identity studies" (p. 169) by providing racial classification categories with a concrete, "measurable," and "logical" basis against which social construction should be analyzed. Instead, I argue that their main accomplishment is the "molecular reinscription of race" (Duster 2011:104). In this article, I review the existing critiques of this type of work.