Effects of Prolonged Exposure to Air Pollution and Neighborhood Disadvantage on Self-Rated Health among Adults in the United States: Evidence from the Panel Study of Income Dynamics.

BACKGROUND: Although overall air quality has improved in the United States, air pollution remains unevenly distributed across neighborhoods, producing disproportionate environmental burdens for minoritized and socioeconomically disadvantaged residents for whom greater exposure to other structurally rooted neighborhood stressors is also more frequent. These interrelated dynamics and layered vulnerabilities each have well-documented associations with physical and psychological health outcomes; however, much remains unknown about the joint effects of environmental hazards and neighborhood socioeconomic factors on self-reported health status. OBJECTIVES: We examined the nexus of air pollution exposure, neighborhood socioeconomic disadvantage, and self-rated health (SRH) among adults in the United States. METHODS: This observational study used individual-level data from the Panel Study of Income Dynamics merged with contextual information, including neighborhood socioeconomic and air pollution data at the census tract and census block levels, spanning the period of 1999-2015. We estimated ordinary least squares regression models predicting SRH by 10-y average exposures to fine particulate matter [particles ≤2.5µm in aerodynamic diameter (PM2.5)] and neighborhood socioeconomic disadvantage while controlling for individual-level correlates of health. We also investigated the interaction effects of air pollution and neighborhood socioeconomic disadvantage on SRH. RESULTS: On average, respondents in our sample rated their health as 3.41 on a scale of 1 to 5. Respondents in neighborhoods with higher 10-y average PM2.5 concentrations or socioeconomic disadvantage rated their health more negatively after controlling for covariates [ß=-0.024 (95% CI: -0.034, -0.014); ß=-0.107 (95% CI: -0.163, -0.052), respectively]. We also found that the deleterious associations of PM2.5 exposure with SRH were weaker in the context of greater neighborhood socioeconomic disadvantage (ß=0.007; 95% CI: 0.002, 0.011). DISCUSSION: Study results indicate that the effects of air pollution on SRH may be less salient in socioeconomically disadvantaged neighborhoods compared with more advantaged areas, perhaps owing to the presence of other more proximate structurally rooted health risks and vulnerabilities in disinvested areas (e.g., lack of economic resources, health access, healthy food options). This intersection may further underscore the importance of meaningful involvement and political power building among community stakeholders on issues concerning the nexus of environmental and socioeconomic justice, particularly in structurally marginalized communities. https://doi.org/10.1289/EHP11268.

Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review.

BACKGROUND: Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients. METHODS: A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends. RESULTS: 218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age. CONCLUSIONS: Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.

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.

Association of Medicaid Expansion With Opioid Overdose Mortality in the United States.

Importance: The Patient Protection and Affordable Care Act (ACA) permits states to expand Medicaid coverage for most low-income adults to 138% of the federal poverty level and requires the provision of mental health and substance use disorder services on parity with other medical and surgical services. Uptake of substance use disorder services with medications for opioid use disorder has increased more in Medicaid expansion states than in nonexpansion states, but whether ACA-related Medicaid expansion is associated with county-level opioid overdose mortality has not been examined. Objective: To examine whether Medicaid expansion is associated with county × year counts of opioid overdose deaths overall and by class of opioid. Design, Setting, and Participants: This serial cross-sectional study used data from 3109 counties within 49 states and the District of Columbia from January 1, 2001, to December 31, 2017 (N = 3109 counties × 17 years = 52 853 county-years). Overdose deaths were modeled using hierarchical Bayesian Poisson models. Analyses were performed from April 1, 2018, to July 31, 2019. Exposures: The primary exposure was state adoption of Medicaid expansion under the ACA, measured as the proportion of each calendar year during which a given state had Medicaid expansion in effect. By the end of study observation in 2017, a total of 32 states and the District of Columbia had expanded Medicaid eligibility. Main Outcomes and Measures: The outcomes of interest were annual county-level mortality from overdoses involving any opioid, natural and semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone, derived from the National Vital Statistics System multiple-cause-of-death files. A secondary analysis examined fatal overdoses involving all drugs. Results: There were 383 091 opioid overdose fatalities across observed US counties during the study period, with a mean (SD) of 7.25 (27.45) deaths per county (range, 0-1145 deaths per county). Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths compared with the rate in nonexpansion states (relative rate [RR], 0.94; 95% credible interval [CrI], 0.91-0.98). Counties in expansion states had an 11% lower rate of death involving heroin (RR, 0.89; 95% CrI, 0.84-0.94) and a 10% lower rate of death involving synthetic opioids other than methadone (RR, 0.90; 95% CrI, 0.84-0.96) compared with counties in nonexpansion states. An 11% increase was observed in methadone-related overdose mortality in expansion states (RR, 1.11; 95% CrI, 1.04-1.19). An association between Medicaid expansion and deaths involving natural and semisynthetic opioids was not well supported (RR, 1.03; 95% CrI, 0.98-1.08). Conclusions and Relevance: Medicaid expansion was associated with reductions in total opioid overdose deaths, particularly deaths involving heroin and synthetic opioids other than methadone, but increases in methadone-related mortality. As states invest more resources in addressing the opioid overdose epidemic, attention should be paid to the role that Medicaid expansion may play in reducing opioid overdose mortality, in part through greater access to medications for opioid use disorder.

Residential Segregation and Racial/Ethnic Disparities in Ambient Air Pollution.

Race and ethnicity are consequential constructs when it comes to exposure to air pollution. Persistent environmental racial/ethnic inequalities call for attention to identifying the factors that maintain them. We examined associations between racial residential segregation and racial/ethnic inequalities in exposure to three types of air pollutants. Using data from the Panel Study of Income Dynamics (1990-2011), the U.S. Census (1990- 2010), and the Environmental Protection Agency, we tested the independent and joint contributions of race/ethnicity and metropolitan-level residential segregation on individual levels of exposure to air pollution nationwide. We found that racial and ethnic minorities were exposed to significantly higher levels of air pollution compared to Whites. The difference between minorities and Whites in exposure to all three types of air pollution was most pronounced in metropolitan areas with high levels of residential segregation. The environmental inequities observed in this study call for public health and policy initiatives to ameliorate the sources of racial/ethnic gaps in pollution exposure. Given the links between the physical environment and health, addressing such uneven environmental burdens may be a promising way to improve population health and decrease racial/ethnic inequalities therein.

Family Systems and Parents' Financial Support for Education in Early Adulthood.

Young adults raised outside of two-parent families receive less financial support from their families for education compared with peers who always lived with both parents. We consider how parents' union status over time shapes contributions for young adult children's education. Our approach emphasizes the dynamic relationship between family structure and family economic resources. Marginal structural models with inverse probability weights estimate the association of parents' union status history with eventual financial transfers while not overcontrolling for the effects of union status operating indirectly through time-varying characteristics, such as coresident family composition and economic circumstances. The analytic sample includes parents of a recent cohort of young adults (Panel Study of Income Dynamics, 1983-2013, N = 2,754). Compared with parents who lived continuously with a child's other parent, unpartnered parents' transfers to children were 44 % to 90 % smaller, and repartnered parents' transfers were one- to two-thirds smaller, depending on how long the parent was unpartnered or repartnered. Through its influence on subsequent coresident family composition and family economic resources, parents' union status has indirect as well as direct associations with financial transfers to adult children for education.

Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990⁻2014.

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO2), a marker of traffic-related pollution, and fine particulate matter (PM2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10⁻1.41 and OR = 1.25, 95% CI = 1.06⁻1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO2 IQR = 8.51 ppb and PM2.5 IQR = 4.43 µ/m³)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk.

Cumulative Effects of Growing Up in Separate and Unequal Neighborhoods on Racial Disparities in Self-rated Health in Early Adulthood.

Evidence suggests that living in a socioeconomically deprived neighborhood is associated with worse health. Yet most research relies on cross-sectional data, which implicitly ignore variation in longer-term exposure that may be more consequential for health. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics merged with census data on respondents' neighborhoods (N = 1,757), this study estimates a marginal structural model with inverse probability of treatment and censoring weights to examine: (1) whether cumulative exposure to neighborhood disadvantage from birth through age 17 affects self-rated health in early adulthood, and (2) the extent to which variation in such exposure helps to explain racial disparities therein. Findings reveal that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite versus white respondents and is associated with significantly greater odds of experiencing an incidence of fair or poor health in early adulthood.

Temporal Effects of Child and Adolescent Exposure to Neighborhood Disadvantage on Black/White Disparities in Young Adult Obesity.

PURPOSE: This study investigates the effects of duration and timing of exposure to neighborhood disadvantage from birth through age 17 years on obesity incidence in early adulthood and black/white disparities therein. METHODS: Individual- and household-level data from the 1970-2011 waves of the Panel Study of Income Dynamics are merged with census data on respondents' neighborhoods (n = 1,498). Marginal structural models with inverse probability of treatment and censoring weights are used to quantify the probability of being obese at least once between ages 18 and 30 years as a function of cumulative exposure to neighborhood disadvantage throughout childhood and adolescence or during each of three developmental stages therein. RESULTS: Longer term exposure to neighborhood disadvantage from ages 0-17 years is more common among blacks than among whites and is associated with significantly greater odds of being obese at least once in early adulthood. Exposure to neighborhood-level deprivation during adolescence (ages 10-17 years) appears more consequential for future (young adult) obesity than exposure that occurs earlier in childhood. CONCLUSIONS: The duration and timing of exposure to neighborhood disadvantage during childhood and adolescence are associated with obesity incidence in early adulthood for both blacks and whites. However, given inequalities in the likelihood and persistence of experiencing neighborhood disadvantage as children and youth, such adverse effects are likely to be more concentrated among black versus white young adults.

A discrete-time analysis of the effects of more prolonged exposure to neighborhood poverty on the risk of smoking initiation by age 25.

Evidence suggests that individuals who initiate smoking at younger ages are at increased risk for future tobacco dependence and continued use as well as for numerous smoking-attributable health problems. Identifying individual, household, and to a far lesser extent, contextual factors that predict early cigarette use has garnered considerable attention over the last several decades. However, the majority of scholarship in this area has been cross-sectional or conducted over relatively short windows of observation. Few studies have investigated the effects of more prolonged exposure to smoking-related risk factors, particularly neighborhood characteristics, from childhood through early adulthood. Using the 1970-2011 waves of the Panel Study of Income Dynamics merged with census data on respondents' neighborhoods, this study estimates a series of race-specific discrete-time marginal structural logit models for the risk of smoking initiation as a function of neighborhood poverty, as well as individual and household characteristics, from ages four through 25. Neighborhood selection bias is addressed using inverse-probability-of-treatment weights. Results indicate that more prolonged exposure to high (>20%) as opposed to low (<10%) poverty neighborhoods is associated with an increased risk of smoking onset by age 25, although consistent with prior literature, this effect is only evident among white and not nonwhite youth and young adults.

THE LONG-TERM DYNAMICS OF RACIAL/ETHNIC INEQUALITY IN NEIGHBORHOOD AIR POLLUTION EXPOSURE, 1990-2009.

Research examining racial/ethnic disparities in pollution exposure often relies on cross-sectional data. These analyses are largely insensitive to exposure trends and rarely account for broader contextual dynamics. To provide a more comprehensive assessment of racial-environmental inequality over time, we combine the 1990 to 2009 waves of the Panel Study of Income Dynamics (PSID) with spatially- and temporally-resolved measures of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) in respondents' neighborhoods, as well as census data on the characteristics of respondents' metropolitan areas. Results based on multilevel repeated measures models indicate that Blacks and Latinos are, on average, more likely to be exposed to higher levels of NO2, PM2.5, and PM10 than Whites. Despite nationwide declines in levels of pollution over time, racial and ethnic disparities persist and cannot be fully explained by individual-, household-, or metropolitan-level factors.

Mental health status and use of mental health services by California adults.

In 2005, nearly one in five adults in California, about 4.9 million people, said they needed help for a mental or emotional health problem. Approximately one in 25, or over one million Californians, reported symptoms associated with serious psychological distress (SPD). Of those adults with either perceived need or SPD, only one in three reported visiting a mental health professional for treatment. This policy brief, based on data from the 2005 California Health Interview Survey (CHIS 2005), presents the first comprehensive overview of mental health status and service use in California, and highlights differences by age, gender, race/ethnicity, income and insurance status. It also demonstrates the critical need for continued efforts to expand mental health services and threats to such services caused by the ongoing state budget crisis.