Assessing the Influence of Redlining on Intergenerational Wealth and Body Mass Index Through a Quasi-experimental Framework.

BACKGROUND: Higher levels of body mass index (BMI), particularly for those who have obesity defined as class II and III, are correlated with excess risk of all-cause mortality in the USA, and these risks disproportionately affects marginalized communities impacted by systemic racism. Redlining, a form of structural racism, is a practice by which federal agencies and banks disincentivized mortgage investments in predominantly racialized minority neighborhoods, contributing to residential segregation. The extent to which redlining contributes to current-day wealth and health inequities, including obesity, through wealth pathways or limited access to health-promoting resources, remains unclear. Our quasi-experimental study aimed to investigate the generational impacts of redlining on wealth and body mass index (BMI) outcomes. METHODS: We leveraged the Panel Study of Income Dynamics (PSID) and Home Owners' Loan Corporation (HOLC) maps to implement a geographical regression discontinuity design, where treatment assignment is randomly based on the boundary location of PSID grandparents in yellowlined vs. redlined areas and used outcome measures of wealth and mean BMI of grandchildren. To estimate our effects, we used a continuity-based approach and applied data-driven procedures to identify the most appropriate bandwidths for a valid estimation and inference. RESULTS: In our fully adjusted model, grandchildren with grandparents living in redlined areas had lower average household wealth (ß = - $35,419; 95% CIrbc - $37,423, - $7615) and a notably elevated mean BMI (ß = 7.47; 95% CIrbc - 4.00, 16.60), when compared to grandchildren whose grandparents resided in yellowlined regions. CONCLUSION: Our research supports the idea that redlining, a historical policy rooted in structural racism, is a key factor contributing to disparities in wealth accumulation and, conceivably, body mass index across racial groups.

Neighbourhood-level policing as a racialised gendered stressor: multilevel analysis of police stops and preterm birth in Seattle, Washington.

BACKGROUND: Most studies capturing the health effects of police violence focus on directly impacted individuals, but a burgeoning field of study is capturing the indirect, community-level health effects of policing. Few empirical studies have examined neighbourhood-level policing, a contextual and racialised gendered stressor, in relation to preterm birth risk among Black and other racially minoritised people. METHODS: We spatially linked individual birth records (2017-2019) in Seattle, Washington (n=25 909) with geocoded data on police stops for three exposure windows: year before pregnancy, first and second trimester. We fit race-stratified multilevel modified Poisson regression models predicting preterm birth (<37 gestational weeks) across tertiles of neighbourhood stop rates controlling for individual and neighbourhood-level covariates. For the second trimester exposure window, birth was operationalised as a time-to-event outcome using multilevel Cox proportional hazard models. RESULTS: Neighbourhood stop rates of Black residents was higher compared with White residents, and Black and Asian pregnant people were exposed to the highest median neighbourhood-level stop rates. Black birthing people living in neighbourhoods with more frequent police stops had increased risk of preterm birth across all exposure windows including the year before pregnancy (adjusted risk ratio (aRR): 1.38, 95% CI 1.02 to 1.85), first trimester (aRR:1.74, 95% CI 1.17 to 2.57) and second trimester (aHR: 1.66, 95% CI 1.14 to 2.42). We found null or inverse associations among Asian, Hispanic and White people. CONCLUSION: Our study adds to the growing evidence documenting associations of higher risk of preterm birth with neighbourhood police stops among Black birthing people. These findings suggest that routine police practices are one aspect of structural racism contributing to racialised perinatal health inequities.

An assessment of the mediating role of hypertension in the effect of long-term air pollution exposure on dementia.

Background: Growing evidence links air pollution exposure to the risk of dementia. We hypothesized that hypertension may partially mediate this effect. Methods: We previously documented an association between air pollution and dementia in the Ginkgo Evaluation of Memory Study, a randomized, placebo-controlled trial of 3069 adults ≥75 years across four US sites who were evaluated for dementia every 6 months from 2000-2008. We utilized a two-stage regression approach for causal mediation analysis to decompose the total effect of air pollution on dementia into its natural direct and indirect effect through prevalent hypertension. Exposure to air pollution in the 10 or 20 years before enrollment was assigned using estimates from fine-scale spatial-temporal models for PM2.5, PM10, and NO2. We used Poisson regression models for hypertension and Cox proportional hazard models for time-to-incident all-cause dementia, adjusting for a priori confounders. Results: Participants were free of mild cognitive impairment at baseline (n = 2564 included in analyses); 69% had prevalent hypertension at baseline. During follow-up, 12% developed all-cause dementia (Alzheimer's disease [AD] = 212; vascular dementia with or without AD [VaD/AD mixed] = 97). We did not find an adverse effect of any air pollutant on hypertension. Hypertension was associated with VaD/AD mixed (HR, 1.92 [95% CI = 1.14, 3.24]) but not AD. We did not observe mediation through hypertension for the effect of any pollutant on dementia outcomes. Conclusions: The lack of mediated effect may be due to other mechanistic pathways and the minimal effect of air pollution on hypertension in this cohort of older adults.

Structural gendered racism and preterm birth inequities in the United States.

Structural gendered racism - the "totality of interconnectedness between structural racism and sexism" - is conceptualized as a fundamental cause of the persistent preterm birth inequities experienced by Black and Indigenous people in the United States. Our objective was to develop a state-level latent class measure of structural gendered racism and examine its association with preterm birth among all singleton live births in the US in 2019. Using previously-validated inequity indicators between White men and Black women across 9 domains (education, employment, poverty, homeownership, health insurance, segregation, voting, political representation, incarceration), we conducted a latent profile analysis to identify a latent categorical variable with k number of classes that have similar values on the observed continuous input variables. Racialized group-stratified multilevel modified Poisson regression models with robust variance and random effects for state assessed the association between state-level classes and preterm birth. We found four distinct latent classes that were all characterized by higher levels of disadvantage for Black women and advantages for White men, but the magnitude of that difference varied by latent class. We found preterm birth risk among Black birthing people was higher across all state-level latent classes compared to White birthing people, and there was some variation of preterm birth risk across classes among Black but not White birthing people. These findings further emphasize the importance of understanding and interrogating the whole system and the need for multifaceted policy solutions.

Individual and Neighborhood Level Predictors of Children's Exposure to Residential Greenspace.

Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother-child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: - 0.036, - 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.

Associations of residential green space with internalizing and externalizing behavior in early childhood.

BACKGROUND: Green space exposures may promote child mental health and well-being across multiple domains and stages of development. The aim of this study was to investigate associations between residential green space exposures and child mental and behavioral health at age 4-6 years. METHODS: Children's internalizing and externalizing behaviors in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort in Shelby County, Tennessee, were parent-reported on the Child Behavior Checklist (CBCL). We examined three exposures-residential surrounding greenness calculated as the Normalized Difference Vegetation Index (NDVI), tree cover, and park proximity-averaged across the residential history for the year prior to outcome assessment. Linear regression models were adjusted for individual, household, and neighborhood-level confounders across multiple domains. Effect modification by neighborhood socioeconomic conditions was explored using multiplicative interaction terms. RESULTS: Children were on average 4.2 years (range 3.8-6.0) at outcome assessment. Among CANDLE mothers, 65% self-identified as Black, 29% as White, and 6% as another or multiple races; 41% had at least a college degree. Higher residential surrounding greenness was associated with lower internalizing behavior scores (-0.66 per 0.1 unit higher NDVI; 95% CI: -1.26, -0.07) in fully-adjusted models. The association between tree cover and internalizing behavior was in the hypothesized direction but confidence intervals included the null (-0.29 per 10% higher tree cover; 95% CI: -0.62, 0.04). No associations were observed between park proximity and internalizing behavior. We did not find any associations with externalizing behaviors or the attention problems subscale. Estimates were larger in neighborhoods with lower socioeconomic opportunity, but interaction terms were not statistically significant. CONCLUSIONS: Our findings add to the accumulating evidence of the importance of residential green space for the prevention of internalizing problems among young children. This research suggests the prioritization of urban green spaces as a resource for child mental health.

Gentrification Yields Racial And Ethnic Disparities In Exposure To Contextual Determinants Of Health.

This article examines racial and ethnic disparities in the relationship between gentrification and exposure to contextual determinants of health. In our study, we focused on changes in selected contextual determinants of health (health care access, social deprivation, air pollution, and walkability) and life expectancy during the period 2006-21 among residents of gentrifying census tracts in six large US cities that have experienced different gentrification patterns and have different levels of segregation: Chicago, Illinois; Los Angeles, California; New York, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington. We found that gentrification was associated with overall improvements in the likelihood of living in Medically Underserved Areas across racial and ethnic groups, but it was also associated with increased social deprivation and reduced life expectancy among Black people, Hispanic people, and people of another or undetermined race or ethnicity. In contrast, we found that gentrification was related to better (or unchanged) contextual determinants of health for Asian people and White people. Our findings can inform policies that target communities identified to be particularly at risk for worsening contextual determinants of health as a result of gentrification.

A tale of many neighborhoods: Latent profile analysis to derive a national neighborhood typology for the US.

INTRODUCTION: Neighborhoods are complex and multi-faceted. Analytic strategies used to model neighborhoods should reflect this complexity, with the potential to better understand how neighborhood characteristics together impact health. We used latent profile analysis (LPA) to derive a residential neighborhood typology applicable for census tracts across the US. METHODS: From tract-level 2015-2019 American Community Survey (ACS) five-year estimates, we selected five indicators that represent four neighborhood domains: demographic composition, commuting, socioeconomic composition, and built environment. We compared model fit statistics for up to eight profiles to identify the optimal number of latent profiles of the selected neighborhood indicators for the entire US. We then examined differences in national tract-level 2019 prevalence estimates of physical and mental health derived from CDC's PLACES dataset between derived profiles using one-way analysis of variance (ANOVA). RESULTS: The 6-profile LPA model was the optimal categorization of neighborhood profiles based on model fit statistics and interpretability. Neighborhood types were distinguished most by demographic composition, followed by commuting and built environment domains. Neighborhood profiles were associated with meaningful differences in the prevalence of health outcomes. Specifically, tracts characterized as "Less educated non-immigrant racial and ethnic minority active transiters" (n = 3,132, 4%) had the highest poor health prevalence (Mean poor physical health: 18.6 %, SD: 4.30; Mean poor mental health: 19.6 %, SD: 3.85), whereas tracts characterized as "More educated metro/micropolitans" (n = 15, 250, 21%) had the lowest prevalence of poor mental and physical health (Mean poor physical health: 10.6 %, SD: 2.41; Mean poor mental health: 12.4 %, SD: 2.67; p < 0.001). CONCLUSION: LPA can be used to derive meaningful and standardized profiles of tracts sensitive to the spatial patterning of social and built conditions, with observed differences in mental and physical health by neighborhood type in the US.

Traffic-related air pollution and dementia incidence in the Adult Changes in Thought Study.

BACKGROUND: While epidemiologic evidence links higher levels of exposure to fine particulate matter (PM2.5) to decreased cognitive function, fewer studies have investigated links with traffic-related air pollution (TRAP), and none have examined ultrafine particles (UFP, ≤100 nm) and late-life dementia incidence. OBJECTIVE: To evaluate associations between TRAP exposures (UFP, black carbon [BC], and nitrogen dioxide [NO2]) and late-life dementia incidence. METHODS: We ascertained dementia incidence in the Seattle-based Adult Changes in Thought (ACT) prospective cohort study (beginning in 1994) and assessed ten-year average TRAP exposures for each participant based on prediction models derived from an extensive mobile monitoring campaign. We applied Cox proportional hazards models to investigate TRAP exposure and dementia incidence using age as the time axis and further adjusting for sex, self-reported race, calendar year, education, socioeconomic status, PM2.5, and APOE genotype. We ran sensitivity analyses where we did not adjust for PM2.5 and other sensitivity and secondary analyses where we adjusted for multiple pollutants, applied alternative exposure models (including total and size-specific UFP), modified the adjustment covariates, used calendar year as the time axis, assessed different exposure periods, dementia subtypes, and others. RESULTS: We identified 1,041 incident all-cause dementia cases in 4,283 participants over 37,102 person-years of follow-up. We did not find evidence of a greater hazard of late-life dementia incidence with elevated levels of long-term TRAP exposures. The estimated hazard ratio of all-cause dementia was 0.98 (95 % CI: 0.92-1.05) for every 2000 pt/cm3 increment in UFP, 0.95 (0.89-1.01) for every 100 ng/m3 increment in BC, and 0.96 (0.91-1.02) for every 2 ppb increment in NO2. These findings were consistent across sensitivity and secondary analyses. DISCUSSION: We did not find evidence of a greater hazard of late-life dementia risk with elevated long-term TRAP exposures in this population-based prospective cohort study.

Associations between adverse childhood experiences, viral suppression, and quality of life among persons living with HIV in Washington state.

Adverse childhood experiences (ACEs) have been linked to numerous negative health outcomes in adulthood and have been recognized as a hurdle to participating in HIV care. However, few studies have examined the cumulative impact that different types of childhood trauma have on HIV care engagement and HIV outcomes. This study characterized the relationship between ACEs, viral suppression, and health-related quality of life (HRQOL) among persons living with HIV (PLWH). We used HIV surveillance data and self-reported information on ACEs and HRQOL from PLWH in Washington State from 2018-2020. Logistic regression was used to assess the relationship between the quantity and type of ACEs and viral suppression. We used Poisson regression to examine the relationship between ACEs and HRQOL as measured by unhealthy days. The majority of PLWH experienced ≥1 ACE (86.8%). ACEs were not significantly associated with the likelihood of viral suppression (OR ≥4 vs 0 ACEs: 0.49, 95% CI: 0.12-2.09), but ACEs were associated with more unhealthy days experienced in a 30-day period (RR ≥4 vs 0 ACEs: 3.19, 95% CI: 1.59-6.40). These findings provide support that trauma is common among PLWH, and efforts to address the impact of childhood trauma may work to improve quality of life.

Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas.

Precarious employment (PE), which encompasses the power relations between workers and employers, is a well-established social determinant of health that has strong ramifications for health and health inequity. In this review, we discuss advances in the measurement of this multidimensional construct and provide recommendations for overcoming continued measurement challenges. We then evaluate recent evidence of the negative health impacts of PE, with a focus on the burgeoning studies from North America and South America. We also establish the role of PE in maintaining and perpetuating health inequities and review potential policy solutions to help alleviate its health burden. Last, we discuss future research directions with a call for a better understanding of the heterogeneity within PE and for research that focuses both on upstream drivers that shape PE and its impacts on health, as well as on the mechanisms by which PE causes poor health. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration.

Importance: Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health. Objective: To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation. Design, Setting, and Participants: This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023. Exposure: Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002). Main Outcomes and Measures: At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations. Results: A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (ß = 0.45; 95% CI, 0.20-0.71; adjusted P = .005). Conclusions and Relevance: These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.

Exposure Disparities by Income, Race and Ethnicity, and Historic Redlining Grade in the Greater Seattle Area for Ultrafine Particles and Other Air Pollutants.

BACKGROUND: Growing evidence shows ultrafine particles (UFPs) are detrimental to cardiovascular, cerebrovascular, and respiratory health. Historically, racialized and low-income communities are exposed to higher concentrations of air pollution. OBJECTIVES: Our aim was to conduct a descriptive analysis of present-day air pollution exposure disparities in the greater Seattle, Washington, area by income, race, ethnicity, and historical redlining grade. We focused on UFPs (particle number count) and compared with black carbon, nitrogen dioxide, and fine particulate matter (PM2.5) levels. METHODS: We obtained race and ethnicity data from the 2010 U.S. Census, median household income data from the 2006-2010 American Community Survey, and Home Owners' Loan Corporation (HOLC) redlining data from the University of Richmond's Mapping Inequality. We predicted pollutant concentrations at block centroids from 2019 mobile monitoring data. The study region encompassed much of urban Seattle, with redlining analyses restricted to a smaller region. To analyze disparities, we calculated population-weighted mean exposures and regression analyses using a generalized estimating equation model to account for spatial correlation. RESULTS: Pollutant concentrations and disparities were largest for blocks with median household income of <$20,000, Black residents, HOLC Grade D, and ungraded industrial areas. UFP concentrations were 4% lower than average for non-Hispanic White residents and higher than average for racialized groups (Asian, 3%; Black, 15%; Hispanic, 6%; Native American, 8%; Pacific Islander, 11%). For blocks with median household incomes of <$20,000, UFP concentrations were 40% higher than average, whereas blocks with incomes of >$110,000 had UFP concentrations 16% lower than average. UFP concentrations were 28% higher for Grade D and 49% higher for ungraded industrial areas compared with Grade A. Disparities were highest for UFPs and lowest for PM2.5 exposure levels. DISCUSSION: Our study is one of the first to highlight large disparities with UFP exposures compared with multiple pollutants. Higher exposures to multiple air pollutants and their cumulative effects disproportionately impact historically marginalized groups. https://doi.org/10.1289/EHP11662.

An Examination of the Joint Effect of the Social Environment and Air Pollution on Dementia Among US Older Adults.

Evidence suggests exposure to air pollution increases the risk of dementia. Cognitively stimulating activities and social interactions, made available through the social environment, may slow cognitive decline. We examined whether the social environment buffers the adverse effect of air pollution on dementia in a cohort of older adults. Methods: This study draws from the Ginkgo Evaluation of Memory Study. Participants aged 75 years and older were enrolled between 2000 and 2002 and evaluated for dementia semi-annually through 2008. Long-term exposure to particulate matter and nitrogen dioxide was assigned from spatial and spatiotemporal models. Census tract-level measures of the social environment and individual measures of social activity were used as measures of the social environment. We generated Cox proportional hazard models with census tract as a random effect and adjusted for demographic and study visit characteristics. Relative excess risk due to interaction was estimated as a qualitative measure of additive interaction. Results: This study included 2,564 individuals. We observed associations between increased risk of dementia and fine particulate matter (µg/m3), coarse particulate matter (µg/m3), and nitrogen dioxide (ppb); HRs per 5 unit increase were 1.55 (1.01, 2.18), 1.31 (1.07, 1.60), and 1.18 (1.02, 1.37), respectively. We found no evidence of additive interaction between air pollution and the neighborhood social environment. Conclusions: We found no consistent evidence to suggest a synergistic effect between exposure to air pollution and measures of the social environment. Given the many qualities of the social environment that may reduce dementia pathology, further examination is encouraged.

Associations Between Insurance, Race and Ethnicity, and COVID-19 Hospitalization, Beyond Underlying Health Conditions: A Retrospective Cohort Study.

Introduction: : People of lower socioeconomic position (SEP) and people of color (POC) experience higher risks of severe COVID-19, but understanding of these associations beyond the effect of underlying health conditions (UHCs) is limited. Moreover, few studies have focused on young adults, who have had the highest incidence of COVID-19 during much of the pandemic. Methods: : We conducted a retrospective cohort study using electronic health record data from the University of Washington Medicine healthcare system. Our study population included individuals aged 18-39 years who tested positive for SARS-CoV-2 from February 2020 to March 2021. Using regression modeling, we estimated adjusted risk ratios (aRRs) and differences (aRDs) of COVID-19 hospitalization by SEP (using health insurance as a proxy) and race and ethnicity. We adjusted for any UHC to examine these associations beyond the effect of UHCs. Results: Among 3,101 individuals, the uninsured/publicly insured had a 1.9-fold higher risk of hospitalization (aRR [95% CI]=1.9 [1.0, 3.6]) and 9 additional hospitalizations per 1,000 SARS-CoV-2 positive persons (aRD [95% CI]=9 [-1, 20]) compared to the privately insured. Hispanic or Latine, non-Hispanic (NH) Asian, NH Black, and NH Native Hawaiian or Pacific Islander patients had a 1.5-, 2.7-, 1.4-, and 2.1-fold-higher risk of hospitalization (aRR [95% CI]=1.5 [0.7, 3.1]; 2.7 [1.1, 6.5]; 1.4 [0.6, 3.3]; 2.1 [0.5, 9.1]), respectively, compared to NH White patients. Conclusions: Though they should be interpreted with caution given low precision, our findings suggest the increased risk of COVID-19 hospitalization among young adults of lower SEP and young adults of color may be driven by forces other than UHCs, including social determinants of health.

A cross-sectional analysis of work schedule notice and depressive symptoms in the United States.

The implementation of last-minute work scheduling practices, including fluctuations in work hours, shift cancellations, and short notice, reflects a new norm in employment in the United States. This study aimed to investigate whether work schedule notice of ≤2 weeks was associated with high depressive symptoms. We used data from the 2019 cycle of the National Longitudinal Survey of Youth 1997 (N = 4963 adults aged 37-42 years). Using adjusted gender-stratified modified Poisson models, we tested the association between schedule notice (≤2 weeks, >2 weeks, consistent scheduling) and high depressive symptoms. Presence of high depressive symptoms was assessed using the 7-item Center for Epidemiologic Studies Depression (CES-D) Short-Form scale and defined as CES-D-SF ≥8. Respondents reporting >2 weeks schedule notice (versus ≤2 weeks) were disproportionately non-Hispanic Black or Hispanic and resided in the South and/or in a rural area. High depressive symptoms were 39% more prevalent among women with schedule notice of ≤2 weeks compared to those with >2 weeks notice (Prevalence Ratio [PR]: 1.39, 95% Confidence Interval (CI): 1.07, 1.80). We did not observe an association among men (PR: 1.06, 95% CI: 0.75, 1.50). Schedule notice of ≤2 weeks was associated with a greater burden of high depressive symptoms among US women. Policies to reduce precarious work scheduling practices should be further evaluated for their impacts on mental health.

Lethal use of force surveillance: practical considerations for open-source database linkage.

Currently, there remains no reliable and timely government tracking in the USA of deaths caused by law enforcement. Federal efforts to track these events are insufficient, generally missing as many as half of community deaths that occur annually because of law enforcement's lethal use of force. The dearth of accurate data on these events limits the ability to accurately quantify their burden and effectively identify opportunities for intervention and policy change. The most reliable data sources on law enforcement related deaths among community members in the USA are publicly run (such as those run by the Washington Post and The Guardian newspapers) or crowdsourced systems, such as Fatal Encounters and Mapping Police Violence, which draw on both traditional and non-traditional sources of reporting and provide open-source access to users. We used successive deterministic and probabilistic linkage to merge these four databases. After exclusions, we found a total of 6333 deaths identified from 2013 to 2017. While most cases were identified by multiple databases, each database also found unique cases during their years of operation. The methodology described here emphasises the importance of these non-traditional data sources and can serve as a helpful resource to improve data accessibility and timeliness for public health agencies and others seeking to expand their study, understanding and response to this growing public health crisis.

Gentrification, Mobility, and Exposure to Contextual Social Determinants of Health.

This study uses individual level consumer trace data for 2006 residents of low- and moderate-income neighborhoods for the principal cities of the 100 largest metropolitan regions in the US using their location in 2006 and 2019 to examine exposure to the following four cSDOH: healthcare access (Medically Underserved Areas), socioeconomic condition (Area Deprivation Index), air pollution (NO2, PM 2.5 and PM10), and walkability (National Walkability Index). The results control for individual characteristics and initial neighborhood conditions. Residents of neighborhoods classified as gentrifying were exposed to more favorable cSDOH as of 2006 relative to residents of low- and moderate-income neighborhoods that were not gentrifying in terms of likelihood to be in a MUA, and level of local deprivation and walkability while experiencing similar level of air pollution. As a result of changes in neighborhood characteristics and differential mobility pattern, between 2006 and 2019, individuals who originally lived in gentrifying neighborhoods experienced worse changes in MUAs, ADI, and Walkability Index but a greater improvement in exposure to air pollutants. The negative changes are driven by movers, while stayers actually experience a relative improvement in MUAs and ADI and larger improvements in exposure to air pollutants. The findings indicate that gentrification may contribute to health disparities through changes in exposure to cSDOH through mobility to communities with worse cSDOH among residents of gentrifying neighborhoods although results in terms of exposure to health pollutants are mixed.

Change in gait speed and fall risk among community-dwelling older adults with and without mild cognitive impairment: a retrospective cohort analysis.

BACKGROUND: Although slow gait speed is an established risk factor for falls, few studies have evaluated change in gait speed as a predictor of falls or considered variability in effects by cognitive status. Change in gait speed may be a more useful metric because of its potential to identify decline in function. In addition, older adults with mild cognitive impairment are at an elevated risk of falls. The purpose of this research was to quantify the association between 12-month change in gait speed and falls in the subsequent 6 months among older adults with and without mild cognitive impairment. METHODS: Falls were self-reported every six months, and gait speed was ascertained annually among 2,776 participants in the Ginkgo Evaluation of Memory Study (2000-2008). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for fall risk relative to a 12-month change in gait speed. RESULTS: Slowing gait speed over 12 months was associated with increased risk of one or more falls (HR:1.13; 95% CI: 1.02 to 1.25) and multiple falls (HR:1.44; 95% CI: 1.18 to 1.75). Quickening gait speed was not associated with risk of one or more falls (HR 0.97; 95% CI: 0.87 to 1.08) or multiple falls (HR 1.04; 95% CI: 0.84 to 1.28), relative to those with a less than 0.10 m/s change in gait speed. Associations did not vary by cognitive status (pinteraction = 0.95 all falls, 0.25 multiple falls). CONCLUSIONS: Decline in gait speed over 12 months is associated with an increased likelihood of falls among community-dwelling older adults, regardless of cognitive status. Routine checks of gait speed at outpatient visits may be warranted as a means to focus fall risk reduction efforts.

Differential Employment Quality and Educational Inequities in Mental Health: A Causal Mediation Analysis.

BACKGROUND: In the United States, inequities in mental distress between those more and less educated have widened over recent years. Employment quality, a multidimensional construct reflecting the relational and contractual features of employer-employee relationships, may mediate this inequity throughout adulthood, yet no study has examined the extent of this mediation in the United States, or how it varies across racialized and gendered populations. METHODS: Using the information on working-age adults from the 2001 to 2019 Panel Study of Income Dynamics, we construct a composite measure of employment quality via principal component analysis. Using this measure and the parametric mediational g-formula, we then estimate randomized interventional analogs for natural direct and indirect effects of low baseline educational attainment (≤high school: no/yes) on the end-of-follow-up prevalence of moderate mental distress (Kessler-6 Score ≥5: no/yes) overall and within subgroups by race and gender. RESULTS: We estimate that low educational attainment would result in a 5.3% greater absolute prevalence of moderate mental distress at the end of follow-up (randomized total effect: 5.3%, 95% CI = 2.2%, 8.4%), with approximately 32% of this effect mediated by differences in employment quality (indirect effect: 1.7%, 95% CI = 1.0%, 2.5%). The results of subgroup analyses across race and gender are consistent with the hypothesis of mediation by employment quality, though not when selecting on full employment (indirect effect: 0.6%, 95% CI = -1.0%, 2.6%). CONCLUSIONS: We estimate that approximately one-third of US educational inequities in mental distress may be mediated by differences in employment quality.