The Relationship Between Neighborhood Socioeconomic Characteristics and Physical Inactivity Among Adolescents Living in Boston,Massachusetts

Objectives. We sought to determine whether the socioeconomic environment was associated with no participation in physical activity among adolescents in Boston, Massachusetts.Methods. We used cross-sectional data from 1878 urban adolescents living in 38 neighborhoods who participated in the 2008 Boston Youth Survey, a biennial survey of high school students (aged 14–19 years). We used multilevel multiple regression models to determine the association between neighborhood-level exposures of economic deprivation, social fragmentation, social cohesion, danger and disorder, and students’ reports of no participation in physical activity in the previous week.Results. High social fragmentation within the residential neighborhood was associated with an increased likelihood of being inactive (odds ratio = 1.53; 95% confidence interval = 1.14, 2.05). No other neighborhood exposures were associated with physical inactivity.Conclusions. Social fragmentation might be an important correlate of physical inactivity among youths living in urban settings. Interventions might be needed to assist youths living in unstable neighborhoods to be physically active.Physical activity is important to the growth and development of children and adolescents.1,2 Physical activity is associated with a decreased risk for overweight and obesity, type 2 diabetes, and other chronic morbidities.1–3 Recent recommendations for physical activity among children and adolescents aged 6 to 17 years include at least 1 hour a day of moderate to vigorous physical activity.3 However, research indicates that only 8% of American adolescents meet these recommendations.4 In 2011, in the United States, 13.8% of students had not participated in at least 60 minutes of physical activity that increased their heart rate and made them breathe hard some of the time on any day during the 7 days before the survey.5 A better understanding of factors that may influence physical inactivity is warranted.Although individual and familial characteristics are known to be determinants,6–12 growing evidence suggests that physical activity is associated with the socioeconomic environment.13–17 The residential neighborhood, where children spend large portions of their time, may influence their health behaviors.Socioeconomic features of the neighborhood have been shown to be associated with adolescent physical activity. Area-level economic deprivation, which is a collective measure of average socioeconomic position of populations living within a particular area,13,17,18 is one such neighborhood characteristic that may influence health behavior. Economic deprivation may be an indication of the distribution of environmental resources and exposures at the area level. Previous work has shown economic deprivation as a significant predictor of physical activity levels.13,17Social fragmentation, a dimension of the socioeconomic environment that is conceptually distinct from economic deprivation, is linked to the concept of anomie, which Emile Durkheim defined as a state of normlessness,19 or the breakdown of social bonds between individuals and their communities, with fragmentation of social identity and rejection of self-regulatory values.19 Instead of being a proxy for poverty, social fragmentation is an indication of rapid population turnover, single-person households, and rented tenancy, which are thought to be related to greater residential instability. Researchers have used census variables, such as the proportion of residents renting, to define specific social conditions. It is hypothesized that social fragmentation leads inhabitants to feel disconnected with their neighbors and their community. This might influence parents to disallow their youths to participate in forms of physical activity such as active transportation to school or work. In a previous study, we found an association between social fragmentation and walking for exercise among mothers of children who are at risk for obesity.20Other area-level characteristics that have been shown to be associated with physical activity behavior include social cohesion,14 disorder,15 and neighborhood safety.15,21 Social cohesion has been defined as the connectedness and solidarity among individuals and groups in society.22 Neighborhood disorder is composed of both social and physical disorder.23 Social disorder involves the presence of threatening individuals or groups, and physical disorder is defined by the deterioration of urban landscapes.23 Neighborhood safety has been measured objectively (e.g., crime rates24–26) and by respondents’ perception of their neighborhoods.15,27–31In the present study, we tested potential pathways through which neighborhood socioeconomics could influence youths’ physical inactivity. First, we examined the potential mediation of the association between each of the neighborhood socioeconomic characteristics and physical inactivity via perceptions of neighborhood safety. For example, a neighborhood that is characterized by high social fragmentation, low social cohesion, high crime rates, high poverty, and high physical disorder might elicit feelings of fear and perceptions of lack of safety. As a result, parents may be less likely to allow their children to use active modes of transportation or play outside. This is supported by numerous studies showing that youths who perceive their neighborhoods to be unsafe are more likely to be physically inactive.15,32,33 A second possible pathway is represented by neighborhood differences in the level of individual-level social cohesion; i.e., communities with high levels of social fragmentation or high economic deprivation are also characterized by lower levels of cohesion between residents. In turn, an erosion of social cohesion is associated with physical inactivity because residents lack the effective means for the transmission of norms that encourage exercise among youths,34,35 or they lack the collective efficacy to maintain the local physical infrastructure for physical activity (e.g., parks and playgrounds).36The additive role of independent area-level socioeconomic factors has not been fully investigated. Also, the mechanisms in which socioenvironmental characteristics influence physical activity need to be better understood. Therefore, the objective of this investigation was to determine the association between neighborhood economic deprivation, social fragmentation, safety, and social disorder on physical inactivity among a sample of public high-school students in Boston, Massachusetts. We also investigated perception of neighborhood safety and student-reported social cohesion as mediators between socioeconomic characteristics and physical activity.     

Socioeconomic and Racial/Ethnic Disparities in Unintended Pregnancy Among Postpartum Women in California

Objective: We examined social disparities in unintended pregnancy among postpartum women to better understand 1) the role of socioeconomic factors in racial/ethnic disparities and 2) factors that might explain both socioeconomic and racial/ethnic disparities in the risk for unintended pregnancy among women who give birth. Methods: We used 1999 and 2000 data from a statewide-representative mail and telephone survey of postpartum women in California (N = 7044). We examined associations between unintended pregnancy and race/ethnicity (African American, Asian or Pacific Islander, U.S.-born Latina, foreign-born Latina, European or Middle Eastern), three socioeconomic factors (poverty status, maternal education, paternal education), and several potential explanatory factors. Results: Overall, racial/ethnic disparities in unintended pregnancy were reduced by the three socioeconomic factors individually and collectively (e.g., reducing higher unadjusted odds for African Americans from 3.4 to 1.9); additional adjustment for marital status age, parity, insurance, language, abuse, sense of control, and interaction between marital status and race/ethnicity (each independently associated with unintended pregnancy) reduced the socioeconomic disparities (e.g., reducing odds for the poorest women from 4.1 to 2.3). Although reduced, significant racial/ethnic and socioeconomic disparities remained after adjustment, but generally only among married women. Results for Latinas appeared to vary by nativity, with foreign-born Latinas being at lower odds and U.S.-born Latinas being at higher odds of unintended pregnancy. Conclusions: Racial/ethnic disparities in unintended pregnancy are partly explained by the socioeconomic factors we measured. Several additional factors were identified that suggest possible directions for policies and programs to help reduce social disparities in unintended pregnancy among childbearing women.     

Racial and Ethnic Disparities in Low Birthweight Among Urban Unmarried Mothers

Objectives We examined racial and ethnic disparities in low birthweight (LBW) among unmarried mothers and the extent to which demographic, economic, psychosocial, health, health care, and behavioral factors explain those disparities. Methods Using a sample of 2,412 non-marital births from a national urban birth cohort study, we estimated multiple logistic regression models to examine disparities in LBW between non-Hispanic white (NHW), non-Hispanic black (NHB), U.S.-born Mexican-origin (USMO), and foreign-born Mexican-origin (FBMO) mothers. Results NHW mothers were almost as likely as NHB mothers to have LBW infants. USMO mothers had 60% lower odds and FBMO mothers had 57% lower odds than NHW mothers of having LBW infants. FBMO mothers had no advantage compared to USMO mothers. Controlling for prenatal health and behaviors substantially reduced the LBW advantages for USMO and FBMO mothers. The odds of LBW for NHB mothers relative to NHW mothers increased with the addition of the same covariates. Conclusions Racial and ethnic disparities in LBW among unmarried mothers—an economically disadvantaged population—do not mirror those in the general population. Prenatal health and behaviors are strongly associated with LBW in this group and explain a sizable portion of the Mexican-origin advantage. The lack of a significant black-white disparity in this group suggests that poverty plays an important role in shaping racial disparities in the general population. The finding that controlling for prenatal health and behaviors widens rather than narrows the racial disparity suggests that efforts to ameliorate black-white disparities in LBW should focus on social and health risks throughout the life course.     

One Size Does Not Fit All: An Examination of Low Birthweight Disparities Among a Diverse Set of Racial/Ethnic Groups

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.     

Violent Injury and Neighborhood Racial/Ethnic Diversity in Oakland,California

Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13–0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08–0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01–0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups.     

Public Mental Health Services to Asian American Ethnic Groups in Two California Counties

PURPOSE OF THE STUDY: The purpose of this article is to examine the use of public mental health services among Chinese, Filipino, Southeast Asians, Japanese, and other Asian Americans. SEARCH METHODS USED: This article used two data sources from San Francisco City and County and Santa Clara County. By combining data from these two counties, the study had access to information on 3,095 adult Asian users of services. SUMMARY OF IMPORTANT FINDINGS: The study found differences among various Asian ethnic groups in their likelihood of using individual service modalities, but fewer statistically significant differences in the amount of use once services started. MAJOR CONCLUSIONS: Differences in the use of public mental health services were related to differences in the two counties' implementing services. KEY WORDS: Asian Americans, Public Mental Health Services, Utilization, Ethnic Differences     

Nativity and Neighborhood Characteristics and Cervical Cancer Stage at Diagnosis and Survival Outcomes Among Hispanic Women in California

Objectives. We examined stage of diagnosis and survival after cervical cancer among Hispanic women, and their associations with Hispanic nativity, and explored whether neighborhood socioeconomic status (SES) and residence in a Hispanic enclave modify the association of nativity with stage and survival.Methods. We used California Cancer Registry data (1994–2009) to identify 7958 Hispanic women aged 21 years and older with invasive cervical cancer. We used logistic and Cox proportional hazards models to estimate the associations between stage and mortality with nativity, neighborhood factors, and other covariates.Results. Foreign-born women had similar adjusted relative odds of being diagnosed with stages II through IV (vs stage I) cervical cancer compared with US-born Hispanic women. However, among foreign-born women, those in low-SES–low-enclave neighborhoods were more likely to have late-stage disease than those in high-SES–low-enclave neighborhoods (adjusted odds ratio = 1.91; 95% confidence interval = 1.18, 3.07). Foreign-born women had lower cervical cancer mortality (adjusted hazard ratio = 0.67; 95% confidence interval = 0.58, 0.76) than US-born women, but only in high enclaves.Conclusions. Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.Despite advances in early detection, cervical cancer remains the second most-common cancer worldwide and the third most-common gynecologic malignancy in the United States,1,2 with an age-adjusted incidence rate of 7.8 per 100 000 and mortality rate of 2.3 per 100 000 from 2007 to 2011.3 Notably, although the incidence of cervical cancer is higher among Hispanic women (10.2 per 100 000) than among Asian/Pacific Islander (6.4), African American (9.4), and non-Hispanic White (7.8) women, mortality rates among Hispanic women are comparable with those of other groups (2.8 per 100 000).3–5Compared with women of other racial/ethnic groups, studies consistently show a survival advantage for Hispanic women after control for stage at diagnosis and other clinical and sociodemographic characteristics2,6–13; this observation of lower mortality among Hispanics compared with non-Hispanic Whites is consistent with the “Hispanic paradox.”14,15 Previous studies further suggest that the paradox applies in particular to Hispanic immigrants, particularly immigrants born in Mexico.15 A recent analysis of national data from the Surveillance, Epidemiology, and End Results (SEER) program found that foreign-born Hispanic women had lower survival than US-born Hispanic women for early-stage disease, but better survival for late-stage disease.16,17 However, this analysis was based on imputed data for women missing place of birth, which is problematic when one considers that SEER birthplace data are not missing at random.18–20 The observed survival advantage may also reflect higher rates of losses to follow-up among foreign-born Hispanics, causing underreporting of cervical cancer mortality in this group if significant numbers of women return to their native country once diagnosed with later-stage disease. Thus, to date, reasons for the apparent immigrant survival advantage among women with cervical cancer are poorly understood.The “healthy immigrant effect” suggests that the Hispanic mortality advantage is greater among the foreign-born than US-born because immigrants are selected for better health21 and have strong family and community ties that support health behaviors22,23 and buffer against discrimination24; this hypothesis may explain the patterns seen for cervical cancer survival. Therefore, neighborhood characteristics including socioeconomic status (SES) and ethnic enclave (geographical areas that are culturally and ethnically concentrated and distinct from the surrounding area) may be important contributors to survival after cervical cancer diagnosis. Low-income residential ethnic enclaves may protect health by increasing residents’ ability to maintain positive health behaviors such as a healthy native diet or abstention from smoking, and provide increased social support. Residents of ethnic enclave communities may also receive targeted public health services or perceive fewer barriers to care. However, ethnic enclaves tend to be of low SES and frequently have higher crime rates and may have lower availability of healthy foods, all of which are risk factors for poor health outcomes.The disproportionate burden of cervical cancer among Hispanic women but paradoxical incidence–mortality patterns, coupled with the rapid rate at which this population is growing, underscores the need to examine diagnostic and survival differences within this population. The purpose of this study was to examine stage of diagnosis and survival after cervical cancer, and their associations with Hispanic nativity, and to explore whether neighborhood SES and residence in a Hispanic enclave modify the association of nativity with stage and survival. Understanding how individual- and neighborhood-level factors jointly and independently contribute to survival outcomes after cervical cancer among Hispanic women may help target interventions that can improve survival after cancer diagnosis, despite socioeconomic disadvantage.     

The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics

ObjectiveIndependent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics.DesignA population-based study (Olmsted County, Minnesota, USA).Setting and ParticipantsOlder adults (age 65+ years) with no prior history of NHP.MethodsElectronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden.ResultsAmong 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1 years). At baseline date, median age was 73 years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI.Conclusions and ImplicationsThis study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.     

The Influence of Neighborhood Characteristics on the Relationship Between Discrimination and Increased Drug-Using Social Ties Among Illicit Drug Users

Social discrimination may isolate drug users into higher risk relationships, particularly in disadvantaged neighborhood environments where drug trade occurs. We used negative binomial regression accounting for clustering of individuals within their recruitment neighborhood to investigate the relationship between high-risk drug ties with various forms of social discrimination, neighborhood minority composition, poverty and education. Results show that experiencing discrimination due to drug use is significantly associated with more drug ties in neighborhoods with fewer blacks. Future social network and discrimination research should assess the role of neighborhood social cohesion.     

Behavioral Health Services use Among Racial and Ethnic Groups: Results from the California Health Interview Survey (CHIS)

Access and utilization of behavioral health services is a public health issue, yet disparities among racial/ethnic groups persist, resulting in fewer access points and lower utilization. Using pooled 2015 and 2016 California Health Interview Survey (N?=?42,089) data of diverse adults, this study examines provider access points for behavioral health services use. Latinx (OR?=?0.55, 95% CI, 0.38–0.80), Asian (OR?=?0.32, 95% CI, 0.17–0.59), and first generation (OR?=?0.56, 95% CI, .38-.83) individuals, reported lower odds of accessing specialty care behavioral health services, compared to no services. First generation adults reported lower odds accessing a primary care physician (OR?=?0.66, 95% CI, 0.44–0.98), compared to none. Results advance knowledge of behavioral health services access points among racial, ethnic and immigrant groups, following passage of the California Mental Health Services Act. Findings suggest primary care may be an important entry point for behavioral health service use engagement among underserved populations.

     

Impact of Neighborhood Social Conditions and Household Socioeconomic Status on Behavioral Problems Among US Children

Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5–14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.     

Impact of Socioeconomic Status and Sociodemographic Factors on Melanoma Presentation Among Ethnic Minorities

Minority melanoma patients have worse survival. In this study, we evaluated the impact of socioeconomic and demographic factors on minority melanoma patients presenting to two different New York City hospitals (one public and one private) managed by the same multidisciplinary team. Sociodemographic and clinicopathologic characteristics were retrieved for melanoma patients presenting to Bellevue Hospital Center (BHC), a public hospital, and the New York University Cancer Institute (NYUCI), a private cancer center. Socioeconomic data was obtained from the United States Census Bureau database. The Kruskal-Wallis and chi-square tests were used to evaluate the associations between race/ethnicity and continuous and categorical variables (e.g. income, stage at presentation), respectively. Minorities comprised 2% (27/1296) of melanoma patients at the NYUCI compared to 42% (50/119) at BHC. Those presenting to the NYUCI were more likely to have a higher median household income (P = 0.05), a higher educational level (P = 0.04), and an earlier stage at presentation (P = 0.02) than those at BHC. NYUCI patients were predominantly covered by commercial insurance (70%), whereas Medicaid (62%) was common among BHC patients. Only 19% of Hispanic patients at BHC chose English as their preferred language. Our data demonstrate that language and health care system factors affect melanoma presentation in minorities.     

Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults

Objectives. We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults.Methods. We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs).Results. During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state.Conclusions. Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.Bacterial pneumonia is an important cause of morbidity and mortality in adults¹ and is a potentially serious complication of influenza infection.^2,3 Racial/ethnic disparities in the incidence of bacterial pneumonia are a public health problem. Among US adults, rates of bacteremic pneumonia caused by Streptococcus pneumoniae (pneumococcus), the leading cause of community-acquired pneumonia, are higher among Blacks than among Whites.⁴ Vaccination against pneumococcal disease is recommended for persons aged 65 years and older, for cigarette smokers, and for persons with certain chronic conditions.⁵ Vaccination coverage with 23-valent pneumococcal polysaccharide vaccine is lower, however, among Hispanic and non-Hispanic Black adults with indications for vaccination than among non-Hispanic White adults.^6,7 The introduction of pneumococcal conjugate vaccination for children in 2000 led to lower pneumococcal disease incidence in all age groups^8,9 and narrowed the difference between incidence in Black and White children, although disparities persist among adults.^10,11 Less is known about the factors influencing racial/ethnic disparities in the incidence of bacteremic pneumonia caused by other common pathogens. A better understanding of the underlying factors that sustain disparities in bacterial disease would help to direct prevention efforts.Several previous studies examined the contributions of socioeconomic inequalities to racial/ethnic disparities in invasive pneumococcal disease.^12–15 Between 1960 and 1970, a series of population-based studies in US communities identified socioeconomic measures, including average income and education, as strongly associated with both race/ethnicity and bacterial meningitis incidence.^16–18 However, socioeconomic data have not routinely been collected in US surveillance systems for invasive bacterial disease. With geocoding software, individual cases can be mapped to census tract of residence.¹⁵ Census tract–level socioeconomic measures can then be included in analyses of health outcomes to better understand racial/ethnic disparities in disease incidence.¹⁹ We used a large population-based surveillance system for invasive bacterial infections to examine associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults. We sought to identify a single, publicly available census tract characteristic that could be used to target interventions to geographic areas likely to have high incidences of bacteremic pneumonia and to monitor inequalities in disease burden.     

Receptivity to Protobacco Media and Its Impact on Cigarette Smoking Among Ethnic Minority Youth in California

Adolescents from different ethnic groups show different cigarette smoking prevalence rates, suggesting potential differences in receptivity to and influences from protobacco media. Understanding these differences will be helpful in tailoring smoking prevention and cessation programs for diverse adolescent populations in the United States. Data from cross-sectional surveys of 20,332 randomly sampled California boys and girls, 12-17 years of age, were analyzed. Results indicate that receptivity to protobacco media was lower among African Americans, Asian Americans, and Hispanics than among White youth. There was a consistent dose-response relationship between receptivity to protobacco media and 30-day cigarette smoking across ethnic groups. Having a cigarette brand preference was associated with the highest risk for cigarette smoking, having a favorite tobacco ad showed the lowest risk, while having received or being willing to use tobacco promotional items was associated with a moderate risk. After controlling for 13 covariates, the odds ratio for receptivity to protobacco media and 30-day cigarette smoking was significant for Whites (RR = 1.38, p < 0.01) and Hispanics (RR = 1.46, p < 0.01), but not for African American (RR = 1.05, p > 0.05) and Asian American (RR = 1.17, p > 0.05) youth. African American, Asian American, and Hispanic adolescents have a lower level of receptivity to protobacco media than do Whites. The association between media receptivity and 30-day cigarette smoking exists for all four ethnic groups without controlling for other smoking predictor variables, but only for Hispanics and Whites when other variables are controlled. Protecting adolescents from protobacco advertising influences is an important element in tobacco control among ethnic minority youth.     

Increased Mortality Among Hispanic Testis Cancer Patients Independent of Neighborhood Socioeconomic Status: A SEER Study

Testis cancer-specific survival (CSS) varies by Hispanic ethnicity. Our goal was to assess whether neighborhood socioeconomic status (SES) accounts for elevated testis CSS among Hispanic patients. We queried the Surveillance, Epidemiology, and End Results (SEER) database for Hispanic (HW) and Non-Hispanic white (NHW) patients. Multivariate Cox regression analyses evaluated Hispanic ethnicity’s impact on tCSS while adjusting for neighborhood socioeconomic status (education and income levels). HWs constituted 14.3% of the 26,258 patients in the cohort. Neighborhood SES factors such as county income (P < 0.001) and education level (P < 0.001) were significant predictors of testis cancer-specific survival (tCSS). Controlling for SES and other variables, Hispanic ethnicity remained a significant predictor of tCSS. Compared to NHWs, HWs experienced a 41% greater cancer-specific mortality (HR: 1.406, 95% CI: 1.178–1.678, P < 0.001). The mechanism underlying the increased testis cancer mortality experienced by Hispanic patients remains unknown.