Does an Increased Share of Black Police Officers Decrease Racial Discrimination in Law Enforcement?

Based on representative bureaucracy theory, the current study investigates whether increasing Black representation in police forces is negatively associated with racial discrimination in law enforcement. This study additionally investigates how associations may differ according to the organizational or environmental contexts of the forces. Results show that an increased share of Black officers is associated with decreased police-involved deaths of Black residents, but is not significantly associated with a change in order maintenance arrests of Black suspects. In addition, the negative association between Black representation and police-involved deaths of Black residents disappears when the percent of Black officers surpasses about 15 percent, especially in organizations where White officers comprise a larger share. These findings support the potential negative role of organizational socialization on the effectiveness of increasing the share of Black officers in policing, implying that additional long-term efforts to change organizational culture are needed to realize the benefits of enhancing Black representation.

Evolution of COVID-19 Health Disparities in Arizona

Objective: COVID-19 burdens are disproportionally high in underserved and vulnerable groups in Arizona. As the pandemic progresses, it is unclear if the disparities have evolved. In this study, we aim to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerged vulnerable subpopulations. Materials and Methods: We compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, during which the COVID-19 growth rate has changed significantly. Within each growth period, we detected health disparities by testing associations between the growth rate of COVID-19 cases in a ZCTA and the population composition of race/ethnicity, income, employment, and age. We then compared the associations between periods to discover temporal patterns of health disparities. Results: High percentage of Latinx or Black residents, high poverty rate, and young median age were risk factors of high cumulative COVID-19 case counts in a ZCTA. However, the impact of these factors on the growth rate of new COVID-19 cases varied. While high percentage of Black residents and young median age remained as risk factors of fast COVID-19 growth rate, high poverty rate became a protective factor. The association between the percentage of Latinx residents and the COVID-19 growth rate converted from positive to negative during summer 2021. The unemployment rate emerged as a new risk factor of fast COVID-19 growth rate after September 2021. Based on these findings, we identified 37 ZCTAs that are highly vulnerable to fast escalation of COVID-19 cases. Discussion and Conclusion: As the pandemic progresses, disadvantaged communities continue suffering from escalated risk of COVID-19 infection. But the vulnerabilities have evolved. While the disparities related to Latinx ethnicity improved gradually, those related to Black ethnicity and young communities aggravated. The struggle of financially disadvantaged communities continued, although the burden had shifted from those living under the poverty line to those with a high unemployment rate. It is necessary to adjust current resource allocations and design and deploy new interventions to address emerging needs.

Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

An Exploratory Study of Environmental Stress in Four High Violent Crime Cities: What Sets Them Apart?

Understanding the social contexts of violent crime remains controversial in the literature. In the current study, we examine common social contexts in four cities (Houston, TX, Baltimore, MD, Jackson, MS, Wilmington, DE). Data were examined in two studies. In the first, each city was compared to national county-level data on health outcomes. In the second, communities within the four cities were examined for correlates of crime. Results suggest that some common social contexts emerge: high STD rates, air pollution, single-parent homes, insufficient food resources and sleep, residential segregation, housing cost burdens, comparatively few older adults and comparatively more females, were common among the four high-violence cities. By contrast, all four cities unexpectedly had uncommonly low suicide rates compared to the national average. At the community level, unemployment, community stress, median household income, and population density all correlated with criminal outcomes. High-violence cities tended to have higher proportions of Black residents, however community level evaluations suggested that class-related issues, not race per se, was correlated with violent crime.

Multiple Hospital Transfers Among MOQI Nursing Home Residents: The Influence of Race

Missouri Quality Initiative (MOQI) was a CMS-funded enhanced care and coordination provider demonstration project (2012-2020) that successfully reduced avoidable hospitalizations and improved nursing home (NH) care quality. Little is known about the influence of race in multiple hospital transfers from NHs. Using a mixed-methods approach we analyzed hospitalization root cause analysis data from 2017-2019 for 1410 residents in 16 MOQI NHs. There were 113 residents who were transferred 609 times. Those with multiple transfers (four or more transfers/year) were compared by race and key characteristics (e.g., code status, diagnosis). A subset of residents with multiple transfers were examined qualitatively to identify and describe key cases. Findings suggest that Black residents have a higher probability for multiple transfers. Findings highlight the need for transfer prevention efforts for Black residents including early assessment and intervention, early/frequent discussion about goals of care, advance directives, resuscitation status, and family/resident understanding of treatment effectiveness.

A Typology of Health Services Regulated in U.S. Assisted Living Communities

State agencies regulate assisted living (AL) with varying approaches across and within states. The implications of this variation for resident case mix, health service use, and policy, are not well described. We collected health services-relevant AL regulatory requirements for all 50 states and DC and used a mixed-methods approach (thematic analysis; k-means cluster analysis) to identify six types: Housing, Affordable, Hybrid, Hospitality, Healthcare, and Hybrid-Healthcare. We stratified Medicare claims data by regulatory type, identifying variation in resident case mix and health service use. Housing and Affordable clusters have larger proportions of dual-eligible beneficiaries, Black residents, and residents of Affordable had more long-term nursing home use compared to other clusters. Dual-eligible beneficiaries account for 26.6% of Housing cluster residents compared to 8.1% of Hybrid Healthcare cluster residents. We provide other examples and explain the implications in terms of sampling AL for single and multi-state studies, racial disparities, and health-related policies.

Cumulative COVID-19 Disparities in Nursing Home: Focusing on Geographical Factors and Racial Components

The impact of COVID-19 has been greatest in vulnerable US populations. This study examines the cumulative geographical and racial disparities of COVID-19 cases in nursing homes. Analysis of COVID-19 Nursing Home Data from Centers for Medicare & Medicaid Services was limited to weekly reports from the nursing homes that reported the ratio of black residents, from 2020-05-31 to 2021-01-17 (N=268,222 from 8,026 nursing homes). The outcomes were weekly COVID-19 cases and death per 1,000 occupied beds. Nursing homes were categorized by a geographic (rural vs. urban) and racial composition (>50% of residents are black vs. else). Elapsed time and county-level weekly COVID-19 cases and deaths/1,000 people were the key covariates. Multilevel zero-inflated negative binomial regression revealed evidence of cumulative COVID-19 disparity between rural and urban nursing homes. At the earliest time, COVID-19 incidence was lower in rural nursing homes than in urban nursing homes (IRR=0.406 for cases, 0.034 for death). The significant interaction with time implied that, over and above evolving disease prevalence, rural nursing homes became more likely than urban nursing homes to experience COVID-19 over time (IRR=1.057 for cases, 1.193 for death). Nursing homes, with >50% black residents, were more likely to experience COVID-19 than their counterparts at the earliest time (IRR=1.339 for cases, 5.630 for death), but independent of local disease prevalence, this disparity decreased over time (IRR=0.973 for cases, 0.972 for death). Our findings suggest that racial and geographic factors contribute to the cumulation of disadvantage during the COVID-19 crisis at the second half of 2020.

Racial Disparities in Use of Memory Care and Prevalence of Duals in Assisted Living

Assisted living (AL) communities with memory care licenses are disproportionately located in affluent and predominantly White communities and Black older adults are underrepresented in AL. But little is known about characteristics of AL that care for Black residents. We estimated the association of facility-level characteristics as proxy measures for AL resources, such as memory care designations and percentage of dual-eligible residents, across low (0-5%), medium (5-10%) and high (>10%) percentages of Black residents. We found broad differences among communities in the three levels of Black-resident prevalence. High percentage of Black residents was associated with large differences in the percentage of Medicaid-enrolled residents (high 54% duals [s.d.=34], med 28% [31], low=13% [22], p<0.001). ALs with high Black populations were less likely to have a memory-care designation than ALs with medium and low percentages of Black residents (high 4.7% memory care, med 11%, low 17%).

Blue lines and blues infrastructures: Notes on water, race, and space

In Detroit, Michigan, the urban poor fear they are being displaced and replaced by water. As part of the city’s recent redevelopment efforts, planners have proposed creating green and blue infrastructure zones to manage urban flooding and mitigate the volume of overflow storm and sewer waters that pollute the Great Lakes each year. The areas slated for these water retention zones are the same marginal neighborhoods where Black residents face frequent foreclosures due to water debts and mass shutoffs from water and sewer services. This paper explores how water materializes and mediates uneven landscapes of livability, as well as new modes of living in common among those excluded from the urban commons. I introduce the concepts of “bluelining” and “blues infrastructures” in order to think through the contested assemblages of water, race, and space at the margins of urban life.

Associations between Experiences of Police Contact and Discrimination by the Police and Courts and Health Outcomes in a Representative Sample of Adults in New York City

Communities marginalized because of racism, heterosexism, and other systems of oppression have a history of being aggressively policed, and in those contexts, researchers have observed associations between a range of negative experiences with police and poor physical, mental, and behavioral health outcomes. However, past studies have been limited in that experiences of police contacts were aggregated at the neighborhood level and, if police contacts were self-reported, the sample was not representative. To address these limitations, we employed NYC Department of Health and Mental Hygiene 2017 Social Determinants of Health Survey (n = 2335) data to examine the associations of self-reported police contacts and discrimination by police and the courts with measures of physical (poor physical health), mental (poor mental health, serious psychological distress), and behavioral health (binge drinking). Residents marginalized because of racial, ethnic, and sexual minority status were more likely to be stopped, searched, or questioned by the police; threatened or abused by the police; and discriminated against by the police or in the courts; those experiences were associated with poor physical, mental, and behavioral health outcomes. The associations between experiences with police and poor health outcomes were strongest among Black residents and residents aged 25–44. Our findings suggest that the health of NYC residents who have had exposure to police and experienced discrimination by the police and courts is poorer than those who have not, and build on a growing body of evidence that aggressive policing practices have implications for public health.