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Carroll AR, Hall M, Noelke C, Ressler RW, Brown CM, Spencer KS, Bell DS, Williams DJ, Fritz CQ. Association of neighborhood opportunity and pediatric hospitalization rates in the United States. J Hosp Med 2024; 19:120-125. [PMID: 38073069 PMCID: PMC10872227 DOI: 10.1002/jhm.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 02/03/2024]
Abstract
We examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.02 hospitalizations per 1000). Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased (p < .001 for each), from 26.56 per 1000 (95% confidence interval [CI] 26.41-26.71) in very low COI areas to 14.76 per 1000 (95% CI 14.66-14.87) in very high COI areas (incidence rate ratio 1.8; 95% CI 1.78-1.81). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in 18 US states. These data underscore the importance of social context and community-engaged solutions for health systems aiming to eliminate care inequities.
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Affiliation(s)
- Alison R. Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, MS
| | - Robert W. Ressler
- Heller School for Social Policy and Management, Brandeis University, Waltham, MS
| | - Charlotte M. Brown
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Katherine S. Spencer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Deanna S. Bell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Derek J. Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Cristin Q. Fritz
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
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Duong SQ, Elfituri MO, Zaniletti I, Ressler RW, Noelke C, Gelb BD, Pass RH, Horowitz CR, Seiden HS, Anderson BR. Neighborhood Childhood Opportunity, Race/Ethnicity, and Surgical Outcomes in Children With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:801-813. [PMID: 37612012 DOI: 10.1016/j.jacc.2023.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Racial and ethnic disparities in outcomes for children with congenital heart disease (CHD) coexist with disparities in educational, environmental, and economic opportunity. OBJECTIVES We sought to determine the associations between childhood opportunity, race/ethnicity, and pediatric CHD surgery outcomes. METHODS Pediatric Health Information System encounters aged <18 years from 2016 to 2022 with International Classification of Diseases-10th edition codes for CHD and cardiac surgery were linked to ZIP code-level Childhood Opportunity Index (COI), a score of neighborhood educational, environmental, and socioeconomic conditions. The associations of race/ethnicity and COI with in-hospital surgical death were modeled with generalized estimating equations and formal mediation analysis. Neonatal survival after discharge was modeled by Cox proportional hazards. RESULTS Of 54,666 encounters at 47 centers, non-Hispanic Black (Black) (OR: 1.20; P = 0.01), Asian (OR: 1.75; P < 0.001), and Other (OR: 1.50; P < 0.001) groups had increased adjusted mortality vs non-Hispanic Whites. The lowest COI quintile had increased in-hospital mortality in unadjusted and partially adjusted models (OR: 1.29; P = 0.004), but not fully adjusted models (OR: 1.14; P = 0.13). COI partially mediated the effect of race/ethnicity on in-hospital mortality between 2.6% (P = 0.64) and 16.8% (P = 0.029), depending on model specification. In neonatal multivariable survival analysis (n = 13,987; median follow-up: 0.70 years), the lowest COI quintile had poorer survival (HR: 1.21; P = 0.04). CONCLUSIONS Children in the lowest COI quintile are at risk for poor outcomes after CHD surgery. Disproportionally increased mortality in Black, Asian, and Other populations may be partially mediated by COI. Targeted investment in low COI neighborhoods may improve outcomes after hospital discharge. Identification of unmeasured factors to explain persistent risk attributed to race/ethnicity is an important area of future exploration.
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Affiliation(s)
- Son Q Duong
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Mahmud O Elfituri
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai- H+H Elmhurst, New York, New York, USA
| | | | - Robert W Ressler
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Bruce D Gelb
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert H Pass
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carol R Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Howard S Seiden
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett R Anderson
- Department of Pediatrics, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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Noelke C, Outrich M, Baek M, Reece J, Osypuk TL, McArdle N, Ressler RW, Acevedo-Garcia D. Connecting past to present: Examining different approaches to linking historical redlining to present day health inequities. PLoS One 2022; 17:e0267606. [PMID: 35587478 PMCID: PMC9119533 DOI: 10.1371/journal.pone.0267606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
In the 1930’s, the Home Owner Loan Corporation (HOLC) drafted maps to quantify variation in real estate credit risk across US city neighborhoods. The letter grades and associated risk ratings assigned to neighborhoods discriminated against those with black, lower class, or immigrant residents and benefitted affluent white neighborhoods. An emerging literature has begun linking current individual and community health effects to government redlining, but each study faces the same measurement problem: HOLC graded area boundaries and neighborhood boundaries in present-day health datasets do not match. Previous studies have taken different approaches to classify present day neighborhoods (census tracts) in terms of historical HOLC grades. This study reviews these approaches, examines empirically how different classifications fare in terms of predictive validity, and derives a predictively optimal present-day neighborhood redlining classification for neighborhood and health research.
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Affiliation(s)
- Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
- * E-mail:
| | - Michael Outrich
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH, United States of America
| | - Mikyung Baek
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH, United States of America
| | - Jason Reece
- Knowlton School of Architecture, Ohio State University, Columbus, OH, United States of America
| | - Theresa L. Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Nancy McArdle
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Robert W. Ressler
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Dolores Acevedo-Garcia
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
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Ressler RW, Paxton P, Velasco K, Pivnick L, Weiss I, Eichstaedt JC. Nonprofits: A Public Policy Tool for the Promotion of Community Subjective Well-being. J Public Adm Res Theory 2021; 31:822-838. [PMID: 34608375 PMCID: PMC8482971 DOI: 10.1093/jopart/muab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Looking to supplement common economic indicators, politicians and policymakers are increasingly interested in how to measure and improve the subjective well-being of communities. Theories about nonprofit organizations suggest that they represent a potential policy-amenable lever to increase community subjective well-being. Using longitudinal cross-lagged panel models with IRS and Twitter data, this study explores whether communities with higher numbers of nonprofits per capita exhibit greater subjective well-being in the form of more expressions of positive emotion, engagement, and relationships. We find associations, robust to sample bias concerns, between most types of nonprofit organizations and decreases in negative emotions, negative sentiments about relationships, and disengagement. We also find an association between nonprofit presence and the proportion of words tweeted in a county that indicate engagement. These findings contribute to our theoretical understanding of why nonprofit organizations matter for community-level outcomes and how they should be considered an important public policy lever.
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Ressler RW, Paxton P, Velasco K. Donations in social context. Nonprofit Manag Leadersh 2020; 31:693-715. [PMID: 38075558 PMCID: PMC10704385 DOI: 10.1002/nml.21449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/06/2020] [Indexed: 01/31/2024]
Abstract
Many nonprofit organizations rely on donations to fund their programs, and a robust literature predicts donations in large-scale quantitative studies. The focus, however, is almost exclusively on the financial characteristics of the organizations, leaving the social context underexplored. In this article, we theorize how ecological context, organizational identity, and social network ties can shape donations. We use the new Internal Revenue Service (IRS) release of e-filed nonprofit reporting forms to consider 95,518 501(c)3 nonprofits around 2015. Using lagged regression models, we find that organizations within a more favorable ecological context, those that use appeals to religion, and organizations with more volunteers report more donations. Furthermore, stressing affiliation with a geographic location is associated with more donations only under certain ecological conditions. The article concludes with a discussion of the implications of these results for nonprofit organizations and social theories regarding what influences donations to organizations.
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Affiliation(s)
- Robert W. Ressler
- The Institute for Child, Youth and Family Policy, Brandeis University, Waltham, Massachusetts
| | - Pamela Paxton
- The Sociology Department and the Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Kristopher Velasco
- The Sociology Department and the Population Research Center, The University of Texas at Austin, Austin, Texas
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Abstract
Nonprofits offer services to disadvantaged populations, mobilize collective action, and advocate for civil rights. Conducting this work requires significant resources, raising the question: how do nonprofits succeed in increasing donations and volunteers amid widespread competition for these resources? Much research treats nonprofits as cold, rational entities, focusing on overhead, the "price" of donations, and efficiency in programming. We argue that nonprofits attract donors and volunteers by connecting to their emotions. We use newly available administrative IRS 990 e-filer data to analyze 90,000 nonprofit missions from 2012 to 2016. Computational text analysis measures the positive or negative affect of each nonprofit's mission statement. We then link the positive and negative sentiment expressed by nonprofits to their donations and volunteers. We differentiate between the institutional fields of nonprofits-for example, arts, education, social welfare-distinguishing nonprofits focused on social bonding from those focused on social problems. We find that expressed positive emotion is often associated with higher donations and volunteers, especially in bonding fields. But for some types of nonprofits, combining positive sentiment with negative sentiment in a mission statement is most effective in producing volunteers. Auxiliary analyses using experimental and longitudinal designs provide converging evidence that emotional language enhances charitable behavior. Understanding the role of emotion can help nonprofit organizations attract and engage volunteers and donors.
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Ressler RW. What Village? Opportunities and Supports for Parental Involvement Outside of the Family Context. Child Youth Serv Rev 2020; 108:10.1016/j.childyouth.2019.104575. [PMID: 32132763 PMCID: PMC7055705 DOI: 10.1016/j.childyouth.2019.104575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Parental involvement research and practice has disproportionately focused on the characteristics of families that promote family-school partnerships. This study focuses instead on school and community characteristics that may elicit or support parental involvement for all families, but especially those from racial/ethnic minority groups. Using the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 enhanced with data from the American Community Survey and the IRS, multilevel models reveal that educational organizations in the community are associated with higher levels of school-based parental involvement behaviors. This association varies across diverse racial/ethnic groups, such that the link between human service organizations and parental involvement is stronger for Latina/o families than for White and Black families.
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Ressler RW, Ackert E, Ansari A, Crosnoe R. Race/ethnicity, human capital, and the selection of young children into early childhood education. Soc Sci Res 2020; 85:102364. [PMID: 31789196 PMCID: PMC8591991 DOI: 10.1016/j.ssresearch.2019.102364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 06/11/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Mexican-origin families face complex ethnic and immigration-based barriers to enrollment in early childhood education programs. As such, reducing barriers to enrollment for this population requires a better understanding of how Mexican-origin families work with, against, or around both general and group-specific constraints on educational opportunities. Using the Early Childhood Longitudinal Study-Birth Cohort, this study tailored broad social theory to the experience of Mexican-origin families to examine associations between human capital considerations and early childhood education enrollment within this population. Results supported the hypothesis that human capital considerations would be associated with early childhood care and education and provide limited evidence for the expectation that this link would be stronger for Mexican-origin families.
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Affiliation(s)
| | | | - Arya Ansari
- Population Research Center, University of Texas at Austin, USA
| | - Robert Crosnoe
- Population Research Center, University of Texas at Austin, USA
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Velasco K, Paxton P, Ressler RW, Weiss I, Pivnick L. Do National Service Programs Improve Subjective Well-Being in Communities? Am Rev Public Adm 2019; 49:275-291. [PMID: 38213570 PMCID: PMC10782458 DOI: 10.1177/0275074018814883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Since the creation of Volunteers in Service to America (VISTA) in 1964 and AmeriCorps in 1993, a stated goal of national service programs has been to strengthen the overall health of communities across the United States. But whether national service programs have such community effects remains an open question. Using longitudinal cross-lagged panel and change-score models from 2005 to 2013, this study explores whether communities with national service programs exhibit greater subjective well-being. We use novel measures of subjective well-being derived from tweeted expressions of emotions, engagement, and relationships in 1,347 U.S. counties. Results show that national service programs improve subjective well-being primarily by mitigating threats to well-being and communities that exhibit more engagement are better able to attract national service programs. Although limited in size, these persistent effects are robust to multiple threats to inference and provide important new evidence on how national service improves communities in the United States.
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Weiss I, Paxton P, Velasco K, Ressler RW. Revisiting Declines in Social Capital: Evidence from a New Measure. Soc Indic Res 2019; 142:1015-1029. [PMID: 38344251 PMCID: PMC10857850 DOI: 10.1007/s11205-018-1956-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 02/15/2024]
Abstract
In the late twentieth century, researchers began calling attention to declining social capital in America and the potential consequences of this trend for a healthy society. While researchers empirically assessed the decline in social capital from the mid-1900s onward, this line of research diminished when the major source of data, the General Social Survey, stopped fielding critical questions in 2004. We do not know, therefore, whether social capital, especially associational social capital, has declined, stabilized, or even increased in a twentyfirst century America. In this paper, we develop a new measure of associational social capital using a confirmatory factor analysis of six indicators from the Civic Engagement Supplement to the Current Population Survey for 2008-2011 and 2013. Our findings support previous research suggesting that associational social capital does not seem to be declining over time. However, we do find evidence of a nonlinear decrease in associating during the Great Recession years. Across the entire time period, though, membership in groups has not declined and there has been little practical change in the amount of time that individuals spend with neighbors. Our analysis of the variance of social capital also shows no general change in the national dispersion of social capital from 2008 to 2013. The paper advances the measurement of social capital and updates our understanding of its possible decline.
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Affiliation(s)
- Inbar Weiss
- Department of Sociology, Population Research Center, The University of Texas at Austin, 305 E 23rd St, A 1700, CLA 3.306, Austin, TX 78712-1086, USA
| | - Pamela Paxton
- Department of Sociology, Population Research Center, The University of Texas at Austin, 305 E 23rd St, A 1700, CLA 3.306, Austin, TX 78712-1086, USA
| | - Kristopher Velasco
- Department of Sociology, Population Research Center, The University of Texas at Austin, 305 E 23rd St, A 1700, CLA 3.306, Austin, TX 78712-1086, USA
| | - Robert W. Ressler
- Department of Sociology, Population Research Center, The University of Texas at Austin, 305 E 23rd St, A 1700, CLA 3.306, Austin, TX 78712-1086, USA
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