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Scholarly Works (5 results)

  • Thesis
  • Peer Reviewed
UC Davis Electronic Theses and Dissertations (2023)

Government endorsed redlining practices carried out by the Home Owners’ Loan Corporation (HOLC) beginning in the mid-1930s have garnered attention in the population health literature over the last few years, with increased recognition of structural racism and de jure residential segregation as fundamental causes of racial/ethnic health disparities. HOLC’s appraisal process was carried out in cities with at least 40,000 residents and entailed the assignment of color-coded “risk grades” to residential properties in urban neighborhoods based on perceived risk for foreclosure. Neighborhoods with concentrations of Black and/or immigrant residents were systematically graded in the highest risk category and experienced subsequent declines in property values, private investment, and lending opportunities associated with the “hazardous” designation. Digitization of HOLC’s infamous “residential security maps” by the University of Richmond’s Mapping Inequality Project has enabled researchers to link historical redlining patterns to a range of contemporary social, economic and health outcomes, from birth outcomes to chronic disease. The connection between historical redlining practices and contemporary health outcomes may highlight an important pathway by which structural racism produces and reproduces racialized and place-based health inequities across generations.

Despite the recent profusion of evidence associating historical redlining and contemporary health outcomes, few studies have probed these relationships for heterogeneity across population groups or geographic areas, and few have examined the mechanisms by which historical redlining practices may impact contemporary neighborhood conditions and health. This dissertation links data from the Centers for Disease Control and Prevention (CDC) PLACES Project (2020 release), Historic Redlining Scores Project, American Community Survey 5-year estimates (2013-2017), and the Home Mortgage Disclosure Act database (2013-2017) to examine historical and contemporary forms of institutionalized racism in housing markets as drivers of neighborhood health inequities. In the first empirical chapter (Chapter 2), I examine whether and how associations between historical redlining patterns and neighborhood health – specifically, prevalence of poor mental health and diagnosed diabetes – are moderated by contemporary neighborhood racial/ethnic composition. The findings of this study may point to differential impacts of historical to contemporary structural racism across racial/ethnic groups. In the second empirical chapter (Chapter 3), I examine whether and to what extent features of contemporary housing markets explain the documented association between historical redlining patterns and neighborhood prevalence of poor mental health. As inequities within local housing markets have particularly affected Black communities, I also examine whether the effects of historical redlining patterns through features of contemporary housing markets are dependent on the relative size of the Black population within a neighborhood. The findings of this study suggest neighborhood property values, homeownership rates, and loan denial rates for home purchase explain a large share of the association between redlining patterns and poor mental health. Finally, in the third empirical chapter (Chapter 4), I examine whether and how associations between historical redlining patterns and neighborhood diabetes prevalence vary across metropolitan areas. Specifically, I examine a novel composite measure of institutionalized anti-Black racism in housing markets as a possible metropolitan/micropolitan area-level modifier of the relationship between historical redlining and neighborhood diabetes prevalence. This study suggests contemporary institutionalized racism in local housing markets may be perpetuating legacies of historical redlining practices and other exclusionary policies. Overall, these studies contribute to a burgeoning body of literature examining the roles of historical to contemporary forms of institutionalized racism in housing markets in the (re)production of racial/ethnic and place-based health inequities. This work is particularly timely as policymakers have garnered stronger interest in pursuing reparations for historical injustices imposed on Black communities, including use of the HOLC maps to prioritize neighborhoods for place-based investments.

    Cover page: Connecting Past to Present: Institutionalized Racism in Housing Markets and Neighborhood Health Inequities
    • Article
    • Peer Reviewed
    UC Davis Previously Published Works (2023)

    Objective

    To describe the perception of professional climate in health services and policy research (HSPR) and efforts to advance diversity, equity, and inclusion (DEI) in the HSPR workforce and workplaces.

    Data source

    We administered the HSPR Workplace Culture Survey online to health services and policy researchers.

    Study design

    Our survey examined participants' sociodemographic, educational, and professional backgrounds, their perception on DEI in HSPR, experience with DEI initiatives, feeling of inclusion, and direct and witnessed experiences of discrimination at their institutions/organizations. We calculated sample proportions of responses by gender identity, sexual orientation, race/ethnicity, and disability status and compared them with Fisher's exact test.

    Data collection

    We administered the survey online from July 28 to September 4, 2020. HSPR professionals and trainees aged 18 and older were eligible to participate. Analyses used complete cases only (n = 906; 70.6% completion rate).

    Principal findings

    53.4% of the participants did not believe that the current workforce reflects the diversity of communities impacted by HSPR. Although most participants have witnessed various DEI initiatives at their institutions/organizations, nearly 40% characterized these initiatives as "tokenistic." Larger proportions of participants who identified as female, LGBQI+, underrepresented racial/ethnic groups, and those with a disability held this perception than their male, heterosexual, White, and non-disabled counterparts. Current DEI initiatives focused on "planning" activities (e.g., convening task forces) rather than "implementation" activities (e.g., establishing mentoring or network programs). 43.7% of the participants felt supported on their career development, while female, Black, Hispanic/Latino, LGBQI+ participants and those with a disability experienced discrimination at their workplace.

    Conclusions

    Despite an increasing commitment to increasing the diversity of the HSPR workforce and improving equity and inclusion in the HSPR workplace, our results suggest that there is more work to be done to achieve such goals.
      Cover page: Perceptions of workplace climate and diversity, equity, and inclusion within health services and policy research
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2016)

      Study objective

      Previous reviews of emergency department (ED) visit reduction programs have not required that studies meet a minimum quality level and have therefore included low-quality studies in forming conclusions about the benefits of these programs. We conduct a systematic review of ED visit reduction programs after judging the quality of the research. We aim to determine whether these programs are effective in reducing ED visits and whether they result in adverse events.

      Methods

      We identified studies of ED visit reduction programs conducted in the United States and targeted toward adult patients from January 1, 2003, to December 31, 2014. We evaluated study quality according to the Grading of Recommendations Assessment, Development, and Evaluation criteria and included moderate- to high-quality studies in our review. We categorized interventions according to whether they targeted high-risk or low-acuity populations.

      Results

      We evaluated the quality of 38 studies and found 13 to be of moderate or high quality. Within these 13 studies, only case management consistently reduced ED use. Studies of ED copayments had mixed results. We did not find evidence for any increase in adverse events (hospitalization rates or mortality) from the interventions in either high-risk or low-acuity populations.

      Conclusion

      High-quality, peer-reviewed evidence about ED visit reduction programs is limited. For most program types, we were unable to draw definitive conclusions about effectiveness. Future ED visit reduction programs should be regarded as demonstrations in need of rigorous evaluation.
        Cover page: The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review.
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2020)
        Mobile health monitoring via non-invasive wearable sensors is poised to advance telehealth for older adults and other vulnerable populations. Extreme heat and other environmental conditions raise serious health challenges that warrant monitoring of real-time physiological data as people go about their normal activities. Mobile systems could be beneficial for many communities, including elite athletes, military special forces, and at-home geriatric monitoring. While some commercial monitors exist, they are bulky, require reconfiguration, and do not fit seamlessly as a simple wearable device. We designed, prototyped and tested an integrated sensor platform that records heart rate, oxygen saturation, physical activity levels, skin temperature, and galvanic skin response. The device uses a small microcontroller to integrate the measurements and store data directly on the device for up to 48+ h. continuously. The device was compared to clinical standards for calibration and performance benchmarking. We found that our system compared favorably with clinical measures, such as fingertip pulse oximetry and infrared thermometry, with high accuracy and correlation. Our novel platform would facilitate an individualized approach to care, particularly those whose access to healthcare facilities is limited. The platform also can be used as a research tool to study physiological responses to a variety of environmental conditions, such as extreme heat, and can be customized to incorporate new sensors to explore other lines of inquiry.
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2023)

          Objectives

          We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans.

          Design

          Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017.

          Setting

          Older adults in Northern California.

          Participants

          Our cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8).

          Measurements

          We used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education.

          Results

          Generational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = -0.96; 95% CI: -1.12, -0.81) than immigration in adolescence (β = -0.68; 95% CI: -0.96, -0.41) or childhood (β = -0.28; 95% CI: -0.49, -0.06). Moreover, immigration in adulthood was associated with lower executive function (β = -0.63; 95% CI: -0.78, -0.48) than immigration in adolescence (β = -0.49; 95% CI: -0.75, -0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores.

          Conclusions

          Our study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.
            Cover page: Generation and age of immigration on later life cognitive performance in KHANDLE
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