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Texas discontinued state-sponsored business restrictions and mask mandates on March 10, 2021, and mandated that no government officials, including public school officials, may implement mask requirements even in areas where COVID-19 hospitalizations comprised more than 15% of hospitalizations. Nonetheless, some public school districts began the 2021–2022 school year with mask mandates in place. We used quasi-experimental methods to analyze the impact of school mask mandates, which appear to have resulted in approximately 40 fewer student cases per week in the first eight weeks of school. (Am J Public Health. 2022;112(6):871–875. https://doi.org/10.2105/AJPH.2022.306769 )

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Racial and ethnic inequities in survival persist for children with acute lymphoblastic leukemia (ALL). In the US, there are strong associations between SES, race/ethnicity, and place of residence. This is evidenced by ethnic enclaves: neighborhoods with high concentrations of ethnic residents, immigrants, and language isolation. The Latinx enclave index (LEI) can be used to investigate how residence in a Latinx enclave is associated with health outcomes. We studied the association between LEI score and minimal residual disease (MRD) in 142 pediatric ALL patients treated at Texas Children’s Hospital. LEI score was associated with end-induction MRD positivity (OR per unit increase 1.63, CI 1.12–2.46). There was also a significant trend toward increased odds of MRD positivity among children living in areas with the highest enclave index scores. MRD positivity at end of induction is associated with higher incidence of relapse and lower overall survival among children with ALL; future studies are needed to elucidate the exact causes of these findings and to improve ALL outcomes among children residing within Latinx enclaves. Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2022.2047850

Dogs began playing new roles as emotional companions in Eurowestern households during the mid-1800s; by the 1880s, dogs were widely considered ‘family members’ in middle-class homes. The nineteenth-century ‘dog drama’, a type of melodrama, helps illuminate how, when, and why this attitudinal change occurred. The transatlantic appeal of dog dramas (such as René-Charles Guilbert de Pixérécourt's 1814 melodrama The Dog of Montargis) and performers who specialised in the genre (such as U.S. actor-entrepreneur Edwin Blanchard) suggest that sentimental stories about dogs appealed to working-class people as well. These plays reflected, and perhaps contributed to, changing views about dogs during the nineteenth century. The dog drama and its afterlives (in film, television, and social media) shed light on both the good intentions and troubling contradictions inherent in humans’ relationships with nonhuman animals, especially pets.

BACKGROUND Social connectedness decreases human mortality, improves cancer survival, cardiovascular health, and body mass, results in better-controlled glucose levels, and strengthens mental health. However, few public health studies have leveraged large social media data sets to classify user network structure and geographic reach rather than the sole use of social media platforms. OBJECTIVE The objective of this study was to determine the association between population-level digital social connectedness and reach and depression in the population across geographies of the United States. METHODS Our study used an ecological assessment of aggregated, cross-sectional population measures of social connectedness, and self-reported depression across all counties in the United States. This study included all 3142 counties in the contiguous United States. We used measures obtained between 2018 and 2020 for adult residents in the study area. The study’s main exposure of interest is the Social Connectedness Index (SCI), a pair-wise composite index describing the “strength of connectedness between 2 geographic areas as represented by Facebook friendship ties.” This measure describes the density and geographical reach of average county residents’ social network using Facebook friendships and can differentiate between local and long-distance Facebook connections. The study’s outcome of interest is self-reported depressive disorder as published by the Centers for Disease Control and Prevention. RESULTS On average, 21% (21/100) of all adult residents in the United States reported a depressive disorder. Depression frequency was the lowest for counties in the Northeast (18.6%) and was highest for southern counties (22.4%). Social networks in northeastern counties involved moderately local connections (SCI 5-10 the 20th percentile for n=70, 36% of counties), whereas social networks in Midwest, southern, and western counties contained mostly local connections (SCI 1-2 the 20th percentile for n=598, 56.7%, n=401, 28.2%, and n=159, 38.4%, respectively). As the quantity and distance that social connections span (ie, SCI) increased, the prevalence of depressive disorders decreased by 0.3% (SE 0.1%) per rank. CONCLUSIONS Social connectedness and depression showed, after adjusting for confounding factors such as income, education, cohabitation, natural resources, employment categories, accessibility, and urbanicity, that a greater social connectedness score is associated with a decreased prevalence of depression. CLINICALTRIAL

Obesity is associated with kidney stone disease, but it is unknown whether this association differs by SES. This study assessed the extent to which obesity and neighborhood characteristics jointly contribute to urinary risk factors for kidney stone disease.This was a retrospective analysis of adult patients with kidney stone disease evaluated with 24-hour urine collection (2001-2020). Neighborhood-level socioeconomic data were obtained for a principal component analysis, which identified 3 linearly independent factors. Associations between these factors and 24-hour urine measurements were assessed using linear regression as well as groupings of 24-hour urine results using multivariable logistic regression. Finally, multiplicative interactions were assessed testing effect modification by obesity, and analyses stratified by obesity were performed. Analyses were performed in 2021.In total, 1,264 patients met the study criteria. Factors retained on principal component analysis represented SES, family structure, and housing characteristics. On linear regression, there was a significant inverse correlation between SES and 24-hour urine sodium (p=0.0002). On multivariable logistic regression, obesity was associated with increased odds of multiple stone risk factors (OR=1.61; 95% CI=1.15, 2.26) and multiple dietary factors (OR=1.33; 95% CI=1.06, 1.67). No significant and consistent multiplicative interactions were observed between obesity and quartiles of neighborhood SES, family structure, or housing characteristics.Obesity was associated with the presence of multiple stone risk factors and multiple dietary factors; however, the strength and magnitude of these associations did not vary significantly by neighborhood SES, family structure, and housing characteristics.

Background: Informal learning experiences in science, technology, engineering, and math (STEM) can enhance STEM learning that occurs in formal educational settings and curricula as well as generate enthusiasm for considering STEM careers. The aim of this systematic review is to focus on the experiences of neurodiverse students in informal STEM learning. Neurodiversity is a subgroup of neurodevelopmental conditions, such as autism, attention deficit disorder, dyslexia, dyspraxia, and other neurological conditions. The neurodiversity movement regards these conditions as natural forms of human variation, as opposed to dysfunction, and recognizes that neurodiverse individuals possess many strengths relevant to STEM fields. Methods: The authors will systematically search electronic databases for relevant research and evaluation articles addressing informal STEM learning for K-12 children and youth with neurodiverse conditions. Eight databases and content-relevant websites (e.g., informalscience.org) will be searched using a predetermined search strategy and retrieved articles will be screened by two members of the research team. Data synthesis will include meta-analysis and meta-synthesis techniques, depending on the quantitative, qualitative, or mixed methods designs of the studies. Discussion: The synthesis of the findings resulting from various research and evaluation designs, across the K-12 age span, and across various informal STEM learning contexts, will lead to depth and breadth of understanding of ways to improve informal STEM learning programs for neurodiverse children and youth. The identification of informal STEM learning program components and contexts shown to yield positive results will provide specific recommendations for improving inclusiveness, accessibility, and STEM learning for neurodiverse children and youth. Systematic Review Registration: The current study has been registered in PROSPERO. Registration number: CRD42021278618

Background We explore the ivermectin discourse and sentiment in the United States with a special focus on political leaning through the social media blogging site Twitter. Methods We used sentiment analysis and topic modeling to geospatially explore ivermectin Twitter discourse in the United States and compared it to the political leaning of a state based on the 2020 presidential election. Results All modeled topics were associated with a negative sentiment. Tweets originating from democratic leaning states were more likely to be negative. Conclusions Real-time analysis of social media content can identify public health concerns and guide timely public health interventions tackling disinformation.

Background:Incidence rates of gastric cancer are increasing in young adults (age Methods:We used population-based data from the California and Texas Cancer Registries from 1995 to 2016 to estimate age-adjusted incidence rates of EOGC among Hispanic and non-Hispanic White persons by year, sex, tumor stage, census tract poverty level, metro versus nonmetro county, and state. We used logistic regression models to identify factors associated with distant stage diagnosis.Results:Of 3,047 persons diagnosed with EOGC, 73.2% were Hispanic White. Incidence rates were 1.29 [95% confidence interval (CI), 1.24–1.35] and 0.31 (95% CI, 0.29–0.33) per 100,000 Hispanic White and non-Hispanic White persons, respectively, with consistently higher incidence rates among Hispanic persons at all levels of poverty. There were no statistically significant associations between ethnicity and distant stage diagnosis in adjusted analysis.Conclusions:There are ethnic disparities in EOGC incidence rates that persist across poverty levels.Impact:EOGC incidence rates vary by ethnicity and poverty; these factors should be considered when assessing disease risk and targeting prevention efforts.

BackgroundMonitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists.ObjectiveTo increase the accessibility of Bayesian methods among health surveillance researchers, we introduce a Bayesian methodology and open source software package, surveil, for time-series modeling of disease incidence and mortality. Given case count and population-at-risk data, the software enables health researchers to draw inferences about underlying risk and derivative quantities including age-standardized rates, annual and cumulative percent change, and measures of inequality.MethodsWe specify a Poisson likelihood for case counts and model trends in log-risk using the first-difference (random-walk) prior. Models in the surveil R package were built using the Stan modeling language. We demonstrate the methodology and software by analyzing age-standardized colorectal cancer (CRC) incidence rates by race and ethnicity for non-Latino Black (Black), non-Latino White (White), and Hispanic/Latino (of any race) adults aged 50-79 years in Texas’s 4 largest metropolitan statistical areas between 1999 and 2018.ResultsOur analysis revealed a cumulative decline of 31% (95% CI –37% to –25%) in CRC risk among Black adults, 17% (95% CI –23% to –11%) for Latino adults, and 35% (95% CI –38% to –31%) for White adults from 1999 to 2018. None of the 3 observed groups experienced significant incidence reduction in the final 4 years of the study (2015-2018). The Black-White rate difference (per 100,000) was 44 (95% CI 30-57) in 1999 and 35 (95% CI 28-43) in 2018. Cumulatively, the Black-White gap accounts for 3983 CRC cases (95% CI 3746-4219) or 31% (95% CI 29%-32%) of total CRC incidence among Black adults in this period.ConclusionsStalled progress on CRC prevention and excess CRC risk among Black residents warrant special attention as cancer prevention and control priorities in urban Texas. Our methodology and software can help the public and health agencies monitor health inequalities and evaluate progress toward disease prevention goals. Advantages of the methodology over current common practice include the following: (1) the absence of piecewise linearity constraints on the model space, and (2) formal inference can be undertaken on any model-derived quantities of interest using Bayesian methods.

Background: Acute lymphoblastic leukemia (ALL) remains a leading cause of death in children and adolescents. We have demonstrated that Hispanic enclaves - neighborhoods with high proportions of Spanish-speaking residents, recent immigrants, and ethnic-specific businesses - are associated with inferior overall survival in children with ALL. However, associations of enclaves with other outcomes remain poorly understood. In the present study, our objective was to determine whether residence in an enclave was associated with end-induction minimal residual disease (MRD), a strong predictor of ALL mortality. Methods: This was a retrospective study of N=142 children aged 0-18 years, treated at Texas Children’s Hospital (Houston, TX) from 2007-2018. MRD was defined as ≥0.01% leukemic blasts in bone marrow at day 29 of therapy. We used the 2010 census tract geography and a modified version of the Hispanic enclave index to identify enclaves. We assigned an enclave index score to each census tract, computed quartiles based on the statewide distribution, and mapped children to quartiles based on address at diagnosis (Q1: least ethnically distinct neighborhoods; Q4: most ethnically distinct neighborhoods). Data on sex, self-reported race/ethnicity, National Cancer Institute (NCI) risk group, primary language, and ALL cytogenetics were abstracted from electronic health records. Cytogenetics were considered either unfavorable (BCR-ABL1 fusion, KMT2A rearrangement, hypodiploidy, or intrachromosomal amplification of chromosome 21) or favorable (ETV6-RUNX1 fusion, double trisomies of chromosomes 4 and 10)/neutral (neither favorable nor unfavorable). We estimated the odds ratio (OR) and 95% confidence interval (95% CI) of MRD according to enclave index score using logistic regression. Results: Neither individual ethnicity nor primary language varied by MRD status, but a greater proportion of MRD-positive children lived in the most ethnically distinct neighborhoods (53% vs. 36%, p=0.04). Enclave index score was associated with MRD after adjusting for sex, NCI risk group, and cytogenetics (OR 1.57 per quartile increment, 95% CI 1.09-2.33). We also observed non-significantly increased odds of MRD among children in Q3 (OR 1.53, 95% CI 0.41-6.55) and Q4 (OR 2.84, 0.83-11.58) relative to Q1. Conclusions: We found that residence in a Hispanic enclave was associated with MRD in children with ALL. Neither ethnicity nor primary language differed by MRD status, suggesting that these did not confound the association with enclave index score. Neighborhood factors may influence early treatment outcomes in ALL, and children living in Hispanic enclaves may constitute a high-risk population. Citation Format: Joshua P. Muniz, John P. Woodhouse, Amy E. Hughes, Sandi L. Pruitt, Karen R. Rabin, Michael E. Scheurer, Philip J. Lupo, Jeremy M. Schraw. Association between residence in a Hispanic enclave and end-induction minimal residual disease among children with acute lymphoblastic leukemia in Texas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3671.

Key Points Question How have trajectories of cardiovascular (CV) mortality among US counties varied over 35 years, and are county-level factors associated with this variation? Findings In this cross-sectional study, cardiovascular mortality declined in all groups from 1980 to 2014 in this cross-sectional analysis of 3133 US counties. Three unique phenogroups based on mortality trajectory were identified, with the difference between high- and low-mortality counties unchanged during the study period, and were associated with social, behavioral, and environmental characteristics at the county level. Meaning These findings suggest that despite an overall decline in CV mortality rates over the past 35 years, differences in health behavior patterns and other societal risk factors are associated with persistent CV mortality disparities at the county level., This cross-sectional study identifies clusters based on cardiovascular mortality trajectory among US counties and county-level social, demographic, environmental, and health-related risk factors that are associated with these clusters., Importance Cardiovascular (CV) mortality has declined for more than 3 decades in the US. However, differences in declines among residents at a US county level are not well characterized. Objective To identify unique county-level trajectories of CV mortality in the US during a 35-year study period and explore county-level factors that are associated with CV mortality trajectories. Design, Setting, and Participants This longitudinal cross-sectional analysis of CV mortality trends used data from 3133 US counties from 1980 to 2014. County-level demographic, socioeconomic, environmental, and health-related risk factors were compiled. Data were analyzed from December 2019 to September 2021. Exposures County-level characteristics, collected from 5 county-level data sets. Main Outcomes and Measures Cardiovascular mortality data were obtained for 3133 US counties from 1980 to 2014 using age-standardized county-level mortality rates from the Global Burden of Disease study. The longitudinal K-means approach was used to identify 3 distinct clusters based on underlying mortality trajectory. Multinomial logistic regression models were constructed to evaluate associations between county characteristics and cluster membership. Results Among 3133 US counties (median, 49.5% [IQR, 48.9%-50.5%] men; 30.7% [IQR, 27.1%-34.4%] older than 55 years; 9.9% [IQR, 4.5%-22.7%] racial minority group [individuals self-identifying as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian, Pacific Islander, other, or multiple races/ethnicities]), CV mortality declined by 45.5% overall and by 38.4% in high-mortality strata (694 counties), by 45.0% in intermediate-mortality strata (1382 counties), and by 48.3% in low-mortality strata (1057 counties). Counties with the highest mortality in 1980 continued to demonstrate the highest mortality in 2014. Trajectory groups were regionally distributed, with high-mortality trajectory counties focused in the South and in portions of Appalachia. Low- vs high-mortality groups varied significantly in demographic (racial minority group proportion, 7.6% [IQR, 4.1%-14.5%]) vs 23.9% [IQR, 6.5%-40.8%]) and socioeconomic characteristics such as high-school education (9.4% [IQR, 7.3%-12.6%] vs 20.1% [IQR, 16.1%-23.2%]), poverty rates (11.4% [IQR, 8.8%-14.6%] vs 20.6% [IQR, 17.1%-24.4%]), and violent crime rates (161.5 [IQR, 89.0-262.4] vs 272.8 [IQR, 155.3-431.3] per 100 000 population). In multinomial logistic regression, a model incorporating demographic, socioeconomic, environmental, and health characteristics accounted for 60% of the variance in the CV mortality trajectory (R2 = 0.60). Sociodemographic factors such as racial minority group proportion (odds ratio [OR], 1.70 [95% CI, 1.35-2.14]) and educational attainment (OR, 6.17 [95% CI, 4.55-8.36]) and health behaviors such as smoking (OR for high vs low, 2.04 [95% CI, 1.58-2.64]) and physical inactivity (OR, 3.74 [95% CI, 2.83-4.93]) were associated with the high-mortality trajectory. Conclusions and Relevance Cardiovascular mortality declined in all subgroups during the 35-year study period; however, disparities remained unchanged during that time. Disparate trajectories were associated with social and behavioral risks. Health policy efforts across multiple domains, including structural and public health targets, may be needed to reduce existing county-level cardiovascular mortality disparities.