Introduction: Important differences exist between the presentation, treatment, and sur-vivorship of patients and survivors with blood cancers. Furthermore, existing research in financial toxicity has not fully addressed the relationship between medical care utilization and patient-reported outcomes of financial barriers and distress. We answered these questions by using a nationally rep-resentative survey. Methods: Respondents with blood cancers and solid tumors from the National Health Interview Survey were identified (2014–2020). We identified 23 survey questions as study outcomes and grouped them into three domains of medical care utilization, financial barriers to care, and financial distress. Associations between the three domains and associations of study outcomes between cancer types were examined using weighted univariate analyses and multivariable linear and logistic regressions. Results: The final study group consisted of 6248 respondents with solid tumors and 398 with blood cancers (diagnosed ≤ 5 years). Across all respondents with cancer, higher medical care utilization is generally associated with increased financial barriers to care. Compared to respondents with solid tumors, respondents with blood cancers had a higher level of medical care utilization (β = 0.36, p = 0.02), a lower level of financial barriers to care (β = −0.19, p < 0.0001), and a higher level of financial distress in affording care (β = 0.64, p = 0.03). Conclusions: Patients and survivors with blood cancers and solid tumors demonstrate divergent patterns in care utilization, financial barriers, and financial distress. Future research and interventions on financial toxicity should be tailored for individual cancer groups, recognizing the differences in medical care utilization, which affect the experienced financial barriers.

Objective: In this study, we investigated Progressive Era public health interventions and connected two subsequent efforts to improve outcomes in the American South: the Rockefeller Sanitary Commission's hookworm eradication efforts in the early 1910s and investments in local health infrastructure between the 1910s and the 1930s. We tested whether hookworm eradication had the largest effects in areas that invested in public health and whether county health organizations-cooperative public-private institutional arrangements-impacted the Rockefeller Sanitary Commission program's success. Materials and Methods: The methods used to measure the effects involved estimation of difference-indifference and triple-difference models across the geographic samples of the Rockefeller Sanitary Commission's surveyed area, the American South, and the United States. Material on hookworm infection rates and activities by the Rockefeller Sanitary Commission is obtained from the Rockefeller Foundation Annual Reports. Material on the activities, spending, and duration of the different county health organizations is obtained from the Public Health Service Bulletin 222 titled, "A history of county health organizations in the United States: 1908-1933". Results: By comparing similar cooperative and independent county health organizations in the American South with the rest of the United States, we find that cooperative efforts are generally important and strengthen the Rockefeller Sanitary Commission's impact on human capital outcomes in the American South. Simultaneously, independent county health organizations produced negative or non-significant effects. Conclusion: The Rockefeller Sanitary Commission is important in guiding local health efforts. Our results are robust in both the short and long runs. This study sheds light on the effectiveness of public-private partnerships in rural public health during the Progressive Era.

This article explores the relationships between supervisor–supervisee gender difference and the scientific impact of doctoral dissertations. We use the China Doctoral Dissertations Full-text Database and pay special attention to the fields of Humanities and Social Sciences in China in our empirical study. By establishing regression models, we find that the ranks of the scientific impact regarding doctoral dissertations are female–female (first), female–male (second), male–male (third) and male–female (fourth) pairs (sequence: student gender and then supervisor gender). The finding has many interesting implications for science policy and gender inequality.

Childhood malnutrition and its later life effects were important concerns in European and North American social policy in the early twentieth century. However, there have been few studies of the long-term socioeconomic consequences of malnutrition in childhood. We use a unique longitudinal dataset to provide credible causal estimates of the effects of childhood nutrition on early-adult educational and employment outcomes. Our dataset includes 2,499 children in Saint Paul, Minnesota who were weighed and measured in a national children’s health survey in 1918/1919 at 0–6 years of age. We observe those same people in the 1920, 1930 and 1940 U.S. censuses allowing us to measure childhood socioeconomic status, adolescent school attendance (1930) and early-adult wages, and employment and educational attainment (1940). Examining variation between biological siblings, we are able to obtain credibly causal estimates of the relationship between childhood stature and weight and later life outcomes, largely canceling out the bias otherwise resulting from their joint correlation with genes and socioeconomic background. Because the initial survey located children within households, we identify the effect of differences in early childhood nutrition from differences between male siblings. Consistent with contemporary evidence from developing countries, we find that being taller and heavier in early childhood is associated with better educational and labor market outcomes. Identifying all effects within families to control for socioeconomic background and family structure, we find a standard deviation increase in BMI in early childhood was associated with a 3% increase in weekly earnings and that boys who were heavier for their age at the initial survey were 10% less likely to be unemployed in 1940. Taken together, these results confirm the importance of investments in early-life health for later-life outcomes.

Many institutions of higher learning aim to promote greater racial diversity to harness learning benefits and foster a sense of inclusion. Nevertheless, the institutional pursuit of racial diversity is difficult to benchmark. The current constitutional boundary limits the use of race to promote the diversity in college admissions to a “narrow,” “holistic,” and “case-by-case” strategy laden with definitional ambiguity. This ambiguity is deepened by constraints, such as institutional history, demographics, geography, and institutional rank, that often go unaccounted for in popular diversity measures. This article creates an expected diversity measure that describes the amount of racial diversity one would expect accounting for the home state of their incoming class. This initial step serves as an example that universities may follow when using their own internal data to account for a richer set of diversity constraints and to better monitor progress toward reaching their racial diversity goals. These measures can free universities from chasing unattainable external judgments on diversity targets, such as national benchmarks, thereby encouraging a more effective redistribution of resources for diversity-related outcomes.

BACKGROUND Wilson (1987) argued that race differences in the frequency of marriage from the 1960s to the 1980s resulted from a shortage of marriageable men in the Black community. A large literature used spatially defined measures of male marriageability to predict marriage rates of women. These studies concluded that the availability of marriageable men can explain only a fraction of race differences in marriage. I argue that this finding may reflect errors in the measurement of the availability of marriageable spouses. METHODS My analysis assesses marriage rates from the perspective of men instead of women, allowing direct assessment of men’s economic positions without resorting to fuzzy spatial indicators. I develop new measures of first marriage rates for the 1960–1980 censuses and combine them with survey-based measures for 2008–2019. I use classic decomposition methods to assess the changing relationship of economic composition to race differences in male first marriage rates over the 1960–2019 period. RESULTS The analysis shows that in the mid- to late 20th century, race differences in economic composition were sufficiently large to account for most race differences in first marriage rates, but the size of the economic component declined dramatically over time. CONCLUSIONS With the decline of male-breadwinner families since the late 20th century, the role of male economic circumstances for race differences in marriage rates has diminished, but it remains substantial. CONTRIBUTION Leveraging a new research strategy and a new measure of first marriage, this analysis provides a consistent decomposition of race differences in first marriage rates over six decades.

How ethnic religious organisations influence immigrants’ assimilation in host societies has been surprisingly understudied. This column looks at the effect of Italian Catholic churches in the US between 1890 and 1920 when four million Italians moved to America and anti-Catholic sentiments were widespread. Italian churches reduced social assimilation of Italian immigrants, lowering intermarriage, residential integration, and naturalisation rates. However, the churches had ambiguous effects on immigrants’ economic outcomes and increased children’s literacy and ability to speak English.

Objective: To test the effect of cigarette and e-cigarette taxes on prescriptions for smoking cessation medications. Data Source: Symphony Health, IDV all-payer prescription claims data for the United States over the period 2009-2017. Prescription fills for smoking cessation products were provided at the patient's age, patient's sex, brand/generic, payment type, year, and quarter levels. Study Design: We study the effect of state-level cigarette and e-cigarette tax rates on prescriptions for smoking cessation medications using two-way fixed effect modified difference-indifferences regressions. We also use a multiperiod difference-indifferences estimator robust to bias from dynamic and heterogeneous treatment effects with a staggered policy rollout. Data Collection/Extraction Methods: We use fills for Chantix, Zyban, and their generics, as well as Food and Drug Administration-approved nicotine replacement therapies that are paid for by insurance. Principal Findings: We observe no statistically significant change in prescription fills following an increase in the e-cigarette tax rate, though we are unable to rule out potentially large effects. However, following a $1.00 increase in the cigarette tax rate, we observe a 1052 increase in prescription fills per 100,000 adults (95% CI: 57, 2046; 4.2% increase). The effect of cigarette taxes on prescription fills was particularly large for 18-34 year-olds. Conclusions: Our findings suggest that, during a period when e-cigarettes are widely available, cigarette tax increases remain effective in increasing use of these medications , but e-cigarette taxes do not increase use of these medications.

IMPORTANCE: Labor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization membership and its economic effects across the health care workforce. OBJECTIVES: To examine the prevalence of labor unionization among health care workers and its associations with pay, noncash benefits, and work hours. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 through 2021. The US nationally representative, population-based household survey allowed for a sample of 14 298 self-identified health care workers (physicians and dentists, advanced practitioners, nurses, therapists, and technicians and support staff). EXPOSURES: Self-reported membership status or coverage in a labor union. MAIN OUTCOMES AND MEASURES: Prevalence and trend in labor unionization. Further comparisons included mean weekly pay, noncash benefits (pension or other retirement benefits; employer-sponsored, full premium–covered health insurance; and employer’s contribution to the worker’s health insurance plan), and work hours. RESULTS: The 14 298 respondents (81.5% women; 7.1% Asian, 12.0% Black, 8.5% Hispanic, 70.4% White individuals; mean [SD] age, 41.6 [13.4] years) included 1072 physicians and dentists, 981 advanced practitioners, 4931 nurses, 964 therapists, and 6350 technicians and support staff. After weighting, 13.2% (95% CI, 12.5% to 13.8%) of respondents reported union membership or coverage, with no significant trend from 2009 through 2021 (P = .75). Among health care workers, those who were members of a racial or ethnic minority group (Asian, Black, or Hispanic individuals compared with White individuals) and those living in metropolitan areas were more likely to report being labor unionized. Reported unionization was associated with significantly higher reported weekly earnings ($1165 vs $1042; mean difference, $123 [95% CI, $88 to $157]; P < .001) and higher likelihood of having a pension or other retirement benefits at work (57.9% vs 43.4%; risk ratio [RR], 1.33 [95% CI, 1.26 to 1.41]; P < .001) and having employer-sponsored, full premium–covered health insurance (22.2% vs 16.5%; RR, 1.35 [95% CI, 1.17 to 1.53]; P < .001). Union members reported more work hours (37.4 vs 36.3; mean differences, 1.11 [95% CI, 0.46 to 1.75]; P < .001) per week. White workers reported mean weekly earnings that were significantly more than members of racial and ethnic minority groups among nonunionized workers ($1066 vs $1001; mean difference, $65 [95% CI, $40 to $91]; P < .001), but there was no significant difference between the 2 groups among unionized workers ($1157 vs $1170; mean difference, −$13 [95% CI, −$78 to $52]; P = .70). CONCLUSIONS AND RELEVANCE: From 2009 through 2021, labor unionization among US health care workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours.

The US Civil War ended in 1865 without the distribution of land or compensation to those formerly enslaved—a decision often seen as a cornerstone of racial inequality. We build a dataset to observe Black households’ landholdings in 1880, a key component of their wealth, alongside a sample of White households. We then link their sons to the 1900 census records to observe economic and human capital outcomes. We show that Black landowners (and skilled workers) were able to transmit substantial intergenerational advantages to their sons. But such advantages were small relative to the overall racial gaps in economic status.

People with disabilities often face serious challenges that impact their daily lives, such as increased discrimination at work or when applying for jobs compared to those without disabilities (Carr and Namkung 2021; Namkung and Carr 2019), and these challenges contribute to employment and pay gaps (Baldwin and Choe 2014; Kruse et al. 2018; Schultz and Rogers 2011; Schur et al. 2017). As a result, people with disabilities earn lower wages and income than people without disabilities (Schur et al. 2017) and have high poverty rates overall (WHO and World Bank 2011). These disadvantages can be compounded for immigrants with disabilities, which is particularly true for those who are female; have limited English proficiency; or have nonpermanent resident, undocumented, or temporary or seasonal worker status (Moyce and Schenker 2018). Immigrant eligibility status restrictions create additional barriers to safety net resources that could mitigate these disadvantages (Perreira and Pedroza 2019). Moreover, the fear of immigration enforcement and retaliation from employers may discourage immigrant workers from enforcing their workplace rights and voicing grievances or wage claims (Bernhardt et al. 2009).

COVID-19 has had dierential eects across ethnicity and race in the United States. Though there is anecdotal evidence that the pandemic has hit Arab-American communities hard, there is limited data documenting infection and mortality rates specically for these communities. Rather, Arab-Americans are generally included in the White racial category for most publicly available data. I argue that this is masking the true impact of the pandemic on Arab-American communities given that these groups may be both more exposed to infection and have higher morbidity. I combine data on COVID infection and mortality at the county level with ACS data on the geographic distribution of Arab-Americans. I nd that infection and mortality rates for the White racial category are signicantly higher in neighborhoods with higher Arab-American population shares, even after controlling for socioeconomic factors. This suggests that infection and mortality rates are indeed higher for Arab-American communities than for Whites of European descent. I then explore potential explanations for this result and argue that underlying health conditions are the leading cause. This nding highlights the specic need for increased intervention in Arab-American communities. It also suggests that the observed racial gaps in COVID infection/mortality rates are likely being underestimated given that these numbers for the White category are being inated by the inclusion of Arab-Americans.

Introduction: This report examines changing college graduate rates between 1990 and 2020 among all Latinos in New York City and within the five largest population nationalities in 2020: Dominicans, Puerto Ricans, Mexicans, Ecuadorians, and Colombians. Methods: All data in this report were derived from the 1990 and 2020 American Community Survey 5-year survey samples found at IPUMS USA found at https://usa.ipums.org/usa/. See Steven Ruggles, Sarah Flood, Ronald Goeken, Megan Schouweiler and Matthew Sobek. IPUMS USA: Version 12.0 [dataset]. Minneapolis, MN: IPUMS, 2022. https://doi.org/10.18128/D010.V12.0 College graduation rates were calculated by the U.S. Census Bureau for the population 25 years of age and older and in this study include all people achieving a B.A. degree or higher educational attainment level. Discussion: Latinos living in New York City in 2020 who had achieved a B.A. degree or higher earned median household incomes of $107,721 compared with high school graduates whose median household incomes stood at $61,879. There were important differences in college graduation rates among the City’s Latino population by sex, nativity, and nationality. Latinas of every nationality were the highest achievers, and this was especially the case if they were born in the United States. There was a very clear hierarchy in college-degree educational attainment when the five largest Latino nationalities are examined, among both women and men. Colombian, Ecuadorian, and Mexican women born in the U.S. had college graduation rates well above 40%, while among Dominican women born in the U.S. about one-third had graduated college. Puerto Rican women born in the U.S. had the lowest college graduation rates at 23%. Although there are no data available it is very likely that New York City Latino populations who had achieved a B.A. degree or higher studied at various CUNY campuses. Among all undergraduates enrolled in all CUNY campuses 31% were of Hispanic origin in the Fall 2019 semester.

The Niskanen Center is proud to endorse the historic immigration framework negotiated by Senators Tillis and Sinema, representing a meaningful step toward improving our immigration system.

Obesity in the USA is more prevalent in younger cohorts than older cohorts and also more prevalent in the South and the Midwest than other regions. However, little research has examined the intersection of cohort patterns and regional differences in obesity. We address the knowledge gap by investigating net of age and period trends, how intercohort and intracohort patterns in obesity may depend on Census regions for black and white men and women.

Rising economic inequality has often been associated to either increasing political polarization or decreasing voter turnout. In this paper, I provide a unified explanation for these associations, by accounting for the interconnection between polarization and turnout. By combining group-based ethical voting and spatial political competition, I propose a theoretical model in which both candidates' platforms and voter turnout are endogenous. I show that the direct effect of inequality on turnout is not straightforward. When candidates' polarization is initially low, rising inequality tends to decrease turnout, while the opposite is true for initially high polarization. Moreover, higher inequality also induces candidates to adapt their platforms, increasing polarization , which has an indirect effect on turnout. Finally, although inequality increases the voters' demand for redistribution, if polarization is too high, it may provide an advantage to the candidate who proposes less redistribution. Using data on the United States, I provide anecdotal evidence consistent with these theoretical predictions.

These essays analyze the labor market implications for workers in the health industry licensed by government agencies in the United States. Licensure is often justified on the grounds that it will protect the public from incompetent practitioners. In practice, however, occupational licensing is often used to restrict entry to a profession in order to raise wages for incumbent practitioners. The first essay examines how the expansion of optometrist scope of practice affects optometrist earnings and population eye health outcomes. Using the scope of practice expansion across states from 1976 to 2011, our estimation shows the expansion increased optometrist hourly wages by about 14 percent. In the second essay, we explore the effect of the Nurse Licensure Compact on telemedicine. The study shows that patients in NLC states used more telemedicine services from outof-state providers than patients in non-NLC states. Our evidence indicates that the NLC reduces some barriers to practicing telemedicine for nurses. The third essay examines the possibility of using referenda to reform occupational licensing. More specifically, the essay examines how referendum would have impacted policy in regard to the Enhanced Nurse Licensure Compact in California

How do financial frictions affect human capital investments and labor market trajectories? To study this question, I build a novel dataset covering more than 700,000 U.S. students, merging commencement records and professional resumes. I use the staggered implementation of universal no-loan policies across 22 universities from 2001 to 2019 as a source of quasi-random variation in student debt. I find that financial frictions affect human capital investments across two dimensions. First, student debt affects an intertemporal trade-off between current and future income: Students with higher student debt choose career paths associated with higher initial earnings and lower earnings “slopes.” Second, student debt differentially affects students depending on their family backgrounds: Students who grew up in low-income families display greater sensitivity to changes in student debt. Combined, these findings highlight the role of financial frictions and dynamic life-cycle trade-offs in labor markets.

Across sub-Saharan African societies where fertility decline is underway, children are born into dramatically different contraceptive contexts: some children reside in places where many women are actively using modern contraceptives, signaling the widespread nature of women’s control over their fertility, their agency, and trust in medical technology, whereas other children reside in contexts where exceedingly few women are contracepting. In this paper, we study whether the contraceptive environment is an underexplored dimension of the fertility context that is relevant to understanding contextual inequalities in children’s health. We analyze the Demographic Health Surveys Program data on 97,428 under-five-year-old children living in 292 subnational regions of 29 sub-Saharan African countries. The results reveal that children live in substantially varied contraceptive contexts, and multilevel logistic models show that this variation patterns child health: each percentage point increase in the prevalence of women using modern contraceptives is associated with 1.2% lower odds that a child is wasted, regardless of their demographic and socioeconomic characteristics, including their own mothers’ contraceptive behavior and fertility history. The results demonstrate that the contraceptive context is a unique summary feature of the fertility landscape—tapping into various dimensions of the broader psychosocial, gender, and health environments—that is relevant to the wellbeing of younger generations.

Objectives Functional limitation from COPD manifests more from physical rather than respiratory impairment. To what extent health access affects the functional limitation among individuals with COPD is yet to be known. This study aims to assess the relationship between healthcare access and functional limitations among individuals with COPD. Study Design Retrospective analysis of a cross-sectional population-based survey Methods This study pooled 11-year (2008 - 2018) data from the Integrated Public Use Microdata Series - National Health Interview Survey (IPUMS-NHIS). We restricted the data to respondents with self-reported COPD, aged 40 years and older. The independent variables were sociodemographic and behavioral characteristics. The exploratory variables were measures of healthcare access – healthcare coverage, delayed appointment, affordable care, and a usual place for care. The outcome variable was the presence or absence of functional limitations. Results The age, race, educational attainment, marital status, smoking status, and poverty-income ratio had a significant association with functional limitation (p<0.001) We found statistically significant associations between functional limitation and healthcare coverage, delayed appointment, affordable care, and a usual place for care. Poverty modified the relationship between functional limitations and the four measures of healthcare access, with the odds of functional limitation increased among the poor with no healthcare coverage, delayed appointment, unaffordable care, and no usual place for care. Conclusions A strong relationship exists between the quartet of healthcare coverage, delayed appointment, affordable care, and usual place for care and self-reported functional limitation among individuals with COPD. Poverty was an effect modifier, with the odds of functional limitation worse among the poor. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Integrated Public Use Microdata Series - National Health Interview Survey <https://healthsurveys.ipums.org/> I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes IPUMS-NHIS data 2008 to 2018 restricted to patients with COPD and functional limitation