An Evaluation of Projection Methods for Detailed Small Area Projections: An Application and Validation to King County, Washington.

Population projections are used by a number of local agencies to better prepare for the future resource needs of counties, ensuring that educational, health, housing, and economic demands of individuals are met. Meeting the specific needs of a county's population, such as what resources to provide, where to target resources, and ensure an equitable distribution of those resources, requires population projections which are both demographically detailed, such as by age, race, and ethnicity, and geographically precise, such as at the census tract level. Despite this need, an evaluation of which methods are best suited to produce population projections at this level are lacking. In this study, we evaluate the accuracy of several cohort-based methods for small area population projections by race and ethnicity. We apply these methods to population projections of King County, Washington and assess the validity of projections using past population estimates. We find a clear pattern that demonstrates while simplified methods perform well in near term forecasts, methods which employ smoothing strategies perform better in long-term forecasting scenarios. Furthermore, we demonstrate that model's incorporating multiple stages of smoothing can provide detailed insights into the projected population size of King county and the places and groups which will most contribute to this growth. Detailed projections, such as those provided by multi-stage smoothing methods, enable city planners and policy makers a detailed view of the future structure of their county's population and provide for them a resource to better meet the needs of future populations.

A conceptual model of health insurance stability in the United States health care system.

In the U.S. health care system, people under age 65 are at risk of losing and regaining health insurance coverage over their lifetimes, which has important consequences for their physical and mental health. Despite the importance of insurance stability, we have an incomplete understanding about the complex factors influencing whether people lose and regain coverage. To advance our understanding of the dynamics of health insurance coverage and guide future research, our purpose is to present a new conceptual model of health insurance stability, where instability is defined as a person's loss or change of coverage, which can occur more than once in a lifetime. Drawing from theory and evidence in the literature, we posit that personal and plan characteristics, the health system, and the environmental context - economic, social/cultural, political/judicial, and geographic - drive health insurance stability over the life course and are understudied. Studies are needed to identify the populations most at risk of experiencing insurance instability and vulnerability in health outcomes that results from such insecurity, which may suggest reforms and health policies at the individual, health system, or environment levels to reduce those risks.

Cumulative Payments Through the Earned Income Tax Credit Program in Childhood and Criminal Conviction During Adolescence in the US.

Importance: Childhood poverty is associated with poor health and behavioral outcomes. The Earned Income Tax Credit (EITC), first implemented in 1975, is the largest cash transfer program for working families with low income in the US. Objective: To assess whether cumulative EITC payments received during childhood are associated with the risk of criminal conviction during adolescence. Design, Setting, and Participants: In this cohort study, the analytic sample consisted of US children enrolled in the 1979 National Longitudinal Study of Youth. The children were born between 1979 and 1998 and were interviewed as adolescents (age 15-19 years) between 1994 and 2016. Data analyses were performed from May 2021 to September 2022. Exposure: Cumulative simulated EITC received by the individual's family from birth through age 14 years. Main Outcomes and Measures: The main outcome was dichotomous, self-reported conviction for a crime during adolescence (age 14-18 years). A cumulative, simulated measure of mean EITC benefits received by a child's family from birth through age 14 years was derived from federal, state, and family-size differences in EITC eligibility and payments during the study period to capture EITC benefit variation due to differences in policy parameters but not endogenous factors such as changes in household income. Logistic regression models with fixed effects for state and year and robust SEs clustered by mother estimated relative risk of adolescent conviction. Models were adjusted for state-, mother-, and child-level covariates. Results: The analytical sample consisted of 5492 adolescents born between 1979 and 1998; 2762 (50.3%) were male, 1648 (30.0%) were Black, 1125 (20.5%) were Hispanic, and 2719 (49.5%) were not Black or Hispanic. Each additional $1000 of EITC received during childhood was associated with an 11% lower risk of self-reported criminal conviction during adolescence (adjusted odds ratio, 0.89; 95% CI, 0.84-0.95). Adjusted risk differences were larger among boys (-14.2 self-reported convictions per 1000 population [95% CI, -22.0 to -6.3 per 1000 population]) than among girls (-6.2 per 1000 population [95% CI, -10.7 to -1.6 per 1000 population]). Conclusions and Relevance: The findings suggest that income support from the EITC may be associated with reduced youth involvement with the criminal justice system in the US. Cost-benefit analyses of the EITC should consider these longer-term and indirect outcomes.

Therapy Staffing in Skilled Nursing Facilities Declined after Implementation of the Patient-Driven Payment Model.

OBJECTIVE: The Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing. DESIGN: Segmented regression interrupted time series. SETTING AND PARTICIPANTS: 15,432 SNFs in the United States. METHODS: Using SNF Payroll Based Journal data from January 1, 2019, through March 31, 2020, we calculated national weekly averages of therapy staffing minutes per patient-day for all therapy staff and for subgroups of physical and occupational therapists, therapy assistants, contract staff, and in-house employees. We used interrupted time series regression to estimate immediate and gradual effects of PDPM implementation. RESULTS: Total therapy staffing minutes per patient-day declined by 5.5% in the week immediately following PDPM implementation (P < .001), and the trend experienced an additional decline of 0.2% per week for the first 6 months after PDPM compared with the negative pre-PDPM baseline trend (P < .001), for a 14.7% total decline by the end of March 2020. Physical and occupational therapy disciplines experienced similar immediate and gradual declines in staffing. Assistant and contract staffing reductions were larger than for therapist and in-house employees, respectively. All subgroups except for assistants and contract staff experienced significantly steeper declines in staffing trends compared with pre-PDPM trends. CONCLUSIONS AND IMPLICATIONS: SNFs appeared to have responded to PDPM with both immediate and gradual reductions in therapy staffing, with an average decline of 80 therapy staffing minutes over the average patient stay. Assistant and contract staff experienced the largest immediate declines. Therapy staffing and quality outcomes require ongoing monitoring to ensure staffing reductions do not have negative implications for patients.

Gun Violence Exposure and Experiences of Depression Among Mothers.

Gun violence is a uniquely prevalent issue in the USA that disproportionately affects disadvantaged families already at risk of health disparities. Despite the traumatic nature of witnessing gun violence, we have little knowledge of whether exposure to local gun violence is associated with higher risks of depression among mothers, whose symptoms of depression are likely to have spillover effects for kin. We examined the association between exposure to gun violence in mothers' neighborhoods and their experiences of depression using longitudinal Fragile Families and Child Wellbeing Study data (n = 4587) in tandem with lagged outcome and fixed effect models. We find that mothers who witness at least one shooting in their neighborhoods or local communities exhibit more symptoms of depression and are 32-60% more likely to meet criteria for depression than mothers who do not witness a shooting. We also find that witnessing a shooting is associated with increases in parental aggravation, which is partially mediated by maternal depression. Given this and other previously documented spillover effects of mothers' mental health on children and family members, these findings have important implications for mothers' wellbeing and their kin. Further, we observe substantial racial and socioeconomic disparities in exposure to gun violence, suggesting that gun violence may heighten health disparities and drawing attention to the importance of providing mental health resources in communities that are most affected by gun violence.

Unequal Opportunity? Racial, Ethnic, and Gender Disparities in the Returns to Internal U.S. Migration.

Internal U.S. migration plays an important role in increasing individuals' access to economic and social opportunities. At the same time, race, ethnicity, and gender have frequently shaped the opportunities and obstacles individuals face. It is therefore likely that the returns to internal migration are also shaped by race, ethnicity, and gender, though we have relatively little knowledge of whether this is the case for contemporary internal U.S. migration. To explore this possibility, I use restricted, geocoded National Longitudinal Survey of Youth 1979 data from 1979 to 2012. I find that white men gain the most economically from migrating, relative to black and Latino men. For women, migration is associated with stable or narrower racial and ethnic disparities in economic outcomes, with Latina women experiencing the largest economic benefits associated with migration and with black and white women exhibiting comparable economic returns to migration. Together, these findings indicate that migration may maintain or even narrow racial/ethnic disparities in economic outcomes among women, but widen them among men.

The Great Migration and Residential Segregation in American Cities during the Twentieth Century.

The Great Migration from the South and the rise of racial residential segregation strongly shaped the twentieth-century experience of African Americans. Yet, little attention has been devoted to how the two phenomena were linked, especially with respect to the individual experiences of the migrants. We address this gap by using novel data that links individual records from the complete-count 1940 Census to those in the 2000 Census long form, in conjunction with information about the level of racial residential segregation in metropolitan areas in 1940 and 2000. We first consider whether migrants from the South and their children experienced higher or lower levels of segregation in 1940 relative to their counterparts who were born in the North or who remained in the South. Next, we extend our analysis to second-generation Great Migration migrants and their segregation outcomes by observing their location in 2000. Additionally, we assess whether second-generation migrants experience larger decreases in their exposure to segregation as their socioeconomic status increases relative to their southern and/or northern stayer counterparts. Our study significantly advances our understanding of the Great Migration and the "segregated century."

Is geography destiny? Disrupting the relationship between segregation and neighbohrood outcomes.

Considerable research has shown that, in the cross-section, segregation is associated with detrimental neighborhood outcomes for blacks and improved neighborhood outcomes for whites. However, it is unclear whether early-life experiences of segregation shape later-life neighborhood outcomes, whether this association persists for those who migrate out of the metropolitan areas in which they grew up, and how these relationships differ for blacks and whites. Using the Panel Study of Income Dynamics from 1979 to 2013, we find that the level of segregation experienced during adolescence is associated with significantly worse neighborhood outcomes in adulthood for blacks. However, migrating out of the metropolitan area an individual grew up in substantially moderates these relationships. In contrast, adolescent segregation is associated with improved, or not significantly different, neighborhood outcomes in adulthood for whites. These findings have important implications for theorizing about the mechanisms linking segregation and neighborhood outcomes and for considering potential means of assuaging racial disparities in harmful neighborhood exposures.

Does Hypersegregation Matter for Black-White Socioeconomic Disparities?

Massey and Denton's concept of hypersegregation describes how multiple and distinct forms of black-white segregation lead to high levels of black-white stratification. However, numerous studies assessing the association between segregation and racial stratification applied only one or two dimensions of segregation, neglecting how multiple forms of segregation combine to potentially exacerbate socioeconomic disparities between blacks and whites. We address this by using data from the U.S. Census from 1980 to 2010 and data from the American Community Survey from 2012 to 2016 to assess trajectories for black-white disparities in educational attainment, employment, and neighborhood poverty between metropolitan areas with hypersegregation and black-white segregation, as measured by the dissimilarity index. Using a time-varying measure of segregation types, our results indicate that in some cases, hypersegregated metropolitan areas have been associated with larger black-white socioeconomic disparities beyond those found in metropolitan areas that are highly segregated in terms of dissimilarity but are not hypersegregated. However, the contrasts in black-white socioeconomic inequality between hypersegregated metropolitan areas and those with high segregation largely diminish by the 2012 to 2016 observation.

Barring progress: The influence of paternal incarceration on families' neighborhood attainment.

A growing body of literature has recognized that incarceration has implications beyond the offender, with detrimental effects reverberating onto families. In this study, we use the Fragile Families and Child Wellbeing Study (N = 3288) to investigate the relationships between paternal incarceration and the neighborhood outcomes of the children of incarcerated fathers and their mothers. Specifically, we examine whether children whose fathers are currently and/or have recently been incarcerated experience more residential instability, live in more socioeconomically disadvantaged neighborhoods, and/or live in less socially cohesive neighborhoods. We find that paternal incarceration is associated with moving more frequently, greater socioeconomic neighborhood disadvantage, and lower social cohesion for the children of incarcerated fathers and their mothers, though some of these relationships depend on the timing of paternal incarceration. Our findings have important implications for understanding the societal costs of incarceration, the nature of neighborhood attainment and inequality for families facing paternal incarceration, and the processes through which some families are sorted into their neighborhood contexts.

Great Migration's great return? An examination of second-generation return migration to the South.

Using novel panel data spanning 1940-2000, we examine the adult offspring of the Great Migration who returned to the South. We observe two types of return migrants: (1) southern-born, "lifetime" return migrants who were born in the South, resided outside of the South in 1940, and returned to the South by 2000, and (2) northern-born, "generational" return migrants whose parents were born in the South but who, themselves, were born in the North, resided in the North in 1940, and had returned to the South by 2000. These data also allow us to observe return migrants and their parents over a longer period of time than any previous data source, permitting us to consider the early-life predictors of return migration. We find that generational migrants comprise a sizeable segment of all second-generation return migrants to the South and that these migrants are positively selected on their own and their parents' socioeconomic characteristics, relative to the second-generation migrants who remain in the North. Conversely, southern-born, lifetime, return migrants are negatively selected. Our investigation provides a broader and more representative view of who return migrants are and illustrates the underappreciated importance of generational ties to place for migration decisions.

Migration, Mobility, and Neighborhood Attainment: Using the PSID to Understand the Processes of Racial Stratification.

In this article we describe the considerable influence of the Panel Study of Income Dynamics (PSID) on research on residential migration, mobility, and neighborhood attainment, as well as the role of PSID-based research in housing policy debates. We review some of the central research findings and key discoveries that have come from analyses that have used the PSID. We then present new research, using PSID data that are linked to geographic data, to demonstrate how geographic moves are associated with changes in neighborhood poverty rates. The relationship differs markedly for blacks and whites, and our results add to a body of work that shows sharp racial differences in residential context, and the role that personal migration plays in shaping this stratification. Finally, we use these findings and the shortcomings of past research to prescribe ways that the PSID could be enhanced to understand more about migration dynamics and processes of residential stratification.

Second-Generation Outcomes of the Great Migration.

The mass migration of African Americans out of the South during the first two-thirds of the twentieth century represents one of the most significant internal migration flows in U.S. HISTORY: Those undertaking the Great Migration left the South in search of a better life, and their move transformed the cultural, social, and political dynamics of African American life specifically and U.S. society more generally. Recent research offers conflicting evidence regarding the migrants' success in translating their geographic mobility into economic mobility. Due in part to the lack of a large body of longitudinal data, almost all studies of the Great Migration have focused on the migrants themselves, usually over short periods of their working lives. Using longitudinally linked census data, we take a broader view, investigating the long-term economic and social effects of the Great Migration on the migrants' children. Our results reveal modest but statistically significant advantages in education, income, and poverty status for the African American children of the Great Migration relative to the children of southerners who remained in the South. In contrast, second-generation white migrants experienced few benefits from migrating relative to southern or northern stayers.