A Closer Look: Examination of Suicide Risk Screening Results and Outcomes for Minoritized Youth in Subspecialty Pediatrics.

OBJECTIVE: To describe a sample of minoritized youth who screened positive for suicide risk within medical subspecialty pediatrics, compared to non-minoritized youth and describe the screening outcomes of these youth. METHODS: This retrospective chart review from October 2018 to April 2021 used electronic medical record data from an academic pediatric medical subspecialty clinic that screens universally for suicide risk for all patients ages 9 and up. Chart reviews were conducted for 237 minoritized youth (operationalized as identifying as non-White or Hispanic/Latinx, identifying as a gender minority, and having a preferred language other than English) who screened positive for suicide risk. Descriptive statistics include need for escalation to an emergency room, connection to mental health care, receival of a mental health referral, and attendance at follow-up visits. RESULTS: Minoritized youth were more likely to screen positive and report a history of suicide attempt when compared to non-minoritized peers. Youth identifying as gender expansive had significant elevation in suicide risk. The majority of youth in this sample were already connected to mental health care, with youth preferring a language other than English being the least likely to be connected. CONCLUSIONS: Findings indicate heightened suicide risk for minoritized youth, with gender expansive youth having particularly elevated suicide risk. A need to support youth with a preferred language other than English in getting connected to mental health care was also revealed.

Holding Space for Facilitated Dialogues on Antiracism in Academic Medicine.

The year 2020 brought unprecedented challenges and renewed focus on racial disparities and inequities in the United States. For racial and ethnic minority groups, and in particular African Americans, racial disparities have been a constant presence and threat from the time of slavery through the present day. These racial disparities, sanctioned and maintained by institutional racism, manifest in all aspects of life for African Americans-segregated and unequal education and housing systems, health and mental health care disparities, disproportionally elevated incarceration rates, and, as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. In addition, most recently, there has been a renewed focus on the increased suicide rate for Black youth and its relationship to these racial disparities.1 In a large urban environment, our academic Child Psychiatry Department recognized that progress toward addressing racial disparities would be impeded without raising awareness and taking individual and collective action to identify implicit bias, power, and privilege differentials, and systemic racism inherent within academic medicine and our own lived experiences. This letter describes the development of such examination through facilitated dialogues on race and antiracism in our department.

Integrating Suicide Risk Screening into Pediatric Ambulatory Subspecialty Care.

BACKGROUND: Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. METHODS: A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9-21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. RESULTS: During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. CONCLUSIONS: Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.

Co-designed PICU Family Stress Screening and Response System to Improve Experience, Quality, and Safety.

OBJECTIVE: Evidence for successful and sustainable models that systematically identify and address family stress in the pediatric intensive care unit (PICU) remains scarce. Using an integrated improvement science and family engagement framework, we implemented a standardized family stress screening tool and response protocol to improve family experience and reduce family crises through the timely coordination of parent support interventions. METHODS: We conducted this improvement initiative in the 12-bed PICU of a children's hospital within a large, urban academic medical center. Our team, which included 2 family advisors, adapted a validated Distress Thermometer for use in pediatric intensive care. A co-designed family stress screening tool and response protocol were iteratively tested, refined, and implemented in 2015-2017. Process and outcome measures included screening and response reliability, parent satisfaction, and security calls for distressed families. RESULTS: Over the 18 months, the percentage of families screened for stress increased from 0% to 100%. Among families who rated stress levels ≥5, 100% received the recommended response protocol, including family support referrals made and completed within 24 hours of an elevated stress rating. From 2015 to 2017, PICU parent satisfaction scores regarding emotional support increased from a mean score of 81.7-87.0 (P < 0.01; 95% CI). The number of security calls for distressed families decreased by 50%. CONCLUSIONS: The successful implementation of a co-designed family stress screening tool and response protocol led to the timely coordination of parent support interventions, the improved family perception of emotional support, and reduced family crises in the PICU.

Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine.

OBJECTIVE: An observational safety study of the quadrivalent human papillomavirus vaccine (HPV4) in women was conducted. This report presents findings from autoimmune surveillance. Design. Subjects were followed for 180days after each HPV4 dose for new diagnoses of 16 prespecified autoimmune conditions. SETTING: Two managed care organizations in California. Subjects. Number of 189,629 women who received ≥1 dose of HPV4 between 08/2006 and 03/2008. OUTCOME: Potential new-onset autoimmune condition cases amongst HPV4 recipients were identified by electronic medical records. Medical records of those with ≥12-month health plan membership prior to vaccination were reviewed by clinicians to confirm the diagnosis and determine the date of disease onset. The incidence of each autoimmune condition was estimated for unvaccinated women at one study site using multiple imputations and compared with that observed in vaccinated women. Incidence rate ratios (IRR) were calculated. Findings were reviewed by an independent Safety Review Committee (SRC). RESULTS: Overall, 1014 potential new-onset cases were electronically identified; 719 were eligible for case review; 31-40% were confirmed as new onset. Of these, no cluster of disease onset in relation to vaccination timing, dose sequence or age was found for any autoimmune condition. None of the estimated IRR was significantly elevated except Hashimoto's disease [IRR=1.29, 95% confidence interval: 1.08-1.56]. Further investigation of temporal relationship and biological plausibility revealed no consistent evidence for a safety signal for autoimmune thyroid conditions. The SRC and the investigators identified no autoimmune safety concerns in this study. CONCLUSIONS: No autoimmune safety signal was found in women vaccinated with HPV4.

Kinetics of DNA load predict HPV 16 viral clearance.

INTRODUCTION: While high HPV 16 viral load measured at a single time point is associated with cervical disease outcomes, few studies have assessed changes in HPV 16 viral load on viral clearance. OBJECTIVE: To measure the association between changes in HPV 16 viral load and viral clearance in a cohort of Thai women infected with HPV 16. STUDY DESIGN: Fifty women (n=50) between the ages of 18-35 years enrolled in a prospective cohort study were followed up every three months for two years. Women positive for HPV 16 DNA by multiplex TaqMan assay at two or more study visits were selected for viral load quantitation using a type-specific TaqMan based real-time PCR assay. The strength of the association of change in viral load between two visits and viral clearance at the subsequent visit was assessed using a GEE model for binary outcomes. RESULTS: At study entry, HPV 16 viral load did not vary by infection outcome. A >2 log decline in viral load across two study visits was found to be strongly associated with viral clearance (AOR: 5.5, 95% CI: 1.4-21.3). HPV 16 viral load measured at a single time point was not associated with viral clearance. CONCLUSIONS: These results demonstrate that repeated measurement of HPV 16 viral load may be a useful predictor in determining the outcome of early endpoints of viral infection.

The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients.

BACKGROUND: Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. OBJECTIVE: To evaluate the effect of glutamine (Gln) dipeptide supplementation of total parenteral nutrition (TPN) on postoperative nitrogen balance and immune response of patients undergoing surgery. METHODS: This study is a prospective, randomized double-blind clinical trial. APACHE II score and TISS were used to evaluate the patients after admission. Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg/day) and isoenergetic (30 kcal/kg/day) TPN for 6 days. Two groups (Conv and Ala-Gln) were further divided to high (APACHE>or=6) and low (APACHE <6) groups. Control group (Conv) received 1.5 g amino acids/kg/day, whereas the Ala-Gln group received 0.972 g amino acids/kg/day and 0.417 g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 after surgery for plasma amino acid and CD4, CD8 cell and T lymphocyte analysis. Cumulative nitrogen balance were also measured on day 2, 3, 4, 5 postoperatively. RESULTS: Although there was a tendency to have better cumulative nitrogen balance on the postoperative days in the Ala-Gln group, no significant difference was observed between two groups. However, a better significant cumulative nitrogen balance was observed on the 2nd, 3rd and 5th postoperative day in the Ala-Gln group than in the Conv group in patients with APACHE II <6, whereas no significant difference was noted in patients with APACHE II >or= 6. No difference in urine 3-methylhistidine excretion were observed between the 2 groups. Patients in the Ala-Gln group had significant higher T lymphocyte and CD4 cells than did those in the Conv group. CONCLUSION: TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.

Effects of medium-chain triglyceride in parenteral nutrition on rats undergoing gastrectomy.

This study was designed to investigate the effects of pre-infusion with total parenteral nutrition (TPN) using medium-chain triglyceride (MCT) versus long-chain triglyceride (LCT) emulsion as fat sources on hepatic lipids, inflammatory mediators and antioxidant capacity in rats undergoing gastrectomy. Rats with internal jugular catheter, were divided into two groups and received TPN. TPN supplied 300 kcal/kg/d with 39% of the energy provided as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fat emulsion, which was composed of MCT/LCT (1 : 1) or LCT. After receiving TPN for 5 days, the rats underwent partial gastrectomy and were sacrificed 24 h after surgery. The results of the study demonstrated that the MCL/LCT group had lower hepatic lipids than did the LCT group. No differences in interleukin-1beta, interleukin-6 and tumor necrosis factor-alpha in peritoneal lavage fluid were observed between the two groups. Erythrocyte glutathione peroxidase activity was significantly higher in the LCT group than the MCT/LCT group, although erythrocyte superoxide dismutase activity did not differ significantly between the two groups. These results suggest that infusion with MCT/LCT before an abdominal operation did not have an effect on modulating the production of inflammatory mediators in the location of the injurious stimulus. However, pre-infusion with MCT/LCT have beneficial effect in improving liver lipid metabolism and reducing oxidative stress in rats with gastrectomy.

Superoxide dismutase in hepatocellular carcinoma affects patient prognosis.

BACKGROUND/AIMS: The free radicals play an important role in the pathogenesis of neoplastic transformation of the tissues. Superoxide dismutase is a metalloenzyme, protecting the cells from oxygen radical insult. The superoxide dismutase activity may therefore alter the cellular signaling pathways against the insults derived from oxidative stress especially in the tumor tissues. Therefore, it is considered that superoxide dismutase activity is crucial in affecting the survival of the cancer bearing patients. This study aims to investigate the level of superoxide dismutase activity in hepatocellular carcinoma tissues and correlate this with patients' survival after surgery for hepatocellular carcinoma. METHODOLOGY: Thirty-six patients who had hepatectomy for hepatocellular carcinoma at the National Taiwan University Hospital from 1992 to 1993 were included in this study. Superoxide dismutase activity of the tumor tissues was determined. The results were correlated with the patients' survival. The patients were grouped based on their postoperative survival time. Those patients who were deceased less then one year after surgery were in group I. Group II included patients who survived more than one year but less than 3 years after operation. Group III patients survived more than 3 years but less than 5 years. Ten patients who survived longer than 5 years after surgical intervention were in group IV. Data were expressed as mean and analyzed with ANOVA. RESULTS: The demographic and clinical information of patients, such as age, gender, plasma albumin, globulin, alpha-fetoprotein levels, and hepatitis markers were comparable among these groups. The superoxide dismutase levels in the hepatocellular carcinoma were significantly higher in group IV than the other three groups (P < 0.05). Similarly, the superoxide dismutase levels of the hepatocellular carcinoma tissues from group III patients were significantly greater than those tissues from patients of either group I or group II. Tumor superoxide dismutase levels tended to be higher in group II than in group I, although it did not reach a statistical significance. CONCLUSIONS: Patients with higher superoxide dismutase levels in the hepatocellular carcinoma survived longer after hepatectomy. The superoxide dismutase levels of the tumor tissue may influence the malignancy and the outcome of the patients. It serves as prognostic factor for patients after hepatocellular carcinoma operation.

A prospective study of human papillomavirus (HPV) type 16 DNA detection by polymerase chain reaction and its association with acquisition and persistence of other HPV types.

Human papillomavirus (HPV)-16 causes about half the cases of cervical cancer worldwide and is the focus of HPV vaccine development efforts. Systematic data are lacking as to whether the prevention of HPV-16 could affect the equilibrium of infection with other HPV types and thus alter the predicted impact of vaccination on the occurrence of cervical neoplasia. Therefore, the associations of HPV-16 detection with subsequent acquisition of other HPV types and with the persistence of concomitantly detected HPV types were examined prospectively among 1124 initially cytologically normal women. Preexisting HPV-16 was generally associated with an increased risk for subsequent acquisition of other types. HPV-16 did not affect the persistence of concomitant infections, regardless of type. These findings suggest that the prevention or removal of HPV-16 is not likely to promote the risk of infection with other types, a theoretical concern with current vaccination efforts.

Cervical HPV DNA detection as a predictor of a recurrent SIL diagnosis among untreated women.

OBJECTIVES: This study was conducted to test whether patient history of untreated cervical intraepithelial neoplasia (CIN) 1 or low-grade squamous intraepithelial lesions (LGSIL) modifies the interpretation of a positive HPV DNA result with regards to subsequent squamous intraepithelial lesions (SIL). METHODS: Seventy-three women with recurrent SIL were compared to 105 controls who remain cytologically normal during follow up. Cervical samples collected at enrollment were assayed for HPV DNA in the subject and control groups. RESULTS: Women with and without a history of LGSIL who tested positive for HPV DNA were at a similarly increased risk of having (recurrent) LGSIL as compared to controls. However, in women with a history of LGSIL, HPV DNA appeared to be less predictive for high-grade squamous intraepithelial lesions (HGSIL) than in women without a history of disease. CONCLUSIONS: Past history of untreated CIN1 or LGSIL does not modify the predictive value of a positive HPV DNA test for subsequent LGSIL. The observed difference of the predictive value of a positive HPV DNA test for the risk of recurrent HSIL compared to incident HSIL should be pursued.

Expression of the cadherin-catenin complex in well-differentiated human thyroid neoplastic tissue.

E-cadherin is a member of the cadherin family that plays a major role in epithelial integrity and tumorigenesis. Catenins are a group of cytoplasmic proteins that regulate the intracellular anchorage of cadherin and are required for the linkage between cadherin and the actin cytoskeleton. Loss of E-cadherin contributes to the pathogenesis in tumor invasion and gives a poor prognosis. In order to investigate the adhesion property of intercellular junctions in thyroid tumors, expression of alpha-,beta, and gamma-catenin should also be studied. A correlation between these molecular markers and malignancy would be useful as a preoperative diagnostic test for thyroid neoplasms. The expression of E-cadherin, alpha-, beta-, and gamma-catenin were studied in normal and neoplastic thyroid tissue by immunofluorescence microscopy and Western blot analysis. In the normal thyroid and in nodular goiter, and follicular adenoma, staining for E-cadherin, alpha-, beta-, and gamma-catenin was seen mainly at the lateral surface of epithelial cells in the follicle and the presence of these molecules was confirmed by Western blot analysis. Follicular carcinoma tissue stained positive for E-cadherin and alpha-catenin, but the results of beta- and gamma-catenin immunostaining were highly variable, with beta-catenin being absent in most follicular carcinomas (8/10) and gamma-catenin being absent in some follicular carcinomas (3/10). These results suggest that E-cadherin expression was not reduced during the pathogenesis of differentiated thyroid malignancies. Impairment of the cadherin-catenin complex at the cell junction may contribute to the malignant progression of differentiated thyroid neoplastic tissue.

Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions.

BACKGROUND: Human papillomavirus (HPV) infection has been strongly associated with cervical carcinoma and its cytologic precursors, squamous intraepithelial lesions (SIL). We investigated the risk of SIL prospectively following polymerase chain reaction (PCR)-based DNA testing for a wide range of genital HPV types in a cohort of initially cytologically normal women, to clarify the role of HPV in the etiology of SIL. METHODS: Starting in April 1989, 17,654 women who were receiving routine cytologic screening at Kaiser Permanente (Portland, OR) were followed for the development of incident SIL. During follow-up, 380 incident case patients and 1037 matched control subjects were eligible for this nested case-control study. Cervical lavages collected at enrollment and, later, at the time of case diagnosis (or the corresponding time for selection of control subjects) were tested for HPV DNA using a PCR-based method. The data were analyzed as contingency tables with two-sided P values or, for multivariable analyses, using odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: In comparison with initially HPV-negative women, women who tested positive for HPV DNA at enrollment were 3.8 times (95% CI = 2.6-5.5) more likely to have low-grade SIL subsequently diagnosed for the first time during follow-up and 12.7 times more likely (95% CI = 6.2-25.9) to develop high-grade SIL. At the time of diagnosis, the cross-sectional association of HPV DNA and SIL was extremely strong (OR = 44.4 and 95% CI = 24.2-81.5 for low-grade SIL and OR = 67.1 and 95% CI = 19.3-233.7 for high-grade SIL). HPV16 was the virus type most predictive of SIL, even low-grade SIL. CONCLUSIONS: These findings are consistent with the hypothesis that HPV infection is the primary cause of cervical neoplasia. Furthermore, they support HPV vaccine research to prevent cervical cancer and efforts to develop HPV DNA diagnostic tests.

Determinants of fast repeat migrations of the labor force: evidence from the linked national survey data of Taiwan.

"The main objectives of this paper are (1) to identify the determinants of job-related fast repeat migrations of individuals in the civilian labor force of Taiwan, and (2) to examine whether the effects of these determinants are largely consistent with the existing theories and with the findings of other empirical studies. Our study is based on the linked microdata of the annual national migration surveys of Taiwan from 1980 through 1989.... We review the main theories of repeat migrations and formulate a set of hypotheses that can be tested against the Taiwanese data."

Preoperative localization procedures for initial surgery in primary hyperparathyroidism.

The experience of the surgeon and precise localization of abnormal parathyroid glands determine the success of surgery for primary hyperparathyroidism (HPT). In HPT patients undergoing repeat surgery, the use of localization studies improved the ability to identify the remaining abnormal parathyroid tissue. This study investigated the roles of preoperative localization techniques for initial surgery for primary HPT. From 1985 through 1997, two noninvasive localization procedures, ultrasonography (US) and 201thallium chloride-99mtechnetium pertechnetate subtraction scanning (Tl-Tc), were used prior to initial exploration for primary HPT in 76 patients. Their accuracy was determined on the basis of surgical and pathologic results. The surgical success rate was 96% (73/76). The sensitivities of US and Tl-Tc were 71% and 49%, respectively. The sensitivity of Tl-Tc was higher for the lower parathyroid glands. In 21 of 26 patients who underwent fine-needle aspiration (FNA) of the suspected enlarged parathyroid gland, the diagnosis of parathyroid adenoma was confirmed preoperatively. We conclude that the concomitant use of US and FNA is a safe and convenient method for preoperative localization of the parathyroid glands prior to initial surgical exploration in patients with primary HPT. Bilateral neck exploration by an experienced surgeon should be the routine procedure. US and Tl-Tc alone offer limited localization information, and unilateral exploration should be reserved for selected cases in which the results of these two imaging studies are consistent with one another.

Mortality attributable to cigarette smoking in Taiwan: a 12-year follow-up study.

BACKGROUND: Assessment of the impact of cigarette smoking on mortality helps to indicate the importance of tobacco control in a given country. OBJECTIVES: To examine the relative risk of dying from various diseases for cigarette smoking and to estimate annual mortality attributable to cigarette smoking in Taiwan. DESIGN: Prospective cohort study. SUBJECTS AND SETTING: A cohort of 14,397 male and female residents aged 40 years or older recruited from 12 townships and precincts in Taiwan from 1982 to 1986. Information on cigarette smoking was collected from each subject at local health centres through a standardised personal interview based on a structured questionnaire. They were followed up regularly to determine their vital status until 1994. MAIN OUTCOME MEASURES: Cox's proportional hazards regression models were used to derive relative risks of cause-specific mortality for current cigarette smokers compared with never-smokers, and to examine dose-response relationships between mortality from various causes and several measures of cigarette smoking (daily consumption, duration, age of initiation, and cumulative smoking in pack-years). RESULTS: A total of 2552 persons died during the study period. Among men, cigarette smoking was significantly associated with an increased risk of dying from all causes combined (relative risk (RR) = 1.3); cancer of all sites combined (RR = 1.5); cancers of the stomach (RR = 1.9), liver (RR = 2.2), and lung (RR = 3.7); ischaemic heart disease (RR = 1.8); other heart diseases (RR = 1.4); and chronic obstructive pulmonary disease (RR = 1.9). Among women, cigarette smoking was significantly associated with an increased risk of dying from all causes combined (RR = 1.8), cancer of the lung (RR = 3.6), and peptic ulcer (RR = 17.8). The estimated number of deaths attributable to cigarette smoking in Taiwan in 1994 was 8161 (13.9% of total deaths) for men and 1216 (3.3% of total deaths) for women. In the same year cigarette smoking caused 21.3% and 2.9% of cancer deaths in men and women, respectively, in Taiwan. CONCLUSIONS: Cigarette smoking has a striking impact on overall mortality and deaths from various causes in the Taiwanese population. Tobacco control should be established as the top priority in public health programmes in Taiwan.

Distribution of the cadherin-catenin complex in normal human thyroid epithelium and a thyroid carcinoma cell line.

E-cadherin is the major cell-cell adhesion molecule expressed by epithelial cells. Cadherins form a complex with three cytoplasmic proteins, alpha-, beta-, and gamma-catenin, and the interaction between them is crucial for anchoring the actin cytoskeleton to the intercellular adherens junctions. The invasive behavior of cancer cells has been attributed to a dysfunction of these molecules. In this study, we examined the distribution of the cadherin-catenin complex in a Chinese human thyroid cancer cell line, CGTH W-2, compared with that in normal human thyroid epithelial cells. In the normal cells, using immunofluorescence staining, E-cadherin and alpha-, beta-, and gammm-catenin were found to be localized at the intercellular junction and appeared as 135, 102, 90, and 80 kD proteins on Western blots. In CGTH W-2 cells, no E-cadherin and gamma-catenin immunoreactivity was detected by immunofluorescence or Western blotting; alpha- and beta-catenin were detected as 102 and 90 kD proteins on blots but gave a diffuse cytoplasmic immunofluorescence staining pattern in most cells, while beta-catenin was also distributed throughout the cytoplasm in most cells but was found at the cell junction in some, where it colocalized with alpha-actinin. The present data indicate that the loss of cell adhesiveness in these cancer cells may be due to incomplete assembly of the cadherin-catenin complex at the cell junction. However, this defect did not affect the linkage of actin bundles to vinculin-enriched intercellular junctions.

South-North immigrants' settlement and opportunity structures in the U.S.

"This article makes the case that the new immigration [to the U.S. from developing Latin American and Asian countries], motivated by kinship ties and family reunification provisions of U.S. immigration law, leads to a clustering of new immigrants into areas that are no longer attracting large numbers of native-born Americans. It is argued that the concentration of these groups into ¿high immigration regions' will limit their access to employment and education opportunities that would facilitate their spatial assimilation and upward mobility."

Impacts of low-skilled immigration on the internal migration of the U.S.-born low-skilled Americans in the United States: an assessment in a multivariate context.

"This paper assesses the impacts of low-skilled immigration on the interstate migration of...U.S.-born low-skilled Americans, based on the disaggregated data of the 1990 Census. Our results reveal that the push effects of...immigration on the departure process [were] much stronger than its discouraging and complementary effects on the destination choice process; and that the push effects of low-skilled immigration are (1) stronger on whites than on non-whites, (2) much stronger on the poor than on the non-poor, (3) weaker on the 15-24 age group than on older age groups, and (4) the strongest on poor whites."