Nurse says Meshawn Maddock’s anti-trans attacks involving her children ‘crossed the line’

An Oakland County-based health care professional says social media posts involving her children by former Michigan GOP Co-Chair Meshawn Maddock have “crossed the line.”

Julia Pulver is a career nurse and patient advocate who now works as an expert nursing consultant after two unsuccessful runs as a Democrat for office in 2018 for state Senate and in 2020 for state House.

On Sunday, Maddock, who is married to state Rep. Matt Maddock (R-Milford), posted a tweet in which she referred to Pulver’s children as “incredibly sad and messed up,” adding, “Democrats like them are willing to sacrifice their own children.”

Pulver and her husband, Ben Pulver, have been outspoken advocates for the LGBTQ+ community, which includes three of their four children, a trans son, a cis son and two non-binary kids.

In response, Julia Pulver noted Meshawn Maddock’s legal woes and speculated that likely played a role in the attack on her kids.

Maddock is one of 16 Michigan Republicans charged last week with submitting false electoral votes in December 2020 in support of former President Donald Trump. Each faces multiple felonies including election law forgery, and conspiracy to commit election law forgery.

“I’m guessing attacking my family & insulting my children are how she’s distracting herself from thoughts of her impending trial & possible long prison sentence for being a fake elector,” she tweeted. “And for the record, our kids she’s attacking are 16, 14, 13 & 10 yo.”

Another tweet by Maddock included an insinuation the Pulvers purposely placed male genitalia in front of their kids, while one from the Grand New Party PAC, founded by state Rep. Steve Carra (R-Three Rivers), a Maddock ally, asked Ben Pulver if he had “chemically castrated” his transgender child.

Requests for comment were made to Maddock and Carra, but have not been returned.

It is also not the first time Maddock has been under fire for social media posts.

In September, while still co-chair of the state party, she tweeted out a homophobic attack against U.S. Transportation Secretary Pete Buttigieg, while earlier in the year Maddock blasted Michigan Lt. Governor Garlin Gilchrist, who is the first African American to hold the position, as a “scary masked man.”

In an interview with the Michigan Advance, Julia Pulver said it was no coincidence that Maddock’s tweet tagged her husband, as he has been active in responding to right-wing talking points.

“Whenever he calls them [right-wing extremists] out on some sort of hypocrisy or disinformation or just weird fetishization like the Kyle Rittenhouse event that they had, their response to his criticism for the last couple weeks is to attack our family by name, and now especially focused on our children, accusing us of all of the weird fever dreams that they have about what it means to actually be the parent of a kid who’s in the LGBTQ spectrum,” she said.

Pulver said she feels compelled to speak out now that the attacks have ramped up from generalizations to accusing her and her husband of personally harming their children.

Julia Pulver | Courtesy photo

“We’re the low-hanging fruit in their little hate vineyard,” she said. “I’m not even in politics anymore. I’m not running for anything. I am just outspoken. But when I see people who want to hurt my kids and who want to turn them into monsters to further their political careers, then I do have a problem with that and I’m going to say something. I feel like they kind of crossed the line. They can come after he and I all they want, but now they’ve just started saying derogatory things about our children, and that’s not OK.”

Ben Pulver told the Advance that the attacks were out of the blue and completely uncalled for.

“It was surprising,” he said. “It was not connected to what was being discussed. I responded to them on political issues specific to what they had posted and they came back with attacks on our kids. It was a mismatch.”

Julia Pulver said the “attacks are very inaccurate either on both a personal level with our family and our children, and in general. 

“Gender affirming care for our kids, who are between ages of 10 and 16, and this isn’t even all of them, just the ones that are exploring who they are, comes down to respecting their chosen names and their chosen pronouns. That’s it,” she said.

As a nurse, Pulver said it’s wrong to equate hormone blockers with chemical castration.

“They have no idea what young people have the need for hormone blockers,” she said. “… These are the same medications that have been used for decades to treat a condition in young children called precocious puberty,” in which a child’s body begins changing into that of an adult too soon.

In the case of transgender children, they are only prescribed by a doctor following a confirmed diagnosis of gender dysphoria and extensive therapy.

“Those are used to help just buy a little more time so that they can have more counseling, they can have more psychiatric treatment,” she said. “They can have more time to figure out exactly what they’re going to be doing in their lives. It is temporary; it is reversible; it is not castrating. They use all of these very loaded words so it makes it seem like parents are just experimenting on their kids and cutting them up and shoving chemicals in them.”

Others have joined Pulver in condemning the attack on her children.

Sommer Foster, executive director of Michigan Voices, tweeted out her support.

“Imagine being a whole ass adult attacking children, in a public forum, because you don’t like the political views of their parents,” said Foster. “As someone that has met the Pulver kids, they are incredibly sweet, kind, and thoughtful — they don’t deserve online abuse.”

Emily Busch, a Democratic candidate for Congress seeking to unseat Republican U.S. Rep. John James (R-Farmington Hills) in the 10th District in 2024, also expressed support.

“How childish and hateful. I’m so sorry,” she tweeted.

16 Michigan Republicans charged with felonies in 2020 fake elector scheme 

Pulver said she’s grateful for the support.

“We have a huge community of people behind us,” she said. “We are very secure in ourselves as parents and the decisions we make for our children. But not everybody has that. And I want to make sure that anybody else who’s out there who doesn’t have the same sort of support system that we do, that they’re not fooled by these people. I don’t want vulnerable people to see them attacking us and for us to say nothing. I don’t want them to be able to virtually bully all of these other parents who are struggling in this either new phase of their kids’ lives or something that’s been ongoing that they have been not sure how to handle.”

Pulver said she has no plans to return to politics at the moment, but wants to try and offer some assistance to parents dealing with similar issues.

“The kind of parents that are going to help their kids survive adolescence and still have good relationships with them through adulthood, are the kinds of parents who are going to ignore all of that noise and just listen to their kids, listen to their kids’, doctors, listen to their gut and not feel like they have to tell their kid that they’re wrong and that they are somehow disturbed or crazy or anything like that,” she said. “They’re OK.”

4.6 million fish have already died on salmon farms so far in 2023

4.6 million fish have already died on salmon farms so far in 2023 – African American News Today – EIN Presswire

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She’s Trinity’s president and Hartford HealthCare’s new chair. She shared thoughts on city’s future and more

HARTFORD — Not long after being appointed president of Trinity College in 2014, Joanne Berger-Sweeney made it known that she’d like to serve on the board of directors of Hartford HealthCare, which operates Hartford Hospital and six others in Connecticut.

Berger-Sweeney is a neuroscientist with a PhD in public health so the fit may seem obvious, but she was thinking well beyond: both Trinity and Hartford Hospital have been part of city since the early 1800s — and have made commitments, Berger-Sweeney said, to “being in and of Hartford.”

Now, after serving eight years on Hartford HealthCare’s board, Berger-Sweeney has been appointed its chair and will lead the board of one of the largest and most powerful health care systems in the state.

In a recent conversation with The Courant, Berger-Sweeney often draws parallels between Trinity and Hartford HealthCare, remembering her first impressions of both when she first arrived in Hartford as she moved on from Tufts University, where she was dean of Arts and Sciences.

“We were both anchor institutions,” Berger-Sweeney, now 64, recalls. “We have physicians or tenured faculty members that are at the heart and soul of delivering the product, but sometimes could be staid in their ways about how they did their jobs. Both organizations had leaders come in that wanted to innovate, but at the same time being very committed to the neighborhoods in which we are settled.”

Trinity College president Joanne Berger-Sweeney
Trinity College President Joanne Berger-Sweeney was the first African-American and first woman ever to lead the college in Hartford. (Aaron Flaum/Hartford Courant)

Hartford HealthCare has placed innovation at the center of the organization and has expanded its network of urgent care centers to shift routine visits away from the emergency rooms of its hospitals. Trinity, which recently celebrated its bicentennial, has worked to shed a historical, elitist image. Both institutions have expanded into downtown: Trinity partnered in Liberal Arts Action Lab on Constitution Plaza and the health system moved into a $14 million headquarters on Pearl Street.

A descendant of enslaved people, Berger-Sweeney — the first African-American and woman to ever lead Trinity — proudly points to the fact that she is the third generation of her family to graduate college. Berger-Sweeney’s father was an attorney and her mother was the president of the Girl Scout Council in Los Angeles, where Berger-Sweeney grew up.

One of the most pivotal experiences early on was as an exchange student before she entered college, living with a family in Malaysia.

“And that very much shaped my worldview, l think, on people in different countries and what it means,” Berger-Sweeney said. “We’re all just people if we are willing to work together.”

During her time in Malaysia, Berger-Sweeney stayed with the head of the state in Malaysia where she was visiting, who was also the Muslim leader in the region.

Hartford HealthCare headquarters in downtown Hartford

Cloe Poisson / Special to the Courant

Hartford HealthCare moved its headquarters and hundreds of employees to the office tower at 100 Pearl Street in downtown Hartford after a $14 million renovation.in 2022. Waves of colorful strips adorn the ceiling in the new facility. (Cloe Poisson/Special to The Courant)

“So that means throughout my life, even though I was raised as a Christian, you could not say to me that Muslims were this or that or all the negative connotations because I’d lived with a family that had opened up their home to this high school student from America and this Black American.”

What follows is a condensed conversation with Berger-Sweeney, edited for length and clarity, on her new role as chair of Hartford HealthCare, diversity and Hartford.

Q: The pandemic exposed wide disparities in access to health care for Black, brown and indigenous communities. A recent study by the Kaiser Family Foundation showed wide gaps continue to persist. Change may not come overnight, but do you see some progress being made?

A: I do see progress. There’s still a ways to go, without question. But sometimes, the first important step is recognizing the problem, recognizing there is a gap.  I was listening to a story today about a Black woman in track and field who died in childbirth, and it was bringing up the differences in outcomes in childbirth between Black women and white women. So as I said, the first step is recognizing the problem and understanding the problem because, otherwise, you’re just throwing solutions at a problem that you don’t really understand.

And since I have been on the board at Hartford HealthCare, they have hired someone who specializes in looking at gaps, these racial gaps and some of the issues related to diversity. That position didn’t exist before. We now have the ability and some resources to shine light on the problem, and that’s where we can come together to work on better solutions. People have to feel as though they are a part, that they’re engaged and that people care about those issues to want to participate.

Aerial view of Hartford Hospital
An aerial view of the main campus of Hartford Hospital. (Sean Patrick Fowler/Special to The Courant)

Q: Hartford Hospital serves a city population that is broadly impoverished. The hospital has cited stunning statistics that show the life expectancy in Hartford’s Northeast neighborhood as 68.9 years, compared with 84.9 years in West Hartford Center. The hospital is addressing the need for community-based health services with its clinic on Jefferson Street, but the hospital said more clinical space is needed. What do you see as the most pressing health need for Hartford residents?

A: What I can tell you is troubling to me is access broadly and particularly with primary care physicians. You can’t get primary care physicians to be located here in Hartford. I cannot find a primary care physician in the city of Hartford. I have to go to West Hartford, which is the closest, but for a while, I was going even farther out to get primary care. We’ve got to figure out ways — and it’s not just Hartford HealthCare.

And we know, statewide, for example, the crisis that we have with mental health care services and not just for young adults, but teens and folks even younger than that — preteens in need of mental health and behavioral health care. So, there are just so many mismatches right now between what we need and our health care system. That’s the meta issue that all of us are dealing with. That’s not just Hartford HealthCare, but health care in the U.S.

Q: How is Hartford HealthCare reaching out to the Hartford community?

A: Hartford HealthCare is very involved in trying to address the issue of gun violence and, in particular, the Brother Carl Hardrick Institute, an organization that Hartford HealthCare supports. It is focused on gun violence and does a lot of its work in the north part of Hartford. It’s people on the ground trying to understand the root causes of gun violence and clearly to try and shift the curve.

On a micro level, there is someone working with the hospital to provide barber services to homeless people. How can you get a job if you clean up and shave and have a haircut? So, I have seen them involved in very direct service issues in the community.

Joanne Berger-Sweeney
Trinity College President Joanne Berger-Sweeney in her office at the college. (Aaron Flaum/Hartford Courant)

Q: How does an urban institution like Hartford Hospital expand to respond to 21st century innovation yet respect the historic buildings that still exist surrounding the campus?

A: Interestingly, it’s the same issue that Trinity College has. I mean, we’re not going to tear down the Long Walk. We are in a historic district, but we need to think about how do we expand what we do? So one way is through renovation and not just expanding the footprint. And one of the commitments that I made during Trinity’s strategic planning process that I don’t want the built footprint of Trinity to grow.

So, if we’re going to expand something in the future, how are we thinking about what we are going to reduce in the future? And it’s a bit of the concept to me of the importance of reusing and not just redoing and that, if possible, can you renovate rather than knock down?

The pandemic was so challenging to health care that we didn’t spend huge amounts of time talking about the footprint and about whether we were going to grow. To be honest, it is a balance because sometimes when we think here at Trinity, some of our older buildings that we deal with really should be torn down. It would be environmentally more efficient to rip it down and build a new one. Is that more important than saving the history of a historic building?

Those are challenges and balances that all of our organizations face. And I’m not sure there’s any right answer, except that doing nothing is not the right answer.

Q: You also serve as chair of the Capital Region Development Authority’s housing committee that considers requests to finance housing projects in and around Hartford. What is the most pressing housing need in the city?

A: I still believe that one of the biggest housing needs is the affordable home. Homeownership is not just the American Dream, it’s the way Americans have built wealth. And as much as I like renovating apartments — and understand the needs that people have to be in good, clean apartments in the central district — I do often ask about: are there possibilities for some portion of it being homeownership?

Another significant need in Hartford is middle class anything. Hartford is the extreme: the very poor on one side of town and the wealthy on the other and not a lot available in between. So, I have also wondered if there can be in some areas some focus on housing that middle income people would be interested in. Maybe they don’t have kids. Maybe they aren’t tied to a particular school district. But if your middle class are faculty, they don’t live in Hartford for the most part because there aren’t a lot of places where middle class people want to be in Hartford. So, we have an opportunity to work on that as part of CRDA.

Q: What is the biggest challenge for urban hospitals like Hartford Hospital in a dramatically changing health care industry?

A: When you can’t rely on patient care in the hospital supporting primarily the entire health care system, so where does it come from, then? Yeah, well, some of it is going to come from the government. But just like in higher education, we are being asked to be more innovative about what and how we do things. And it’s not that we are trying to do side businesses. We  are trying to create systems that are more innovative that continue to deliver what we want, whether it’s in health care or education, but do so in a manner that might be more cost effective or provide different sources of income such that we can continue to support the entire system.

Kenneth R. Gosselin can be reached at kgosselin@courant.com.

All US racial and ethnic minority groups are underrepresented in Alzheimer’s neuroimaging research, study shows

Alzheimer’s disease (AD), which affects an estimated 6.5 million adults in the United States, hits some groups harder than others. Compared to non-Hispanic whites, Hispanic Americans are 1.5 times as likely to develop AD, and African Americans are twice as likely.

But scientists know little about the reasons behind these disparities, because the vast majority of AD research has been done with non-Hispanic white people.

A new study that reviewed 11,871 research articles on AD brain imaging, led by researchers at the Keck School of Medicine of USC, has now revealed the extent of the gap in representation. Overall, approximately 84% to 87% of study participants are non-Hispanic white. (Non-Hispanic white people make up less than 60% of the U.S. population.) According to the new research, funded by the National Institute on Aging, all racial and ethnic minority groups, including Black/African Americans, Hispanic/Latinos, Asian Americans and American Indian/Alaska Natives are underrepresented. The results were just published in Communications Medicine, a Nature journal.

“As far as we know, this is the most comprehensive review of representation in the Alzheimer’s disease neuroimaging literature,” said senior author Duke Han, PhD, director of neuropsychology in the Department of Family Medicine and a professor of family medicine, neurology, psychology and gerontology at the Keck School of Medicine. “It gives us a good sense of the current state of the literature and what needs to be addressed moving forward.”

A gap in representation

From the pool of nearly 12,000 studies on AD and neuroimaging, the research team identified a subset of papers that recruited samples in the U.S. and met other experimental criteria. In their final analysis, they calculated representation for 719 studies that reported participant race or ethnicity directly (“direct studies”) and 1,745 studies that drew from external databases where race or ethnicity was reported (“indirect studies”).

The researchers reported the median diversity statistics from the studies they analyzed, meaning those that fell in the middle of the range, to avoid results being skewed by extreme outliers. Among direct studies, 87.4% of median study participants were non-Hispanic white, 7.3% of participants were Black/African American, 3.4% were Hispanic/Latino and 0% were Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, multiracial or another race. Indirect studies derived from larger databases were slightly more diverse, with median representation of 83.7% non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. In all cases, minority groups were underrepresented relative to their share of the U.S. population.

“This is a pretty big deal, especially as we look toward the future, where an increasing proportion of the U.S. will be ethnic minority groups,” said Aaron Lim, PhD, a postdoctoral fellow in Han’s research lab and first author of the study. “If their representation isn’t adequately captured, then this disparity in research will grow and grow.”

The researchers also found that 94% of indirect studies drew from just 10 shared databases, suggesting that these large, multi-site studies—which collect data from thousands of participants over many years—are driving a sizable chunk of AD research.

“If that’s the case, it’s incumbent upon those research groups to adequately represent the communities they are recruiting from,” Lim said.

A two-pronged approach

Improving representation in the AD neuroimaging literature will require a two-pronged approach, said Han. First of all, large, multi-site studies need to recruit more diverse samples.

Fortunately, that is already starting to happen, thanks in part to grants from funding agencies (such as the National Institute on Aging) specifically geared toward improving diversity. In 2020, the Alzheimer’s Disease Neuroimaging Initiative, one of the largest studies of AD, launched a new effort to recruit underrepresented minority groups. Those changes are even starting to be reflected in the literature: Han, Lim and their colleagues found that representation of Black/African American participants increased from 3.39% between 1994 and 2017 to 8.29% between 2018 and 2022.

Smaller AD studies focused specifically on collecting brain scans of people from ethnic and racial minority groups will also be key. Those can help capture details of participants’ lived experience, Lim said, including how systemic inequities such as health care access or socio-economic status may affect AD risk.

“In the past, some researchers were so focused on recruiting large groups of participants, that it took priority over the importance of representation,” said Han. “Now, there’s an increasing focus on balancing numbers with representation. This increased emphasis on diversity in neuroimaging is a welcome sight.”

About this study

In addition to Han and Lim, the study’s other authors are Annie L. Nguyen and Jennifer Herrera from the Department of Family Medicine, Keck School of Medicine of USC; Laura Fenton from the Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences; Lisa L. Barnes and Melissa Lamar from the Rush Alzheimer’s Disease Center, Rush University Medical Center; and Gali H. Weissberger from the Interdisciplinary Department of Social Sciences, Bar-Ilan University.

This work was supported by the National Institute on Aging [K24AG081325, 1R01AG055430, 1RF1AG068166, T32AG000037, 5R01AG056405, R01AG062711, K01AG064986].


Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Mental Health App Launches for NV Emergency Responders

Being a first responder can bring all kinds of challenges, and a new “app” – available free in Southern Nevada – is designed to help emergency responders assess their own mental health needs. Called psySTART, it was launched by the Responders Wellness Program of the Las Vegas Strong Resiliency Center.

Tiffany Oba, responder wellness coordinator for the Las Vegas Strong Resiliency Center, said it is “closely comparable” to another app called “MyFitnessPal,” but is for mental health. psySTART is the first app of its kind in Nevada and will allow first responders to conduct what she calls a “self-triage” for their own mental health needs.

“It lets them identify some of their triggers that they may be having, helps identify some of the issues that may not be present and forefront for them, but it gives them that tool,” she explained.

Oba added the app also provides the user with direct access to services and programs available in the Vegas Valley, and said emergency crews should not have to suffer in silence. According to the Substance Abuse and Mental Health Services Administration, about 30% of first responders develop conditions like depression and post-traumatic stress disorder due to the difficult situations they often face.

Oba said suicide rates are highest among firefighters and police officers, who deal with higher levels of trauma and stress than the average person, and added the app tracks the cumulative exposure to those stressors – and once a certain threshold of concern has been reached, it can provide confidential feedback to the responder for how to mitigate those mental challenges.

“We want to make sure that they have services and resources available to them, and this app helps put those services at their fingertips,” she continued.

Oba said the psySTART app is ready for all emergency response workers in the Vegas Valley, including hospital workers and security staff.

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Sociodemographic and Geographic Risk Factors for All-Cause Mortality in Patients with COPD

Introduction

In 2019, chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality worldwide.1 The progression of COPD displays strong heterogeneity, with some patients living decades with the disease and minimal symptoms, while others experience frequent exacerbations or early death. Most studies identifying predictors of COPD mortality are relatively small cohorts that focus on individual risk factors such as exacerbation rate, hospitalizations, lung function and comorbidities.2 Fewer studies are population based that include community risk factors. Identifying both individual and community risk factors associated with higher mortality in people with COPD is essential to improve outcomes.

Community risk factors such as neighborhood socioeconomic status and urbanicity have been identified as possible factors associated with differences in both respiratory disease severity and mortality.3 Higher COPD-specific mortality is reported in rural areas; however, the variation in death rates among people with COPD has not been assessed across the urban–rural gradient.4 Socioeconomic status (SES) is an additional important risk factor established as influencing COPD outcomes.3 Whether this disparity is attributed to differences in health care access, social risk factors, or environmental exposures is unknown. In addition, few population-level studies relating community risk factors to COPD mortality have included race.

Larger studies examining factors associated with increased mortality in COPD have used population-level aggregated data and are prone to ecological fallacy, when individuals are assigned characteristics representing an average across a broader geographic region. For example, higher rates of COPD may be associated with increased rurality in counties, but this does not necessarily indicate an individual who died in that county lived in a rural area. Exposure misclassification using population-level sociodemographic or health data may be driving variation and bias in research findings. A potential solution is the exploration of mortality in COPD patients using a large population with geographically precise exposures and spatially refined community measures, but few large studies have access to patient-level data.

To address this gap in knowledge, we used geographically precise patient-level data from a large cohort of patients with COPD to describe the associations between demographic characteristics and socioeconomic status with all-cause mortality.

Methods

Study Design, Data Source, and Participants

We performed a nationally representative retrospective cohort analysis of patients enrolled in the Veteran Health Administration (VHA) which provides care to Veterans of the United States and includes over 1000 health care facilities across the country and its territories. Electronic health record data were obtained from the national VHA Corporate Data Warehouse (CDW). The VHA CDW is a system-wide electronic repository of administrative and clinical data. Mortality data came from the CDW, Medicare claims, the Veterans Benefits Administration, and the Social Security Administration. Included were all patients across the United States and its territories, aged ≥35 and less than 100 years with at least one International Classification of Diseases, Ninth (ICD-9) or Tenth (ICD-10) Revision codes for COPD (ICD-9: 490–492, 496; ICD-10: J40, J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9) between 2016 and 2019. Specific age criteria were included to increase the specificity of the diagnosis of COPD. Demographic characteristics (age, gender, race), Charlson Comorbidity Index (CCI),5 and geocoded residential addresses were obtained from the CDW Patient Domain File and Vital Status Files. CCI was calculated prior to COPD diagnosis and therefore does not include COPD. Race and gender were self-reported. Those with a gender other than male or female (N=20) were excluded from analysis due to the relatively small sample size. We used patient’s residential addresses to spatially assign an Area Deprivation Index (ADI) percentile ranking of neighborhood-level socioeconomic status.6 ADI ranking is based on data from the American Community Survey which includes factors for income, education, and housing quality at the census block group level with 1 being the least deprived and 100 being the most deprived neighborhoods. Rurality is defined using the Rural–Urban Commuting Area (RUCA) codes, where “urban” are RUCA codes 1.0 or 1.1, “highly rural” is RUCA code 10.0, and “rural” is all others.7

Statistical Analysis

Descriptive statistics were used to summarize the demographics, comorbidities, quintile-binned ADI, and rurality of the cohort. We used an age-adjusted logistic regression model to assess the associations between sociodemographic and geographic characteristics and all-cause mortality. A second model adjusting for potential confounders including both biologic variables (age, sex, CCI) and socioeconomic variables (race, ADI, and rurality) was performed. Analysis was completed using R Statistical software (version 4.1.2).

Study Oversight

This retrospective study involved no more than minimal risk to the participants and was approved with waiver for informed consent by institutional review boards at the Minneapolis VA Health Care System (VAM-20-00583) and the University of Minnesota (STUDY00011069). All procedures were in accordance with the ethical standards of the Declaration of Helsinki, and participant confidentiality was protected.

Results

Participant Characteristics

Of the 1,106,163 patients with a diagnosis of COPD, 33.4% were deceased as of January 2021. The cohort was predominantly male (95.5%). White (78.3%) and Black/African American (13.2%) proportions were similar to racial breakdowns observed in the US general population (Table 1). While most of the cohort lived in urban areas (58.8%), an estimated 39.5% and 1.6% lived in rural and highly rural areas, respectively, which is higher than the general US population.

Table 1 Characteristics of Patients with Chronic Obstructive Pulmonary Disease (COPD)

Association of Race, ADI, and Rurality with All-Cause Mortality

In age-adjusted only models, male gender, Black/African American race, higher CCI score, higher neighborhood deprivation, and living in a more urban area were associated with higher odds of all-cause mortality. In contrast, females (aOR 0.67, [95% CI: 0.65–0.69]), Asian race (aOR 0.64, [95% CI: 0.59–0.70]), and living in a more rural area were associated with lower odds of all-cause mortality (Figure 1).

Figure 1 Odds ratios for all-cause mortality in COPD patients. Age-adjusted logistic models (A) and model adjusting for all other covariates (age, sex, race, CCI, ADI, rurality; (B)). Higher ADI indicates higher neighborhood disadvantage. Error bars denote 95% confidence intervals.

Abbreviations: ref, reference; ADI, Area Deprivation Index; CCI, Charlson Comorbidity Index.

Black/African American race was associated with 9% higher odds of all-cause mortality (95% confidence interval (CI): 1.08–1.11) compared to White race. The odds of all-cause mortality steadily increased with higher ADI quintile (greater neighborhood disadvantage). Compared to patients in ADI quintile 1, patients in ADI quintile 5 had aOR 1.30 [95% CI: 1.28–1.32] for all-cause mortality. Patients living in highly rural areas (aOR 0.92, [95% CI: 0.89–0.95]) had lower odds of all-cause mortality compared to patients living in urban areas.

After adjusting for age, CCI, race, ADI, and urbanicity, the odds of all-cause mortality associated with Black/African American race reversed from aOR 1.09 [95% CI: 1.08–1.11] to aOR 0.98 [95% CI: 0.96–0.99] and was associated with decreased odds of mortality. The odds of all-cause mortality with all other covariates remained similar in both models.

Discussion

The goal of this study was to identify risk factors associated with all-cause mortality in a large, diverse population of patients with COPD. This cohort is diverse by geography, socioeconomic status, and race. Like other studies, we found a significant association of all-cause mortality with co-morbidities and male sex.2 In our age-adjusted model, Black/African American race was also associated with increased mortality. In addition to individual characteristics, we found that higher neighborhood disadvantage and urbanicity were associated with a higher age-adjusted all-cause mortality. Interestingly, when we controlled for all covariates, the association of Black/African American race with all-cause mortality was abrogated.

In this cohort, we found an increase in association with all-cause mortality with increasing neighborhood disadvantage. Lower individual socioeconomic status has widely been accepted to be associated with poorer outcomes in chronic disease. In a systematic review by Gershon et al, five studies described an inverse association of socioeconomic status with COPD mortality.8 All these studies explore socioeconomic status based on individual characteristics, such as occupation, education and income, with one study containing over two million individuals. None were based on community or neighborhood socioeconomic status, as we used for this study. The causal factors of socioeconomic status with increased mortality are not fully understood. Gaps in health equity are associated with socioeconomic status. For example, lower SES has been associated with lower influenza vaccination rate, the latter is associated with higher COPD mortality.9 For our population, all patients were enrolled in the VA Health Care System suggesting financial barriers to healthcare (eg, lack of insurance or high copays) were less likely significant contributors. However, many other factors associated with lower neighborhood SES, including poor air quality and deficient housing, need to be considered.

In our VA patient cohort, we found urban areas to be associated with higher all-cause mortality in people with COPD. This is notable because population studies observe people living in rural areas have higher rates of COPD-related mortality compared to people living in urban areas.4 This difference is likely secondary to a higher baseline prevalence of COPD in rural areas. Urban areas are associated with higher levels of air pollution, as measured by PM2.5, in part due to the proximity to high volume roadways. Living in proximity to major roadways is associated with increased COPD and cardiovascular mortality.10 Measurements of air pollution and/or proximity to major roadways may help define the association of urbanicity with mortality.

An interesting finding in our study was the association of all-cause mortality with race. In our analysis, we found Asian race was associated with lower odds and Black/African American race was associated with a higher odds of all-cause mortality in our age-adjusted model. However, this reversed for Black/African American when adjusted for all covariates including age, CCI, race, ADI, and urbanicity. This implies that race alone is not a determinant in all-cause mortality and that other factors included in our model, such as socioeconomic status, co-morbidities and urbanicity, influence the outcome. Further studies are necessary to evaluate the factors that contribute most to mortality in Black/African Americans with COPD.

The strength of our study includes a large and geographically broad cohort with patient-level data and precise residential geocodes to support spatially accurate assignments of neighborhood characteristics. Unlike other studies, this VA study is not subject to the geographic or age limitations found in insurance or Medicare datasets and supports the investigation of individuals with a pre-existing condition, such as COPD. The choice of all-cause mortality reduces biases in the attribution of the cause of death. The exact cause of death can be imprecise, particularly in people with multiple comorbidities, including chronic respiratory diseases where people often die from cardiovascular causes rather than respiratory failure.

Limitations include a predominantly male population and aggregated RUCA codes, with some suburbs being classified as rural. Since our population is limited to those seeking care in the Veterans Hospital Administration, our service-based cohort is biased towards males and limits our capacity to make conclusions for female populations. As is true in medical practice, the diagnosis of COPD in this study may not be accurate. We have chosen to define COPD as having at least a single encounter with COPD ICD code and age ≥35, rather than multiple encounters or a COPD hospitalization. Prior studies show that although COPD is frequently over-diagnosed, it is also under-diagnosed in a significant proportion of cases.10 One factor contributing to misdiagnosis is underutilization of spirometry which is also a limitation in this observational study. Unexplored environmental exposures and comorbidities may additionally contribute to our associations. Exposure during military deployment may contribute to COPD progression and outcomes, although the long duration between service and COPD in our older population makes this less likely. In addition, smoking status was not available and is a known contributor to COPD outcomes. Air pollution was not explored but is another important contributor to early death and increased cardiovascular events.10

In conclusion, all-cause mortality in patients with diagnosis of COPD is disproportionately higher in patients living in poorer neighborhoods and urban areas, suggesting the impact of social determinants of health on COPD outcomes. Black race was associated with higher age-adjusted all-cause mortality, but this association was abrogated after adjusting for gender, socioeconomic status, comorbidities, and urbanicity. Future studies should focus on exploring mechanisms by which disparities arise and developing interventions to address these.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

This research was supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute grant T32 HL007741-23 (CR) and National Center for Advancing Translational Sciences, grants KL2TR002492 and UL1TR002494 (AKB). This material is the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System. The views expressed in this article are those of the authors and do not reflect the views of the United States Government, the Department of Veterans Affairs, the National Institutes of Health, the National Institutes of Health’s National Center for Advancing Translational Sciences or any of the authors’ affiliated academic institutions.

Disclosure

All authors declare that they have no conflict of interests related to this study.

References

1. World Health Organization. Chronic Obstructive Pulmonary Disease (COPD). World Health Organization; 2022. Available from https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd). Accessed July 17, 2023.

2. Celli BR. Predictors of mortality in COPD. Respir Med. 2010;104(6):773–779. doi:10.1016/j.rmed.2009.12.017

3. Brigham E, Allbright K, Harris D. Health disparities in environmental and occupational lung disease. Clin Chest Med. 2020;41(4):623–639. doi:10.1016/j.ccm.2020.08.009

4. Croft JB, Wheaton AG, Liu Y, et al. Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(7):205–211. doi:10.15585/mmwr.mm6707a1

5. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–1139. doi:10.1097/01.mlr.0000182534.19832.83

6. Kind AJH, Buckingham W. Making neighborhood disadvantage metrics accessible: the neighborhood atlas. N Engl J Med. 2018;378:2456–2458. doi:10.1056/NEJMp1802313

7. USDA ERS – Rural-Urban Commuting Area Codes. Rural-urban commuting area codes. United States Department of Agriculture; 2020. Available from: https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/. Accessed October 24, 2022.

8. Gershon AS, Dolmage TE, Stephenson A, Jackson B. Chronic obstructive pulmonary disease and socioeconomic status: a systematic review. COPD. 2012;9(3):216–226. doi:10.3109/15412555.2011.648030

9. Vukovic V, Lillini R, Lupi S, et al. Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review. Eur J Public Health. 2020;30(1):132–141. doi:10.1093/eurpub/cky264

10. Rosenbloom JI, Wilker EH, Mukamal KJ, Schwartz J, Mittleman MA. Residential proximity to major roadway and 10-year all-cause mortality after myocardial infarction. Circulation. 2012;125(18):2197–2203. doi:10.1161/CIRCULATIONAHA.111.085811

NYU study shows Black women may have uncommon symptoms of depression

Experts say you should know the signs of mental illness— but what do you look for when it can all look different for everyone?

LITTLE ROCK, Ark. — You may have heard the saying, “prioritize your mental health,” but how exactly do you prioritize something that looks so different for everyone?

A recent study that was conducted by New York University shows how depression may be increasingly difficult to diagnose for Black women.

The study analyzed data from 227 Black women with children.

As part of a larger study that looked into high blood pressure, researchers screened the women for depression.

What the study found is that Black women reported symptoms of sleep disturbances, self-criticism, and irritability, rather than typical depression symptoms like feelings of hopelessness or depressed mood.

“Based on our findings, it’s possible that health care providers may miss depression symptoms in Black women, resulting in underdiagnosis and undertreatment,” said Nicole Perez, Ph.D., RN, 

She’s a psychiatric-mental health nurse practitioner and a postdoctoral associate at NYU Rory Meyers College of Nursing. She’s also the lead author of the study that was published in Nursing Research.

The study also found that Black women with signs of depression also reported having a low sex drive, feelings of self-hate, and self-blame— rather than those more common symptoms.

This issue has not only been happening at the national level but it has also been seen by NYU researchers, and it has affected Black women in Arkansas too.

We spoke with local women in Arkansas who experienced changes within themselves, not realizing those changes were signs of depression.

Nakala Jones is a mom of five who just completed nursing school and has also been running her own candle business.

“The process is kind of long, it’s not just the wax, the wick, there you go. It has to be like chemistry in there and the right fragrance,” Jones described.

Starting this candle business was something she created that brought her peace and joy.

It also helped bring Jones out of postpartum depression.

“Excessive crying, distancing myself from family, wanting to be alone,” were all symptoms Jones said she faced.

As things got worse, Jones decided she should seek help.

“The lack of sleep, the lack of eating, the lack of concentration, my mood is up and down, my excessive crying.” Jones went on to say, “I have to do something about this because it’s making me and my family very uncomfortable.”

Though those symptoms align with postpartum depression, they’re also symptoms that doctors say they’ve been seeing more in Black women outside of the traditional postpartum window.

This finding has led researchers to believe that symptoms like these are more common for Black women with depression in general.

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Mariah Sumlin is a licensed counselor in Little Rock who explained that Black women in particular should pay closer attention when things don’t feel normal.

“With depressive symptoms, they can present in all types of ways. High-functioning depression is very common not only among African American women but among African American adolescents as well,” she described.

Sumlin also said that because Black women may be more “high-functioning,” it could cause depression to fly under the radar.

“On the outside, they’re doing great, until you talk to them, or they open up about those experiences, you’ll never know,” she added.

Olympia Atkinson is a mother, a teacher, and a Veteran who shared how she also missed the early signs of depression.

Back in 2017, she was diagnosed with depression and bipolar disorder.

“It was untreated, and I didn’t know. The activities, and the training we endure as soldiers, can be stressful. It can affect you mentally,” she said.

Those near and dear to Atkinson recognized something was different before she even realized it herself.

“I would have highs and lows. I would maybe react impulsively or become maybe aggressive towards family and friends,” Atkinson described.

She credits her family and friends, for helping her get the right treatment and getting her back on track.

“I’m so lucky and blessed that I had my mom who at the time became my caregiver because I couldn’t take care of my kids,” she said.

Seeking the proper care and having an outlet helped get both Jones and Atkinson to a better place.

For Jones, she poured herself into her candle business. For Atkinson, her outlet was writing.

“I wrote jokes, I wrote poetry, I wrote music, and it’s always been something I could depend on. When I was in the mental health facility, I remember asking them for paper and a pencil,” said Atkinson.

Though it’s not just about seeking treatment, Sumlin said another important factor in getting Black women the help they need is an increased understanding of the uncommon symptoms that they face.

“One thing we practice in therapy is actively listening and interpreting it in the way they’re saying it. Not in the way you’re wanting them to say it. When you do that, you’re able to better understand that person’s experience uniquely for them,” she said.

Therapists are now urging increased studies specifically focused on Black women to help expand access to care.

“If you don’t know the signs, you don’t know what to look for,” Jones concluded.

For more information on the study done by New York University, please click here.

Democrats Smear RFK Jr. as Anti-Semitic

In the wake of Democratic presidential candidate Robert F. Kennedy Jr. talking about whether COVID-19 had been genetically engineered and had its least effect on “the people who are most immune” — “Ashkenazi Jews and Chinese” — two facts are evident.

First, context is everything. And the underlying context here is that RFK Jr. is challenging the Democrat Party Establishment, which is currently in the care of President Joe Biden. Which is to say, as with most party insurgents (of either party!), a challenge to the status quo as run by the party establishment is decidedly not received well. On the Democratic side, history shows Establishment Democrats going after RFK Jr.’s own father in 1968, when he challenged incumbent Democrat President Lyndon B. Johnson. In 1980, the Democrat Establishment was furious with RFK Jr.’s uncle Sen. Ted Kennedy for challenging incumbent Democrat President Jimmy Carter for renomination. The lesson? The Democrat Party Establishment — no matter who is in charge — takes a dim view of being challenged and, especially, of the challengers.

RFK Jr. is challenging the Establishment big time — and the Establishment doesn’t like it.

Shocking.

Not.

For Americans of either party who love democracy, the RFK Jr. challenge is bracing and deserving of applause, whether he wins or not.

Second, to start with, Kennedy has been discussing a hard-core scientific fact that yes, in fact, some ethnic populations are more vulnerable to a disease than others. Anyone with a rudimentary knowledge of history and science knows this is accurate.

Here are but a few examples.

This from WebMD:

Why 7 Deadly Diseases Strike Blacks Most

Health care disparities heighten disease differences between African-Americans and white Americans.

Then there was this from U.S. News & World Report:

COVID-19’s Tragic Effect on American Indians: A State-by-State Analysis

This report begins by saying this:

In the United States, people of color have been disproportionately impacted by the coronavirus pandemic, and Native Americans are no exception. According to the Centers for Disease Control and Prevention, American Indian and Alaska Native people are 5.3 times more likely than white people to be hospitalized due to COVID-19, the largest disparity for any racial or ethnic group.

This next one is also from U.S. News & World Report:

What Makes Ashkenazi Jews More Susceptible to Breast Cancer?

In other words? To suggest as RFK Jr. did that a particular disease — COVID-19, in this case — could have a more disproportionate effect on some ethnic groups than on others — with “Ashkenazi Jews and Chinese” being less susceptible than others — is hardly anti-Semitism. RFK was simply repeating a known and easily demonstrable scientific fact that, depending on the disease, some ethnic groups are affected differently.

But there is more to the disgraceful charge that discussing science makes RFK Jr. “anti-Semitic.”

Hello? Do the Kennedy critics have any idea of the effect anti-Semitism has tragically had directly on the life of RFK Jr. and his siblings and mother?

As someone who is old enough to recall the assassination of his father in 1968, it is apparently the moment to educate RFK Jr.’s critics who are smearing him as anti-Semitic.

What follows is hardly new information. It was everywhere during the day. But here are the basics, in this case from a biography of his father, Bobby Kennedy: The Making of a Liberal Icon, by Larry Tye.

Tye describes the immediate aftermath of the shooting:

The next twenty-five hours were a hellish whirlwind. When the police showed up at the hotel about fifteen minutes after the shooting — Chief Reddin says they weren’t there originally because “we were asked not to be” — they quickly assembled evidence that the gunman was a twenty-four-year-old Palestinian named Sirhan Sirhan who hated Israel, hated Kennedy for supporting Israel, and shot the senator a year to the day after the start of the Six-Day War in which Israel routed its Arab enemies.

Decades later, RFK Jr. pushed for a reinvestigation, as reported here in the Times of Israel:

Kennedy’s son and namesake, Robert F. Kennedy Jr, is not convinced the Palestinian-born convict did it, or at least not alone, and wants a fresh investigation of the assassination — an appeal which is supported by only one of his eight surviving siblings.

Which is to say, quite understandably, that RFK Jr.’s adult self wanted to get to the bottom of his father’s murder. His father was, says the historical record in blunt terms, murdered by Sirhan Sirhan, a Palestinian with a seriously on-the-record hatred of Israel — which is to say, Jews. All of which was recorded in the day.

To suggest, as RFK Jr.’s critics are doing, that the son of the man assassinated by a decided Israel-hater is now himself an anti-Semite?

This would be a disgrace. There is zero record out there that RFK Jr. has any time for anti-Semitism. And if he ever needed a reason to understand its poison, he received it on a hot June night in a Los Angeles hotel kitchen in 1968.

The decidedly appalling real fact here is that those inside the Democratic Establishment have put on a vivid display of historical ignorance about anti-Semitism and Robert Kennedy — father and son — that should embarrass all of them.

And they should be ashamed of themselves.

BVHS Column: Asthma

Asthma is a heterogeneous respiratory disease that affects an estimated 25 million Americans, with six million being children. The financial cost of asthma exceeds $81 billion every year and despite all the resources invested, asthma is responsible for over 3,500 deaths annually in the nation. The prevalence of asthma is proven to be higher among individuals of low socioeconomic status in contrast to those with higher socioeconomic status.

Generally, there has been a lack of priority in the effects and differences in asthma prevalence among populations as well as the response to therapies among racial and ethnic minorities. To illustrate, African American patients respond differently to corticosteroids in contrast with White patients. One study suggests Hispanic and non-Hispanic White children exhibit better responses to increasing therapy with Long-Acting Beta Agonist (LABA), rather than higher doses of Inhaled Corticosteroids (ICS), whereas African American children were less likely to respond to adding leukotriene receptor antagonists, and more likely to respond to increasing dosing of ICS.

Genetic variants in the receptors for these pharmaceutical agents may be the potential explanation for these response variations according to racial background. More recently, the therapeutic approach to asthmatic patients has been broadened by better phenotypic characterization and the recognition of particular inflammatory pathways that can be targeted through novel medications produced in living organisms. These medications are commonly known as biologicals. Though biologicals are proven to significantly improve outcomes for patients, racial groups and socioeconomic status still play a factor in access to specialty care in addition to income ranking. These barriers still fully need to be identified and addressed.            

Diet is also a major factor in asthma symptoms. Certain diet structures can cause systemic inflammation, oxidative stress, and the microbiome all have notable effects on asthma. In the United States, 12 percent of households are limited or unable to obtain adequate food, notably being highly prevalent among racial and ethnic minority groups. Moreover, racial and ethnic minority populations are more likely to live in urban areas which have limited access to fresh quality foods at affordable prices. To help governmental efforts such as the Supplemental Nutritional Assistance Program also known as “SNAP” have shown significant benefits in reducing the number of emergency room visits due to asthma and could contribute to eliminating the “eat or breathe” challenge that many low-income families face and overall health care.

Air pollution is another significant culprit in asthma cases. An estimated four million cases of new pediatric asthma are attributed to a single pollutant: nitrogen dioxide (NO2), which is a gas commonly associated with traffic pollution. Despite progress being made, three decades later, air pollutants affect predominately populated neighborhoods by minorities far greater than White neighborhoods. Asthma prevalence is also associated with poor housing, relating to a higher instance of emergency room visits. Overall health outcomes are reliant on housing quality, affordability, and stability.

In conclusion, efforts to recruit and include populations of minority origin need to be made, unfortunately, clinical trials thus far do not report the distribution of race and ethnicity in their participants. In the United States, prevalence rates are overwhelmingly disproportionate in racial and ethnic minorities. To aid in conditions causing asthma in these existing disparities, housing and environmental policies must be set in place, as well as continued efforts in identifying contributing factors. With persistence, these systematic efforts will assist in diminishing asthma-related health disparities.

Jami Koziel, RRT, CPFT                      Pulmonary Services                        Blanchard Valley Health System

Harris Health proposes new $2.5 billion bond proposal to improve wait times, lines at LBJ Hospital

HOUSTON, Texas (KTRK) — Officials with Harris Health fielded questions from the public in a community forum on Monday evening as they presented the latest details on their $2.5 billion bond proposal to build a new Lyndon B. Johnson Hospital. Patients often reported waiting in long lines for hours to get into the emergency room.

Leron Bradford brought his mother in for urgent care at LBJ Hospital on Monday. He told ABC13 at that point she waited 45 minutes and counting to see a doctor. But it wasn’t an uncommon experience for their family.

“It’s packed in there. The emergency room line is out the door. There’s people covered in blankets and stuff cause they’ve been sitting so long waiting. Some people sleep because they’ve been waiting so long,” Bradford said. “It’s like this every day, not just today. They need more space, more doctors, more everything here.”

READ MORE: LBJ and Ben Taub make staffing adjustments to deal with COVID-19 surge

Harris Health President and CEO Dr. Esmaeil Porsa said the strain on space and staff has long been a critical problem for the hospital. He explained the facility was already too small to handle the demand 30 years ago when he first started his training. Since then, the county’s population has more than doubled in size.

“When I visit the hospital, I see patient beds in the hallways of the hospital because we don’t have rooms to put our patients in. That’s how our nurses take care of our patients in the hallways, and it’s the same thing with the emergency room. We have people waiting in excess of 24 hours in the ER to be seen. That’s what got me emotional,” said Porsa.

That’s why Porsa said he presented a $2.5 billion bond proposal to Harris County Commissioners in June, $1.6 billion of which will go to building a new hospital on the LBJ campus. The other $400 million will be invested in increasing capacity at Ben Taub Hospital, and $500 million will be used for community clinics.

Harris Health plans to spend an additional $400 million from philanthropic funds, operational cash, and personal cost savings to refurbish the existing LBJ hospital and provide other services, such as inpatient and acute psychiatric care.

READ MORE: ‘Please send help now’: Lyndon B. Johnson Hospital staff say they’re beyond breaking point

The expansion aims to help bridge health disparities for the people they treat across Harris County, 46% of which are uninsured, and 21% use Medicaid or CHIP, a low-cost health care program for children. Breaking it down by ethnicity, 52.9% of patients are Hispanic/Latino, 24% are African American, 14.4% Caucasian, and 8.7% Asian and other.

“This is the first time the Harris Health system is going to the voters of Harris County for a bond proposal. For us being the largest public health system in the state of Texas, it shouldn’t be that way when you compare us to other public health systems in the state of Texas. Normally every 5 to 10 years, hospital systems go to voters for a bond proposal to expand services and invest in their infrastructure,” Porsa said.

Bishop James Dixon, president of NAACP Houston, said their goal is to keep the decision-makers accountable. His organization hosted Monday’s community forum at the Community of Faith Church, along with the Community Leadership Coalition for Accountability that, includes more than 30 leaders and organizations.

“The death age amongst vulnerable people in Northeast Houston is about 15 to 20 years younger than those in the suburbs. We have some very deep systemic issues that affect their quality of life like health deserts. The fact is that minorities lead to hypertension, cancer, and high blood pressure. We believe this is an opportunity for Harris Health to do some things proactively for preventative healthcare,” Dixon said.

“We’re not going to give this bond proposal our support as leaders if it does not meet the smell test if it does not satisfy major questions about the future health of our community and the economic viability of our community at the same time. This is an opportunity to really see an upsurge in what minority-owned businesses can experience when it comes to construction, operators, and community services,” he added.

This event is one of several that’s been held regarding to the bond. Porsa said Harris County Commissioners are scheduled to vote on Aug. 17 on whether to approve the bond for the November ballot.

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