UCLA Luskin School of Public Affairs

This article demonstrates-based on an interpretive discourse analysis of three types of memes (Rabid Feminists, Women's Bodies, Policy Ideas) and secondary thread discourse on 4chan's "Politically Incorrect" discussion board-two key findings: (1) the existence of a gendered hate based scientific discourse, "science fan fiction," in online spaces and (2) how gender "science fan fiction" is an outcome of the male supremacist cosmology, by producing and justifying resentment against white women as being both inherently untrustworthy (politically, sexually, intellectually) and dangerous. This perspective-which combines hatred and distrust of women with white nationalist anxieties about demographic shifts, racial integrity, and sexuality-then motivates misogynist policy ideas including total domination of women or their removal. 4chan users employ this discourse to "scientifically" substantiate claims of white male supremacy, the fundamental untrustworthiness of white women, and to argue white women's inherent threat to white male supremacist goals.

Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 min increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients quicker and sicker, rather, AMI patients recovered more quickly due to an improvement in care quality per day.

There is growing attention to how unfounded beliefs about biological differences between racial groups affect biomedical research and health care, in part, through race adjustment in clinical tools. We develop a case study of the Eighth Joint National Committee (JNC 8)'s 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, which recommends a distinct initial hypertension treatment for Black versus nonblack patients. We analyze the historical context, study design, and racialized findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that informed development of the guideline. We argue that ALLHAT's racialized outcomes emanated from a poor and artificial study design and analysis weakened by implicit assumptions about race as biological. We show that the acceptance and utilization of ALLHAT for race correction arises from its historical context within the "inclusion-and-difference paradigm" and its indication of the inefficacy of angiotensin-converting-enzyme inhibitors for Black patients, which follows from the enduring, yet, refuted slavery hypertension hypothesis. We demonstrate that the JNC 8 guideline displays the self-fulfilling process of racial reasoning: presuppositions about racial differences inform the design and interpretation of research, which then conceptually reinforce ideas about racial differences leading to differential medical treatment. We advocate for the abolition of race adjustment and the integration of structural competency, biocritical inquiry, and race-conscious medicine into biomedical research and clinical medicine to disrupt the use of race as a proxy for ancestry, environment, and social treatment and to address the genuine determinants of racialized disparities in hypertension.

Immigrants without legal or long-term residency are even more likely to be purposefully excluded from public healthcare or healthcare assistance. Due to the Healthy Illinois campaign and network of health equity-focused organizations, Illinois has made much progress in expanding Medicaid-like healthcare services to all low-income residents in Illinois, regardless of immigration status. Currently, Illinois has three immigrant-focused healthcare programs that are almost functionally identical to federal Medicaid: All Kids (ages 0-18), Health Benefits of Immigrant Seniors (ages 65+), and Health Care for Immigrant Adults (ages 42-64). As a result, immigrants who are federally ineligible for Medicaid between the ages of 0 to 18 and 42+ have access to state healthcare coverage. However, there is a gap in coverage for those ages 19 to 41. Using enrollment data from the Illinois Department of Health and Family Services (HFS) and analyzing interviews with HBIS/A enrollees and healthcare providers, we identified important program data such as enrollment rates, insurance claims, program costs, health conditions affecting enrollees, and gaps in program or health resources. From that analysis, a few main findings emerged. First, there are enrollees in both HBIA and HBIS throughout the state. These programs benefit not only the densely populated Cook County but the affected population that resides throughout Illinois in every community. Second, there are more 42-54-year-olds enrolled in HBIA than any other age group enrolled in HBIA or HBIS. Several factors may contribute to this enrollment rate and we encourage the program administrators to consider potential program barriers for older populations. Third, enrollees credited community-based organizations in assisting them through the application process. These organizations are a critical part of the care network.Based on data analysis informed by this research, we have provided Healthy Illinois with supporting data and recommendations for expanding Medicaid-like healthcare benefits to immigrant adults in the 19-41 age group.

We examine pre-COVID declines in transit ridership, using Southern California as a case study. We first illustrate Southern California's unique position in the transit landscape: it is a large transit market that demographically resembles a small one. We then draw on administrative data, travel diaries, rider surveys, accessibility indices, and Census microdata for Southern California, and demonstrate a strong association between rising private vehicle access, particularly among the populations most likely to ride transit, and falling transit use. Because we cannot control quantitatively for the endogeneity between vehicle acquisition and transit use, our results are not causal. Nevertheless, the results strongly suggest that increasing private vehicle access helped depress transit ridership. Given Southern California's similarity to most US transit markets, we conclude that vehicle access may have played a role in transit losses across the US since 2000.

Long-acting injectable antiretroviral medications are new to HIV treatment. People with HIV may benefit from a treatment option that better aligns with their preferences, but could also face new challenges and barriers. Authors from the fields of HIV, substance use treatment, and mental health collaborated on this commentary on the issues surrounding equitable implementation and uptake of LAI ART by drawing lessons from all three fields. We employ a socio-ecological framework beginning at the policy level and moving through the community, organizational, interpersonal, and patient levels. We look at extant literature on the topic as well as draw from the direct experience of our clinician-authors.

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UNLABELLED: While the COVID-19 pandemic upended many aspects of life as we knew it, its effects on U.S. public transit were especially dramatic. Many former transit commuters began to work from home or switched to traveling via private vehicles. But for those who continued to work outside the home and could not drive-who were more likely low-income and Black or Hispanic-transit remained an important means of mobility. However, most transit agencies reduced service during the first year of the pandemic, reflecting reduced ridership demand, increasing costs, and uncertain budgets. To analyze the effects of the pandemic on transit systems and their users, we examine bus ridership changes by neighborhood in Boston, Houston, and Los Angeles from 2019 to 2020. Combining aggregated stop-level boarding data, passenger surveys, and census data, we identify associations between shifting travel patterns and neighborhoods. We find that early in the pandemic, neighborhoods with more poor and non-white households lost proportionally fewer riders; however, this gap between high- and low-ridership-loss neighborhoods shrank as the pandemic wore on. We also model ridership change controlling for multiple factors. Ridership in Houston and LA generally outperformed Boston, with built environment and demographic factors accounting for some of the observed differences. Neighborhoods with high shares of Hispanic and African American residents retained more riders in the pandemic, while those with higher levels of auto access and with more workers able to work from home lost more riders, all else equal. We conclude that transits social service role elevated during the pandemic, and that serving travelers in disadvantaged neighborhoods will likely remain paramount emerging from it. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11116-022-10345-1.