Jarvis T Chen

• Harvard University

Controlling partner dynamics—when a person’s sexual or romantic partner exerts disproportionate control over their behavior and/or joint decisions—can adversely impact sexual and mental health. For transgender and/or nonbinary (TNB) young adults, cissexism—the system of power relations that marginalizes TNB people in favor of cisgender people—may c...

Our descriptive study examined current associations (2022–2024) between US state-level health outcomes and 4 US state-level political metrics: 2 rarely used in public health research (political ideology of elected representatives based on voting records; trifectas, where 1 party controls the executive and legislative branches) and 2 more commonly u...

Context Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention’s (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for co...

Transgender and gender diverse (TGD) adults experience increased discrimination and victimization relative to cisgender adults, thus elevating their risk for suicidal ideation (SI). Social support and connection to the broader TGD community may mitigate the relationship between gender identity-based stressors (i.e., interpersonal minority stressors...

Importance Epigenetic age acceleration is associated with exposure to social and economic adversity and may increase the risk of premature morbidity and mortality. However, no studies have included measures of structural racism, and few have compared estimates within or across the first and second generation of epigenetic clocks. Objective To dete...

Controlling partner dynamics—when a person’s sexual or romantic partner exerts disproportionate control over their behavior and/or joint decisions—can adversely impact sexual and mental health. For transgender and/or nonbinary (TNB) young adults, cissexism—the system of power relations that marginalizes TNB people in favor of cisgender people—may c...

Racialized healthcare inequities in the USA remain glaring, yet root causes are understudied. To address this gap, we created a state-level structural racism legal index (SRLI) using the Structural Racism-Related State Law Database and analyzed its association with racialized inequities in four outcomes (lacking health insurance coverage, lacking a...

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

Importance. Epigenetic accelerated aging is associated with exposure to social and economic adversity and may increase risk of premature morbidity and mortality. However, no studies have included measures of structural racism and few have compared estimates within or across the 1st and 2nd generation of epigenetic clocks (the latter additionally tr...

Importance: DNA methylation (DNAm) provides a plausible mechanism by which adverse exposures become embodied and contribute to health inequities, due to its role in genome regulation and responsiveness to social and biophysical exposures tied to societal context. However, scant epigenome-wide association studies (EWAS) have included structural and...

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

Most evaluations of health equity policy have focused on the effects of individual laws. However, multiple laws' combined effects better reflect the crosscutting nature of structurally racist legal regimes. To measure the combined effects of multiple laws, we used latent class analysis, a method for detecting unobserved "subgroups" in a population,...

Objectives: Understanding how environmental and social stressors cluster is critical to explaining and addressing health disparities. It remains unclear how these stressors cluster at fine spatial resolution in low to medium-income, urban households. We explored patterns of environmental and social exposures at the household-level and potential pr...

The U.S. Census Bureau will implement a modernized privacy-preserving disclosure avoidance system (DAS), which includes application of differential privacy, on publicly released 2020 census data. There are concerns that the DAS may bias small-area and demographically stratified population counts, which play a critical role in public health research...

Objectives The focus of this study was to calculate and contextualize response rates for a community-based study conducted during the COVID-19 pandemic, a topic on which scant data exist, and to share lessons learned from recruiting and enrolling for implementation of future studies. Design The Life+Health Study, a cross-sectional population-based...

Epigenetic clocks are increasingly being used as a tool to assess the impact of a wide variety of phenotypes and exposures on healthy ageing, with a recent focus on social determinants of health. However, little attention has been paid to the sociodemographic characteristics of participants on whom these clocks have been based. Participant characte...

Lesbian, gay, bisexual, transgender/nonbinary, and queer (LGBTQ +) adolescents experience considerable disparities in dating violence and sexual assault victimization relative to heterosexual and cisgender peers. These disparities may be driven in part by the disruptive effects of heterosexism and cissexism on school-based and family relationships....

Objectives. To examine whether, and if so how, US national and state survey response rates changed after the onset of the COVID-19 pandemic. Methods. We compared the change in response rates between 2020 and 2019 of 6 (3 social and economic, 3 health focused) major US national surveys (2 with state response rates). Results. All the ongoing surveys...

Areal spatial misalignment, which occurs when data on multiple variables are collected using mismatched boundary definitions, is a ubiquitous obstacle to data analysis in public health and social science research. As one example, the emerging sub-field studying the links between political context and health in the United States faces significant sp...

The COVID-19 pandemic has had intense, heterogeneous impacts on different communities and geographies in the United States. We explore county-level associations between COVID-19 attributed deaths and social, demographic, vulnerability, and political variables to develop a better understanding of the evolving roles these variables have played in rel...

Adolescent sexual harassment victimization is increasingly recognized as a strong risk factor for dating violence victimization and perpetration. Research on this association has focused on older adolescents and on sexual harassment at a single time point rather than chronic exposure. Furthermore, potential mechanisms, such as psychological distres...

Epigenetic clocks are increasingly being used as a tool to assess the impact of a wide variety of phenotypes and exposures on healthy ageing, with a recent focus on social determinants of health. However, little attention has been paid to the sociodemographic characteristics of participants on whom these clocks have been based. Participant characte...

DNA methylation (DNAm) is commonly assayed using the Illumina Infinium MethylationEPIC BeadChip, but there is currently little published evidence to define the lower limits of the amount of DNA that can be used whilst preserving data quality. Such evidence is valuable for analyses utilizing precious or limited DNA sources. We used a single pooled s...

Background: We characterized informally employed US domestic workers' (DWers) exposure to patterns of workplace hazards, as well as to single hazards, and examined associations with DWers' work-related and general health. Methods: We analyzed cross-sectional data from the sole nationwide survey of informally employed US DWers with work-related h...

US Census Bureau (USCB) has implemented a new privacy-preserving disclosure avoidance system (DAS), which includes application of differential privacy (DP), on the public-release 2020 decennial census data. There are increasing concerns among social scientists, epidemiologists, and public health practitioners that DP may bias small-area and demogra...

Recent studies showed that implicit measures are valuable instruments for assessing exposure to discrimination and predicting negative physical conditions. Between March 10, 2020, and April 1, 2020, we conducted three experiments (577 participants) in the USA to evaluate the use of group-specific vs. general race/ethnicity categories in implicit me...

Objectives We characterized informally employed US domestic workers’ (DWers) exposure to patterns of workplace hazards, as well as singular hazards, and examined associations with DWers’ work-related and general health. Methods We analyzed cross-sectional data from the sole nationwide survey of informally employed US DWers with work-related hazard...

Introduction: Few studies, mostly descriptive, have quantitatively analyzed the working conditions of domestic workers (DWers) informally employed by private households in the USA. These workers are explicitly or effectively excluded from numerous workplace protections, and scant data exist on their exposures or how best to categorize them. Metho...

Background Scant research has analyzed contemporary US cancer incidence rates in relation to historical redlining, ie, 1930s US federally-imposed residential segregation, implemented via the color-coded federal Home Owners’ Loan Corporation (HOLC) maps. Methods We analyzed Massachusetts Cancer Registry data for all cases of primary invasive breast...

Background: DNA methylation (DNAm) is commonly assayed using the Illumina Infinium MethylationEPIC BeadChip, but there is currently little published evidence to define the lower limits of the amount of DNA that can be used whilst preserving data quality. Such evidence is valuable for analyses utilising precious or limited DNA sources. Materials and...

Small area estimates of population are necessary for many epidemiological studies, yet their quality and accuracy are often not assessed. In the United States, small area estimates of population counts are published by the United States Census Bureau (USCB) in the form of the Decennial census counts, Intercensal population projections (PEP), and Am...

Purpose: Stroke is a leading cause of mortality worldwide, and air pollution is the third largest contributor to global stroke burden. Existing studies investigating the association between long-term exposure to particulate matter (PM) and stroke incidence have been mixed and very little is known about the associations with medium-term exposures....

Health inequities are assessed by health departments to identify social groups disproportionately burdened by disease and by academic researchers to understand how social, economic, and environmental inequities manifest as health inequities. To characterize inequities, group-specific small-area health data are often modeled using log-linear general...

Eviction upends children's lives and exacerbates deprivation; it remains largely unexamined as a determinant of cognitive development. We assess whether children evicted in infancy, early childhood, and middle childhood exhibit lower scores on four cognitive assessments (measuring executive function, mathematical reasoning, written language skills,...

Importance More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. Objective To investigate the association between Medicai...

The ubiquity of smartphones, with their increasingly sophisticated array of sensors, presents an unprecedented opportunity for researchers to collect longitudinal, diverse, temporally-dense data about human behavior while minimizing participant burden. Researchers increasingly make use of smartphones for “digital phenotyping,” the collection and an...

Background Fatal police violence in the United States disproportionately affects Black, Native American, and Hispanic people, and for these groups it is a racially oppressive population-level stressor that we hypothesize increases the risk of pregnancy loss. Focusing on core based statical areas (CBSAs) surrounding small and large urban centers, we...

Background Identifying county-level characteristics associated with high coronavirus 2019 (COVID-19) burden can help allow for data-driven, equitable allocation of public health intervention resources and reduce burdens on health care systems. Methods Synthesizing data from various government and nonprofit institutions for all 3142 United States (...

6543 Background: After state-mandated cessation of screening mammography (SM) in Spring 2020 due to COVID-19, centers were urged to resume screening, particularly of patients at increased risk. As our tertiary-care medical center’s screening program provides SM at four sites across our metropolitan area, we examined whether sites that historically...

Background Inequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes.Objective Use available data to characterize COVID-19 mortality...

Across the United States public health community in 2020, in the midst of a pandemic and increased concern regarding racial/ethnic health disparities, there is widespread concern about our ability to accurately estimate small-area disease incidence rates due to the absence of a recent census to obtain reliable population denominators. 2010 decennia...

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Background To date, research assessing discrimination has employed primarily explicit measures (i.e., self-reports), which can be subject to intentional and social desirability processes. Only a few studies, focusing on sex and race/ethnicity discrimination, have relied on implicit measures (i.e., Implicit Association Test, IAT), which permit asses...

Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this paper, we test whether infants experiencing an adverse birth outcome—low birthweight or prematurity, as well as lengthy hospital stays—are more lik...

Over 390 million people worldwide are infected with dengue fever each year. In the absence of an effective vaccine for general use, national control programs must rely on hospital readiness and targeted vector control to prepare for epidemics, so accurate forecasting remains an important goal. Many dengue forecasting approaches have used environmen...

The ubiquity of smartphones, with their increasingly sophisticated array of sensors, presents an unprecedented opportunity for researchers to collect diverse, temporally-dense data about human behavior while minimizing participant burden. Researchers increasingly make use of smartphone applications for "digital phenotyping," the collection of phone...

Background National monitoring of police–public contact does not extend below age 16 and few studies have examined associations with adolescent mental health. Methods We describe the distribution of police stops in a nationally representative cross-sectional sample of adolescents ages 12 to 18 years in the Panel Study of Income Dynamics Child Deve...

Objectives. To investigate how census tract (CT) estimates of mortality rates and inequities are affected by (1) differential privacy (DP), whereby the public decennial census (DC) data are injected with statistical “noise” to protect individual privacy, and (2) uncertainty arising from the small number of different persons surveyed each year in a...

Objectives. To address evidence gaps in COVID-19 mortality inequities resulting from inadequate race/ethnicity data and no socioeconomic data. Methods. We analyzed age-standardized death rates in Massachusetts by weekly time intervals, comparing rates for January 1 to May 19, 2020, with the corresponding historical average for 2015 to 2019 stratifi...

The United States (US) has been among those nations most severely affected by the first—and subsequent—phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortal...

Background In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic...

Objective: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. Design: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, pe...

Objectives To illustrate the intersections of, and intercounty variation in, individual, household and community factors that influence the impact of COVID-19 on US counties and their ability to respond. Design We identified key individual, household and community characteristics influencing COVID-19 risks of infection and survival, guided by inte...

Over 390 million people worldwide are infected with dengue fever each year. In the absence of an effective vaccine for general use, national control programs must rely on hospital readiness and targeted vector control to prepare for epidemics, so accurate forecasting remains an important goal. Many dengue forecasting approaches have used environmen...

Objectives: The metabolic syndrome (MetS) refers to a cluster of interrelated physiological characteristics that are associated with an increased risk of cardiovascular disease and diabetes. While the clinical usefulness of the MetS has been the subject of controversy for years, increasingly sophisticated methods are being used to measure the conc...

Background The spread of Coronavirus Disease 2019 (COVID-19) across the United States confirms that not all Americans are equally at risk of infection, severe disease, or mortality. A range of intersecting biological, demographic, and socioeconomic factors are likely to determine an individual’s susceptibility to COVID-19. These factors vary signif...

In the 1930s, the federal Home Owners' Loan Corporation (HOLC) maps nationalized racial residential segregation via "redlining," whereby the color red designated areas with black, foreign-born, or low-income residents, which were deemed unsuitable for mortgage lending. We used the recently digitized HOLC redlining maps for 28 municipalities in Mass...

Jail incarceration is widely prevalent in the United States, with disproportionate impacts on communities of color, yet little research has quantified its health consequences for communities. We assess county-level jail incarceration as a contextual stressor for individual-level preterm birth among non-Hispanic Black and White U.S. women, the vast...

Objective Decompose the US black/white inequality in premature mortality into shared and group-specific risks to better inform health policy. Setting All 50 US states and the District of Columbia, 2010 to 2015. Participants A total of 2.85 million non-Hispanic white and 762 639 non-Hispanic black US-resident decedents. Primary and secondary outc...

Purpose: In order to improve colorectal cancer outcomes in the United States, there is an urgent need for research on the drivers of geographic disparities in stage at diagnosis. Our objective was to determine the effects of racialized economic segregation on the odds of late diagnosis. Methods: Among 187,843 adults (≥ 18 years old) with new dia...

Evidence suggests contemporary population distributions of breast cancer estrogen receptor (ER) status may be shaped by earlier major societal events, such as the 1965 abolition of Jim Crow (legal racial discrimination in the US) and the Great Famine in China (1959-1961). We accordingly analyzed changes in ER status in relation to Jim Crow birth pl...

Research on residential segregation and health, primarily conducted in the USA, has chiefly employed city or regional measures of racial segregation. To test our hypothesis that stronger associations would be observed using local measures, especially for racialized economic segregation, we analyzed risk of fatal and non-fatal assault in Massachuset...

Objective To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day. Design Retrospective observational study. Setting Paediatric wards in England, Northern Ireland, Scotland, and Wales. Participants 186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015. Main outcome me...

Introduction: Little current research examines associations between infant mortality and US states' funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality. Material and methods: We obtained publicly a...

Summary Points • During the past year, the United States has experienced major controversies—and civil unrest—regarding the endemic problem of police violence and police deaths. • Although deaths of police officers are well documented, no reliable official US data exist on the number of persons killed by the police, in part because of long-standing...

Policy-oriented population health targets, such as the Millennium Development Goals and national targets to address health inequities, are typically based on trends of a decade or less. To test whether expanded timeframes might be more apt, we analyzed 50-year trends in US infant death rates (1960-2010) jointly by income and race/ethnicity. The lar...

US infant death rates for 1960 to 1980 declined most quickly in (1) 1970 to 1973 in states that legalized abortion in 1970, especially for infants in the lowest 3 income quintiles (annual percentage change = -11.6; 95% confidence interval = -18.7, -3.8), and (2) the mid-to-late 1960s, also in low-income quintiles, for both Black and White infants,...

To inform current national discussions about the deaths of black men due to the police, we present novel data on long-term trends (1960-2010) in deaths due to legal intervention (i.e., deaths due to law enforcement actions) among US black and white men, by county income level. Among the three health studies investigating trends in this outcome, one...

Objectives: We investigated 50-year US trends in age at menarche by socioeconomic position (SEP) and race/ethnicity because data are scant and contradictory. Methods: We analyzed data by income and education for US-born non-Hispanic Black and White women aged 25 to 74 years in the National Health Examination Survey (NHES) I (1959-1962), National...

Scant research has analyzed the health impact of abolition of Jim Crow (ie, legal racial discrimination overturned by the US 1964 Civil Rights Act). We used hierarchical age-period-cohort models to analyze US national black and white premature mortality rates (death before 65 years of age) in 1960-2009. Within a context of declining US black and wh...

Debates exist over whether health inequities are bound to rise as population health improves, due to health improving more quickly among the better off, with most analyses focused on mortality data. We analysed 50 years of socioeconomic inequities in measured health status among US-born Black and White Americans, using data from the National Health...

To date, limited and inconsistent evidence exists regarding racial discrimination and risk of cardiovascular disease (CVD). Cross-sectional observational study of 1005 US-born non-Hispanic black (n = 504) and white (n = 501) participants age 35-64 randomly selected from community health centers in Boston, MA (2008-2010; 82.4% response rate), using...

Objectives: We explored associations between the abolition of Jim Crow laws (i.e., state laws legalizing racial discrimination overturned by the 1964 US Civil Rights Act) and birth cohort trends in infant death rates. Methods: We analyzed 1959 to 2006 US Black and White infant death rates within and across sets of states (polities) with and with...

Although socioeconomic position is conceptualized by social epidemiologists as a multidimensional construct, most research on socioeconomic disparities in health uses a limited set of observable indicators (e.g., educational attainment, household income, or occupational class) and typically analyzes and reports gradients in relation to one measure...

Background: Most public health literature on trends in population health and health inequities pertains to observed or targeted changes in rates or proportions per year or decade. We explore, in novel analyses, whether additional insight can be gained by using the 'haldane', a metric developed by evolutionary biologists to measure change in traits...

To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. SES, gender, and race/ethnicity are socia...

Although there are few confirmed risk factors for prostate cancer (PCa), mortality rates are known to vary geographically across the United States. PCa mortality is higher among black and younger white men in a band of states spanning from Washington DC to Louisiana (the "PCa belt"). This study assessed the associations of birth and adult residence...

Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or...

Summary Temporal boundary misalignment occurs when area boundaries shift across time (e.g., census tract boundaries change at each census year), complicating the modeling of temporal trends across space. Large area-level datasets with temporal boundary misalignment are becoming increasingly common in practice. The few existing approaches for tempor...

OBJECTIVES OF STUDY: To test recent claims that cancer inequities are bound to increase as population health improves. We analyzed 1960-2006 age-standardized US county cancer mortality data, total and site-specific (lung, prostate, colorectal, breast, cervix, stomach), stratified by county income quintile for the US total, black, and white populati...

To date, research on racial discrimination and health typically has employed explicit self-report measures, despite their potentially being affected by what people are able and willing to say. We accordingly employed an Implicit Association Test (IAT) for racial discrimination, first developed and used in two recent published studies, and measured...

Research on racial discrimination and health faces numerous challenges, including: (a) the challenges of engaging with communities of color that have historically been exploited in medical research; (b) the sensitivity of the topics of race and racial discrimination; and (c) logistical difficulties, e.g., time and space constraints, in under-resour...

To date, most research on racial discrimination and health has relied on self-report exposure data which necessarily reflect only what people are willing and/or able to say, and thus may not capture the health impact of internalizing racial discrimination. Building on our pilot work with the Implicit Association Test (IAT) to measure exposure to ra...

We investigated associations among racial discrimination, psychological distress, and self-rated health among US-born and immigrant Black Americans. We conducted a cross-sectional analysis of a cohort of employed working-class Black Americans (193 US-born, 275 foreign-born). Both US-born and foreign-born Black participants had high levels of exposu...

Although differential exposure by socioeconomic position (SEP) to hazardous waste and lead is well demonstrated, there is less evidence for particulate air pollution (PM), which is associated with risk of death and illness. This study determined the relationship of ambient PM and SEP across several spatial scales. Geographic information system-base...

Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations. A cross-sectional study (2003-2004) of 1202 workers employed at 14 worksites in the greate...

For at least three decades, many investigators have reported on the US black/white breast cancer case ratio for estrogen receptor (ER) status as if it reflected an intrinsic biological difference. In light of racial/ethnic differences in declines in the incidence of ER+ breast cancer, as linked to changing use of hormone therapy, we empirically tes...

Adding insult to injury – This well-worn phrase redounds with new ­significance when considering healthcare disparities in the context of social inequalities in health. The very same social groups at greatest risk of being subjected to inadequate access to and unequal treatment in healthcare also endure the greatest risk of poor health status and p...

We investigated the extent to which smoking status was associated with exposure to occupational (e.g., dust, chemicals, noise, and ergonomic strain) and social (e.g., abuse, sexual harassment, and racial discrimination) workplace hazards in a sample of U.S. multiethnic working-class adults. United for Health is a cross-sectional study designed to i...