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Many economic analyses, including those that address the COVID-19 pandemic, focus on the value of averting deaths and do not include the value of averting nonfatal illnesses. Yet, incorporating the value of averting nonfatal cases may change conclusions about the desirability of the policy. While per case values may be small, the number of nonfatal cases is often large, far outstripping the number of fatal cases. The value of averting nonfatal cases is also increasingly important in evaluating COVID-19 policy options as vaccine- and infection-related immunity and treatments reduce the case-fatality rate. Unfortunately, little valuation research is available that explicitly addresses COVID-19 morbidity. We describe and implement an approach for approximating the value of averting nonfatal illnesses or injuries and apply it to COVID-19 in the USA. We estimate gains from averting COVID-19 morbidity of about 0.01 quality-adjusted life year (QALY) per mild case averted, 0.02 QALY per severe case, and 3.15 QALYs per critical case. These gains translate into monetary values of about $5300 per mild case, $11,000 per severe case, and $1.8 million per critical case. While these estimates are imprecise, they suggest the magnitude of the effects.
Multidrug-resistant Enterobacteriaceae pose a serious infection control challenge and have emerged as a public health threat. We examined national trends in the proportion of Klebsiella pneumoniae isolates resistant to carbapenems (CRKP) and third-generation cephalosporins (G3CRKP).
Design and Setting.
Retrospective analysis of approximately 500,000 K. pneumoniae isolates cultured between January 1999 and July 2010 at 287 clinical laboratories throughout the United States.
Isolates were defined as CRKP if they were nonsusceptible to 1 or more carbapenems and were defined as G3CRKP if they were nonsusceptible to ceftazidime, ceftriaxone, or related antibiotics. A multivariable analysis examined trends in the proportion of resistant isolates, adjusting for age, sex, isolate source, patient location, and geographic region.
The crude proportion of CRKP increased from less than 0.1% to 4.5% between 2002 and 2010; the frequency of G3CRKP increased from 5.3% to 11.5% between 1999 and 2010. G3CRKP and CRKP were more common among elderly patients (those greater than 65 years of age); the adjusted odds ratio (aOR) relative to pediatric patients (those less than 18 years of age) was 1.2 for G3CRKP (95% confidence interval [CI], 1.2–1.3) and 3.3 for CRKP (95% CI, 2.6–4.2). G3CRKP and CRKP were also more common among patients from the northeastern United States (aOR, 2.9 [95% CI, 2.8–3.0] and 9.0 [95% CI, 7.9–10.4]) than among those from the western United States. The prevalence of outpatient CRKP isolates increased after 2006, reaching 1.9% of isolates in our sample in 2010 (95% CI, 1.6%–2.1%).
The frequency of G3CRKP and CRKP is increasing in all regions of the United States, and resistance is emerging among isolates recovered in the outpatient setting. This underscores the need for enhanced laboratory capacity and coordinated surveillance strategies to contain the further spread of these emerging pathogens.
Latinos in the New Millennium is a comprehensive profile of Latinos in the United States: looking at their social characteristics, group relations, policy positions and political orientations. The authors draw on information from the 2006 Latino National Survey (LNS), the largest and most detailed source of data on Hispanics in America. This book provides essential knowledge about Latinos, contextualizing research data by structuring discussion around many dimensions of Latino political life in the US. The encyclopedic range and depth of the LNS allows the authors to appraise Latinos' group characteristics, attitudes, behaviors and their views on numerous topics. This study displays the complexity of Latinos, from recent immigrants to those whose grandparents were born in the United States.
The attitudes that people hold with regard to gender roles often have a significant influence on their life experiences, including most aspects of marital and family relationships. They can help continue or can help bring to an end gender-differentiated opportunities and accomplishments in education, employment, and politics. This chapter explores what the LNS respondents regard as proper gender roles, as well as their gender-related attitudes.
Gender roles are sometimes viewed as the division of labor by gender, but feminist scholars argue that this is a simplistic approach that ignores the power relationships that exist between men and women (DeBiaggi 2002; Ridgeway and Correll 2004; McCabe 2005). We use DeBiaggi's (2002, 39) definition of gender roles as “an individual's endorsement of personal characteristics, occupations and behaviors considered appropriate for women and men in a particular culture.” Attitudes toward gender roles range from very traditional ideas to extremely egalitarian views.
Latinos have long identified the education of their children as one of the most important policy challenges confronting their communities. Improving the educational attainment of Mexican Americans and Mexican immigrants was a primary goal of the League of United Latin American Citizens when it was established in 1929. This organization argued that communities needed to value formal education as a necessary resource to limit discrimination and promote their civil rights (Marquez 1993). Latino leaders and organizations were at the forefront of challenging the de jure segregation of Mexican and Mexican American children in California and Texas in the 1930s and 1940s that led to the dismantling of so-called Mexican schools in much of the southwestern United States (San Miguel 1987). More recently, Latinos challenged the de facto segregation of their children in the Southwest by filing lawsuits such as Cisneros v. Corpus Christi Independent School District (1970) and Keyes v. School District No. 1, Denver, Colorado (1973). The federal court decisions that followed determined that Mexican American and Mexican schoolchildren had histories of enrollment segregation that contributed to limited educational opportunities and low educational attainment more similar to the experiences of African Americans than to those of Caucasians.
It should not be surprising, therefore, that education ranks highly in recent polls that ask Latinos to list the policy issues of greatest concern to their communities. A survey conducted in 2004 found that when Latino respondents were asked, “What do you think is the most important issue to you and your family today – education, jobs and the economy, health care, terrorism, or immigration?” approximately 26 percent listed education as the most important issue. It was listed second only to jobs and the economy (Bendixen and Associates 2004). Also in 2004, a Pew Hispanic Center survey of Latino registered voters education was listed by 54 percent of respondents as the issue that was most likely to determine whom they would support for president. Results from our 2006 Latino National Survey (LNS) reveal that when respondents were asked, “What is the most important problem facing the Latino community today?” education ranked third at 9 percent, behind immigration at 30 percent and unemployment and jobs at 12 percent.
Introduction: The Changing Demographics of the Latino Community
Over the past twenty years there have been significant changes in the demographics of the Latino population in the United States. These have occurred in five areas. First, and most important, the Latino population is now much larger than previously, and it represents a larger share of the national population. The Latino population grew 58 percent between 1990 and 2000 and increased 43 percent between 2000 and 2010. The 2000 census revealed that Latinos were 12.5 percent of the U.S. population, surpassing African Americans as the largest minority group (who accounted for only 12 percent). The most recent data from the 2010 census indicate that the Latino population has grown to 16.3 percent of the U.S. population, and that trend is expected to continue for decades to come. Indeed, the Pew Research Center projects that Latinos will make up about 30 percent of the U.S. population by 2050 (Passel and Cohn 2008).
Second, we are continuing to see both immigration and native births driving Latino population growth. Immigration has increased in part as a result of expanding employment opportunities, as well as new immigration policies. The Immigration Reform and Control Act of 1986 (IRCA), for instance, regularized the immigration status of a significant number of people, many of whom were then able to sponsor additional family members to enter the country. The Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) of 1996 had the unintended effect of encouraging undocumented migrants to remain in the country rather than risk apprehension by traveling between a home country and the United States (U.S. Commission on Immigration Reform 1997). The largest source of Latino population growth is not immigration, however, but native births. For example, from 2000 to 2006, the Latino population grew by 10.2 million, 58.6 percent of which was due to native births (Nasser 2008).
Over the past decade political scientists and sociologists have come to see the importance of people coming together for social or civic reasons. Whether through bridge clubs, food pantries, or political organizations, Americans benefit both individually and as a society when people leave their homes and become involved with others. This coming together, or civic engagement, also helps people develop civic skills that can carry over into other social arenas, including the electoral and political realms, such as voting, political party affiliation, interest groups, social movements, contacting, and others. Greater civic involvement has also been found to heighten interpersonal trust and sense of efficacy, and to give people the sense that they can have an impact on social issues affecting them as well as more generally to improve their attitudes toward the social and political realms, including government.
The term civic engagement has two key ideas associated with it: civic association and social capital. Social capital refers to “connections among individuals in social networks,” and such social contacts, or “connectedness,” affect the well-being and “productivity of individuals and groups” (Putnam 2000, 19). Although the phenomena of social capital and civic engagement are associated in that they seem to go together with trust, reciprocity, and the like, the direction of causation (i.e., which leads to which) is not clear (see, e.g., Hero 2007). Some of the ways social capital contributes to democratic processes include the following:
“Associations and less formal networks of civic engagement instill in their members habits of cooperation and public-spiritedness, as well as the practical skills necessary to partake in public life” (Putnam 2000, 338; see also Verba, Schlozman, and Brady 1995).
“Political information flows through social networks, and in these networks public life is discussed” (Knack 2002, 774).
“Externally, voluntary associations…allow individuals to express their interests and demands on government and to protect themselves from abuses of power from political leaders.” That is, extensive and nurturing social connections through civic association facilitate norms of reciprocity and social trust that deeply enrich a group and the larger society, thus leading to a host of salutary effects (Putnam 2000, 19).
Voting in a meaningful election is the defining act of democratic citizenship. Voting is a unique form of political participation in that it is widely engaged in, generally of low cost, and enjoys widespread support as a behavioral norm. Although there are many other forms of political action – ranging from simple conversations to revolutionary violence, and more generally including contacting elected officials, joining civic groups, attending a meeting or donating money – none is as frequently engaged in as registration and voting.
Despite the centrality of the vote to democratic citizenship, voting has often not been an easy undertaking for Latinos. For Latino citizens, voting often involved overcoming vote suppression tactics; low levels of political information; resource disadvantages, including poor education and low income; and in many instances, language barriers that foreclosed participation and that jurisdictions were not motivated to redress. On top of those obstacles to voting, once a Latino voter gained access to the ballot box, there were often poor choices of candidates and few or none from the community itself. Latinos elected to public office, outside of New Mexico at least, were exceedingly rare.
Themes and imagery about Latinos in the United States often focus on the rapid and substantial growth of this population and projections about the continuing impact of those demographic changes into the future. Portrayals in policy debates and the media have depicted the central facets of this fast-growing community – where they come from, how they are transforming traditional centers of migration with new destinations, the trials and tribulations of making it in America, and how the greater American society and its institutions respond to Latinos – imperfectly at best. The faces, stories, and life experiences of Latinos tend to be portrayed largely through sketchily drawn caricatures of working-class, immigrant-based communities trying to find an economic foothold to achieve the American dream; yet also holding steadfastly to traditions, cultural beliefs, and practices that sometimes fit uncomfortably with contemporary America.
But how accurate are these sketchy images, individually and collectively? What is the reality of the Latino experience in the United States? How can we better understand the views and perspectives of Hispanics in American society regarding such issues as education, politics, and public policy? What hard evidence can be brought to bear on this large, growing, and complex population that would help us situate the group in the American polity?
It is not surprising that the unique place of Latinos in American society – as well as the variation within the group on many dimensions – serves to structure Latino opinion on important policy concerns. The Latino National Survey explored Latino opinion on several important policy dimensions.
Over the past two decades, scholars examining Latino public opinion have consistently found certain response patterns on issues of public importance (see, e.g., Welch and Sigelman 1993; Branton 2007; Nicholson and Segura 2005; Branton 2007). Education, economic concerns, and crime have historically been considered the most important problems facing the nation and the most important problem confronting the Latino community specifically. Indeed, the California politician Cruz Bustamante, who was elected California's first Latino assembly speaker in the late 1990s and went on to two terms as lieutenant governor and an ill-fated run for governor, frequently articulated that the Latino agenda is “the American agenda,” ostensibly to emphasize Latinos’ common concerns with these bread-and-butter political issues.
This chapter explores the attachment Latinos feel to group identities, ranging from their attachment to their compatriots from their same country of origin to their affinity with pan-ethnic identification such as Latino or Hispanic, and their identification as American. The identity labels individuals choose have consequences for the belief and attitudes individuals hold and the way that individuals act. These consequences are political because they shape both the manner that individuals think of themselves collectively and the way that they calculate the costs and benefits of collective action.
Collective action is at the root of politics. Without the coordinated effort of groups of people, the redistribution of public goods, which is at the root of all politics, cannot occur. There are, however, very different conceptions of collective action, with two principle approaches in the social science literature: in the first, collective action is considered the result of the amalgamation of individual interests, and in the second, it is the consequence of mobilized group identities.
What might this all mean in the coming years? What will Latinos’ attitudes and public opinion look or sound like after the second decade of the twenty-first century? Which factors will influence those views? The preceding chapters have drawn on the 2006 Latino National Survey and have considered an array of evidence on a wide range of substantive questions regarding Latinos’ perspectives about issues central to their place in the American political and social structure. Along with learning much about what Latinos think regarding those issues, we have explored why that is, which variables and attributes may be related to and thus help explain their outlooks. In conclusion, we extend the assessment of those explanatory factors and consider their implications for Latinos in the (near) future of American society and politics, providing a discussion looking forward and extrapolating from the body of evidence presented in our analyses. In short, we offer some informed suppositions on what the future may hold.
To a considerable degree, what emerges from the chapters in this volume points to a modified assimilation story. However, the breadth and richness of our evidence has also allowed us to uncover nuance and variation in Latinos’ views on an array of issues, which suggests a different, more complex outlook – one that might be characterized as neoassimilation – with Latinos both adapting to the larger society and the larger society changing in response, and with assimilation not precluding the retention of distinctive cultural ties. This conclusion highlights some of our most notable findings.
Another aspect of the Latino experience in the United States deals with acquiring information about the American political system and politics. This chapter focuses on media usage and news sources among Latinos, as well as their language of preference for those sources. In addition, what has been referred to as a digital divide among racial-ethnic and social-class grouping is examined briefly by exploring Latinos’ access to the Internet. In essence, this chapter represents an introduction to the small but growing area of research and interest regarding Latinos and media use, as well as its application to the world of politics.
Political Knowledge and Media Usage
Gateways to the world of politics can be enhanced by becoming more knowledgeable about the political system, its institutions, and its leadership (Subvervi-Velez 2008). In addition, accounts of governmental actions, policy considerations and debates, and activities of political parties are important pieces of information that direct an individual's civic and political engagement (Johnson and Arceneaux 2010). A major source of that political knowledge comes from mass media outlets. Obviously, media outlets have been expanding in recent years with more nontraditional media (e.g., electronic news, magazines, blogs, social networks, international news media). For the most part, our introductory examination will focus on the two more traditional outlets – newspapers and television. Historically, mass media has been a source of both political facts or news and political expression or opinion on issues, candidates, and public policies (Johnson and Arceneaux 2010).
Transnationalism refers to the persistent ties that immigrants and their descendants have with their countries of origin. These ties can be social, such as maintaining contact with their friends and family; economic, for example, continuing to own land and businesses; or political, for instance, having an interest in, and taking part in, their country of origin's politics. Researchers characterize these transnational ties as made up of multiple attachments that stretch across national borders to make up a unified social world that is simultaneously located in two different places (Basch, Glick Schiller, and Szanton-Blanc 1994; Smith and Guarnizo 1998; Levitt and Glick Schiller 2004). Two leading immigration scholars describe how this occurs:
Over time and with extensive movement back and forth, communities of origin and destination increasingly comprise transnational circuits – social and geographic spaces that arise through the circulation of people, money, goods and information.…Over time, migrant communities become culturally “transnationalized,” incorporating ideologies, practices, expectations, and political claims from both societies to create a “culture of migration” that is distinct from the culture of both the sending and receiving nation. (Massey and Durand 1992, 8)
In this view, nation-states are seen as increasingly less relevant as an organizing principle of social interaction (Basch et al. 1994; Glick Schiller 1999; Portes 1999), facilitated by the ease of international travel and communication in an era of e-mail and Internet cafes, video-conferencing parlors in which immigrants can see and talk to the family they have left behind, instant money transfers, and cheap airfare.
Scholars generally use a few key indicators as measures of transnational ties: (1) the existence of organizational networks, such as immigrant hometown associations (Orozco 2000; Alarcón 2002; De la Garza and Hazan 2003); (2) immigrant attitudes and behaviors, such as engagement in remittance practices (i.e., immigrants sending money back to relatives in their countries of origin; Conway and Cohen 1998; Flores-Macias 2009); (3) travel back to immigrants’ countries of origin; and (4) the desire to one day live there again (Guarnizo 2000; Waldinger 2008. However, despite general agreement that the phenomenon of transnationalism exists, a number of disagreements and debates persist (Jones-Correa 2003; Waldinger and Fitzgerald 2004).
Few issues regarding Latinos, particularly Latino immigrants, have been as normatively controversial as perceptions and assessments of the extent to which they hold and embrace core American beliefs and values. But identifying, and measuring, “core” values and beliefs in American politics has never been a simple task in the first place. Both the media and the political realm offer frequent assertions about the existence of an “American Creed,” but there is some debate about what the specific elements of such a creed might be and the importance of each of the values that might constitute that creed, both in its own right and relative to others (see Fraga and Segura 2006). Ideas such as democracy, liberty, equality (of opportunity), and individual achievement (self-reliance) are all considered part of the American creed (Citrin et al. 1990). However, scholars suggest that values, such as equality and the potential need for a firm equality of condition, are pivotal. Moreover, numerous scholars have claimed there is no single tradition but multiple political traditions in American politics (Smith 1993), the existence of which belie the assertion of a singular American creed.
Of these multiple traditions it is the liberal tradition that is generally considered the most prominent. This is, the tradition that stresses freedom, liberty, individualism, and equality of opportunity as the defining elements of American political thought. Individualism is often associated with (strong) beliefs in self-reliance, hard work, and taking responsibility for one's own economic and social situation. There is also a corollary assumption that equality of opportunity is inherently important and an essential structural feature linked to individual beliefs about self-reliance and hard work. Also influential is the civic republican tradition that promotes civic engagement, community, and fraternity as essential traits of American society. We discuss civic engagement in Chapter 7, but readers will find aspects of community integrated into topics throughout the book. A third tradition, ascriptive hierarchy, focuses on traits such as race-ethnicity, gender, and class,which have served as ostensible justifications for exclusion and/or an unequal status by those who would argue that some individuals and groups are less (or more) deserving or worthy of a legitimate place in the American polity (Smith 1993; see Elazar 1966). We chose to focus our survey questions on issues associated with individualism, self-reliance, and equality of opportunity that are most closely associated with the liberal tradition because of that tradition's ostensible primacy among American political values, and because Latinos’ beliefs in such values has often been an implicit and sometimes explicit basis on which Latinos are “evaluated” by the larger society.
Among the areas in which there has been much speculation about the growth and especially increased political participation of Latinos is their patterns of partisan identification, registration, and voting. It is well accepted that current Latino party identification favors Democrats, with the consistent exception of those Latinos of Cuban origin (DeSipio 1996; de la Garza, DeSipio, Garcia, Garcia, and Falcon 1992). However, significant speculation exists as to how stable this Democratic advantage is, how deeply these patterns hold, what the value foundations are of Latino partisan preferences, and whether the growing size and diversity of the Latino electorate present new opportunities and challenges for political parties to garner significant Latino voter support (Fraga and Ramírez 2003–2004; Fraga and Leal 2004).
We examine several aspects of Latino partisanship in this chapter, beginning with a summary of social science research regarding Latino partisanship. We then break down partisan identification by generation and citizenship, national origin, income, and education. This is followed by a discussion of the patterns of reported party registration by the same categories. We then provide data on important correlates of partisan identification, including recent changes in attitudes toward parties, ideology, coethnic candidates, and political knowledge. The chapter concludes with a consideration of what we learn about patterns of Latino partisanship from the LNS.
It is clear that Latinos exhibit a diverse “profile,” along the lines of nativity, language use, degree of assimilation, and sense of own group identity (or identities), not to mention the usual sociodemographic characteristics (e.g., class, educational attainment, income levels). At the same time, Latinos are clustered together as both members of national origin groups and as members of a pan-ethnic confederation. This section of the book looks at this complex group to explore the extent of commonalities and contrasts among this growing and diverse set of Latino respondents in the Latino National Survey. In addition, we explore Latinos’ perceptions and experiences of living in the United States, as well as the nature and extent of intergroup connections with other groups (e.g., whites, African Americans and Asian Americans). In doing so, we can examine how much nativity and citizenship status affects Latinos views, attitudes, and experiences.
We begin the focus with the LNS respondents’ views about their life chances and opportunities in America, their experiences with discriminatory treatment in a variety of settings, and their perceptions about intergroup relations. The “outside” groups identified are whites (or Anglos), African Americans, and Asian Americans. As Latinos represent a pan-ethnic grouping (i.e., transcending national origin identities), we also examine intragroup relations and attitudes about the various Latinos subgroups. These types of queries can provide us with a benchmark view of how Latinos are fitting in our sociopolitical system and can allow us to compare views among key subgroup distinctions under the “Latino” umbrella.