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Silver D, Blustein J, and BC Weitzman. 2012. Transportation to Clinic: Findings from a Pilot Clinic-Based
Survey of Low-Income Suburbanites. Journal of Immigrant and Minority Health, 14(2): 350-355.
Health care policymakers have cited transportation
Silver D, Holleman M, Mijanovich T, and BC Weitzman. 2012. How Residential Mobility and School Choice Challenge Assumptions of Neighborhood Place-Based Interventions. American Journal of Health Promotion, 26(3): 180-183.
Purpose. Explore the importance of residential mobility and use of services outside neighborhoods when interventions targeting low-income families are planned and implemented.
Design. Analysis of cross-sectional telephone household survey data on childhood mobility and school enrollment in four large distressed cities.
Setting. Baltimore, Maryland; Detroit, Michigan; Philadelphia, Pennsylvania; and Richmond, Virginia.
Subjects. Total of 1723 teens aged 10 to 18 years and their parents.
Measures. Continuous self-report of the number of years parents lived in the neighborhood of residence and city; self-report of whether the child attends school in their neighborhood; and categorical self report of parents' marital status, mother's education, parent race, family income, child's age, and child's sex.
Analysis. Chi-square and multivariate logistic regression.
Results. In this sample, 85.2% of teens reported living in the city where they were born. However, only 44.4% of black teens lived in neighborhoods where they were born, compared with 59.2% of white teens. Although 50.3% of black teens attended schools outside of their current neighborhoods, only 31.4% of whites did. Residential mobility was more common among black than white children (odds ratio = 1.82; p < .001), and black teens had 43% lesser odds of attending school in their home communities.
Conclusions. Mobility among low-income and minority families challenges some assumptions of neighborhood interventions premised on years of exposure to enriched services and changes in the built environment.
Elbel B, Mijanovich T, Dixon B, Kersh R, Abrams C, and BC Weitzman. 2011. Calorie Labeling and Food Choice: Results from Philadelphia. Obesity, 19 (Supplement 1): S53-S53.
Silver D, Mijanovich T, Uyei J, Kapadia F, and BC Weitzman. 2011. Lifting Boats Not Closing Gaps: Child Health Outcomes in Distressed Cities 1992-2002. American Journal of Public Health, 101(2): 278-84.
Objectives. We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002.
Methods. We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period.
Results. Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths.
Conclusions. A strong national economy during the study period may have facilitated improvements in health outcomes for children and youths in US cities, but these benefits did not close gaps between distressed and nondistressed cities.
Although an increasing amount of community mental health research has investigated the deleterious effects of disasters and the targeting and efficacy of treatment in their aftermath, little research has sought to identify preexisting characteristics of the social environment that are predictive of post-disaster distress. A national US telephone survey fielded before and after September 11, 2001, was used to investigate the psychological distress among American adolescents related to the attacks, and to identify environmental and other characteristics that predisposed youth to experience higher or lower levels of post-disaster distress. The study found that widespread characteristics of children’s school environments—school disorder and physical threats—were at least as strongly associated with a proxy for psychological distress as exposure to the events of 9/11. Further, children exposed to physical threats at school appeared to be more vulnerable to the psychological effects of disasters than children in safer school environments.
Brecher C, Brazill C, Weitzman BC, and D Silver. 2010. Understanding the Political Context of "New " Policy Issues: The Use of the Advocacy Coalition Framework in the Case of Expanded After-School Programs. Journal of Public Administration Research and Theory 20(2): 335-355.
This article uses the Advocacy Coalition Framework to identify the stakeholders and their coalitions in the arena of after-school policy, which drew much new attention beginning in the early 1990s in many American cities. Using evidence from case studies in five cities, we show how the framework can be extended beyond stakeholder analysis to include identification of core and secondary value conflicts and of opportunities for policy analysis to help strengthen coalitions and pressures for change. Coalitions in each of the cities differ over core values relating to the purposes of after-school programs (academics versus “fun”), but policy analysts can promote common goals by developing options to deal with the secondary conflicts over the relative importance of facilities versus program content, the modes of collaboration between public schools and community based organizations, and the incentives for public school teachers to engage in staffing after-school programs.
Weitzman BC, Mijanovich T, Silver D, and C Brecher 2009. Finding the Impact in a Messy Intervention: Using an Integrated Design to Evaluate a Comprehensive Citywide Health Initiative. American Journal of Evaluation 30 (2009), pp. 495 - 514.
This article uses the evaluation of the Robert Wood Johnson Foundation’s (RWJF) Urban Health Initiative (UHI), a 10-year effort to improve health and safety outcomes in distressed cities, to demonstrate the strength of an evaluation design that integrates theory of change and quasiexperimental
Bernell S, Mijanovich T, and BC Weitzman. 2009. Does the Racial Composition of the School Environment Influence Children's Body Mass Index? Journal of Adolescent Health 45(1): 40-46.
This study investigates the degree to which the racial composition of the school environment may influence the body mass index (BMI) of children aged 10 to 18 years. This research may be viewed as extending prior work that has found that the prevalence of risk behaviors among nonwhite adolescents is influenced by exposure to white adolescents.
This research used data from the Survey of Adults and Youth, which was conducted as part of the evaluation of the Robert Wood Johnson Foundation's Urban Health Initiative. The study population for this analysis is comprised of parent and child respondents in the 2004 to 2005 survey wave who lived in one of the five program cities: Baltimore, Detroit, Oakland, Philadelphia, and Richmond. We constructed two-level school random effects models and added school and census tract-level variables that describe the racial composition of the residential community and the school attended.
Black and Hispanic adolescent girls who attend schools with a mostly nonwhite student body have higher BMIs than do their white counterparts. However, black girls in predominately white schools do not have higher BMIs than white girls. Further, black and Hispanic girls whose schoolmates are predominately white have significantly lower BMIs than black and Hispanic girls in schools where fewer than half the students are white. These associations are not found among boys, and are net of a broad variety of individual, household, and group level characteristics.
Our findings suggest that the BMI of minority adolescent girls is influenced by the norms of the social environment.
Silver D and BC Weitzman. 2009. The Pros and Cons of Comprehensive Community Initiatives at the City Level: The Case of the Urban Health Initiative. The Foundation Review, 1(1): 85-95.
Weitzman BC, Silver D, Mijanovich T, and C Brazill 2008. If you build it, will they come? Estimating unmet demand for after-school programs in America’s distressed cities. Youth and Society 40(1): 3-34.
Telephone-survey data were gathered from parents and youth in five of
Shinn M, Schteingart JS, Williams NP, Carlin-Mathis J, Bialo-Karagis N, Becker-Klein R, and BC Weitzman. 2008. Long-term associations of homelessness with children’s well-being. American Behavioral Scientist 51(6): 789-809.
To analyze long-term consequences of homelessness, the authors compared 388 formerly homeless children 55 months after shelter entry with 382 housed peers, birth to 17, using mother- and child-reported health, mental health, community involvement, cognitive performance, and educational records. Both groups scored below cognitive and achievement norms. Small group differences favored housed 4- to 6-year-olds on cognition and 4- to 10-year-olds on mental health only. Child care and recent stressful events, which were high, were as or more important than prior homelessness. Only children living with mothers were included, potentially biasing results. Policy implications are discussed.
Brady, JE and BC Weitzman. 2007. Inconsistencies in Place Definition: How Different Operational Place Definitions Affect Estimates of Adolescent Smoking and Drinking Risk. Health & Place 13(2): 562-568.
We find that estimates of the prevalence of teenage smoking and drinking in “urban,” “suburban,” and “rural” areas vary with different definitions of these types of geographic units. Given the salience of youth risk behavior to the public debate, we urge researchers to purposefully choose their definitions of geographic areas and to be explicit about those choices.
Many studies have explored the extent to which physicians’ characteristics and Medicaid program factors influence physicians’ decisions to accept Medicaid patients. In this article, we turn to patient race/ethnicity and residential segregation as potential influences. Using the 2000/2001 Community Tracking Study and other sources we show that physicians are significantly less likely to participate in Medicaid in areas where the poor are nonwhite and in areas that are racially segregated. Surprisingly—and contrary to the prevailing Medicaid participation theory—we find no link between poverty segregation and Medicaid participation when controlling for these racial factors. Accordingly, this study contributes to an accumulating body of circumstantial evidence that patient race influences physicians’ choices, which in turn may contribute to racial disparities in access to health care.
Weitzman BC, Silver D, and C Brazill. 2006. Efforts to Improve Public Policy and Programs through Data Practice: Experiences in 15 Distressed American Cities. Public Administration Review 66:3 (2006), pp.386-399.
Philanthropies and government agencies interested in children’s issues are encouraging localities to improve the process of collecting, linking, and sharing microdata and aggregated summary statistics. An implicit assumption of these efforts is that outcomes will improve as a result of the new approaches. However, there has been little systematic study of these efforts. In this article, we examine efforts to improve data practice in 15 distressed American cities. Interviews conducted in these cities revealed variation in the types of information collected, dissemination, and intended audiences. We identify significant challenges to these efforts, including adequate resources, turf battles, technical problems, access to information sources, inconsistent leadership, and absence of political will. We find that little is known about the impact of these initiatives on decision making. Assumptions that improved data practice will lead to improved policy making have not yet been realized in these cities.
Brecher, C., Silver, D. & Weitzman, B.C. 2005. Following the Money: Using Expenditure Analysis as an Evaluation Tool. American Journal of Evaluation, Volume 26, Number 2, 150-165.
This article describes the nature and utility of fiscal analysis in evaluating complex community interventions. Using New York University's evaluation of the Robert Wood Johnson Foundation's Urban Health Initiative as an example, the authors describe issues arising in defining and operationalizing constructs for fiscal analysis. The approach's utility is demonstrated in the use of interim findings to help redefine the program's goals for resource allocation, to modify its theory of change to include greater emphasis on state-level action, and to emphasize the importance of local public schools as resource centers and intervention targets. The fiscal analysis also provides new insights into the limitations of "preventive" versus "corrective" spending categories and helps make goals for such functional reallocation more realistic. The authors discuss limitations of fiscal analysis due to available data quality, the extent of cooperation needed from public officials to collect relevant data, and the level of expertise needed to interpret the data.
Brecher C, Searcy C, Silver D, and BC Weitzman. 2004. What Does Government Spend on Children? Evidence from Five Cities. The Brookings Institution, Center on Urban and Metropolitan Policy.
Rafferty, Y., Shinn, M. & Weitzman, B. 2004. Academic Achievement Among Formerly Homeless Adolescents and Their Continuously Housed Peers. Journal of School Psychology, Vol. 42, No. 3, pp. 179-199.
This study examined the school experiences and academic achievement of 46 adolescents in families who experienced homelessness and 87 permanently housed adolescents whose families received public assistance. Measures taken after the homeless students were rehoused showed that both groups valued school highly and were similar in cognitive abilities assessed with the similarities subtest of the Wechsler Intelligence Scale for Children—Revised (WISC-R). Formerly homeless students had more school mobility, more grade retention, and worse school experiences by mother report and lower plans for post secondary education by self-report. Both groups scored poorly on standardized tests of academic achievement. Homelessness was associated with further declines in achievement during the period of maximal residential disruption, but did not have effects 5 years later.
Weitzman BC and SN Fischer. 2004. New York City.. Encyclopedia of Homelessness. David Levinson, ed. Berkshire Publishing, 2004.
Toohey, Siobhan, M., Shinn, M. & Weitzman, B.C. 2004. Social Networks and Homelessness Among Women Heads of Household. American Journal of Community Psychology , 33:1-2, pp. 7-20.
To examine possible bidirectional relationships between homelessness and deficient social networks, we compared the networks of 251 mothers before, and approximately 5 years after, their families entered shelters with networks of 291 consistently housed poor mothers. At Time 1, more women on the verge of homelessness than housed women reported that they had mothers, grandmothers, friends, and relatives but fewer believed these network members were housing resources. At Time 2, after homeless women were rehoused, these network differences between consistently housed and formerly homeless women had largely disappeared. Contrary to prior research findings, formerly homeless mothers did not report smaller networks, more children or fewer partners. However, formerly homeless women did report fewer positive functions. Because of city policies, homeless mothers were frequently rehoused far from network members.
Gallup-Black, A. & Weitzman, B.C. 2004. Teen Pregnancy and Urban Youth: Competing Truths, Complacency, and Perceptions of the Problem. Journal of Adolescent Health , 34:5, pp.366-375.
Purpose: To compare and contrast perceptions of community leaders, adults, and youth about the extent of the teen pregnancy problem in five American cities: Baltimore, Detroit, Oakland, Philadelphia, and Richmond.
Conclusions: Although few leaders see teen pregnancy as a pressing problem, adults remain deeply concerned, and youth indicate that the problem is prevalent and accepted.
Weitzman BC and D Silver. 2003. Facing the Challenge of Evaluating a Complex, Multi-Site Initiative. The Evaluation Exchange, a quarterly publication of the Harvard Family Research Project, V IX: 3 (Fall, 2003).
Weitzman, B.C., Guttmacher, S., Weinberg, S. & Kapadia, F. 2003. Low Response Rate Schools in Surveys of Adolescent Risk-Taking Behaviors: Possible Biases, Possible Solution. Journal of Epidemiology and Community Health 57:1 , pp. 63-7.
Objectives. This investigation examined the effectiveness of intensive efforts to include frequently absent students in order to reduce bias in classroom-based studies.
Mijanovich, T. & Weitzman, B.C. 2003. Which 'Broken Windows' Matter? School, Neighborhood, and Family Characteristics Associated with Youth's Feelings of Unsafety. Journal of Urban Health, Volume 80, Number 3, pages 400-415.
Young people’s fears of victimization and feelings of unsafety constitute a serious and pervasive public health problem and appear to be associated with different factors than actual victimization. Our analysis of a population-based telephone survey of youths aged 10–18 years in five economically distressed cities and their suburbs reveals that a substantial minority of youths feel unsafe on any given day, and that an even greater number feel unsafe in school. While some traditional predictors of victimization (such as low socioeconomic status) were associated with feeling unsafe, perceived school disorder was the major factor associated with such feelings. Disorderliness may thus be the school’s version of “broken windows,” which serve to signal to students a lack of consistent adult concern and oversight that can leave them feeling unsafe. We suggest that fixing the broken windows of school disorderliness may have a significant, positive impact on adolescents’ feelings of safety.
Weitzman, B.C., Silver, D. & Dillman, K. 2002. Integrating a Comparison Group Design into a Theory of Change Evaluation: The Case of the Urban Health Initiative. American Journal of Evaluation 23:4 (Dec 2002), pp 371-385.
This paper describes how we strengthened the theory of change approach to evaluating a complex social initiative by integrating it with a quasi-experimental, comparison group design. We also demonstrate the plausibility of selecting a credible comparison group through the use of cluster analysis, and describe our work in validating that analysis with additional measures. The integrated evaluation design relies on two points of comparison: (1) program theory to program experience; and (2) program cities to comparison cities. We describe how we are using this integrated design to evaluate the Robert Wood Johnson Foundation’s Urban Health Initiative, an effort that aims to improve health and safety outcomes for children and youth in five distressed urban areas through a process of citywide, multi-sector planning and changed public and private systems. We also discuss how the use of two research frameworks and multiple methods can enrich our ability to test underlying assumptions and evaluate overall program effects. Using this integrated approach has provided evidence that the earliest phases of this initiative are unfolding as the theory would predict, and that the comparison cities are not undergoing a similar experience to those in UHI. Despite many remaining limitations, this integrated evaluation can provide greater confidence in assessing whether future changes in health and safety outcomes may have resulted from the Urban Health Initiative (UHI).
Guttmacher, S., Weitzman, B.C., Kapadia, F. & Weinberg, S. 2002. Classroom Based Surveys of Adolescent Risk-Taking Behavior: Reducing the Bias of Absenteeism. (publication link courtesy of) American Journal of Public Health 92:2 , pp. 235-237.
Objectives. This investigation examined the effectiveness of intensive efforts to include frequently absent students in order to reduce bias in classroom-based studies.
Methods. Grade 10 students in 13 New York City high schools (n = 2049) completed self-administered confidential surveys in 4 different phases: a 1-day classroom capture, a 1-day follow-up, and 2 separate 1-week follow-ups. Financial incentives were offered, along with opportunities for out-of-classroom participation.
Results. Findings showed that frequently absent students engaged in more risk behaviors than those who were rarely absent. Intensive efforts to locate and survey chronically absent students did not, however, significantly alter estimates of risk behavior. Weighting the data for individual absences marginally improved the estimates.
Conclusions. This study showed that intensive efforts to capture absent students in classroom-based investigations are not warranted by the small improvements produced in regard to risk behavior estimates.
Cowal, K., Shinn, M., Weitzman, B.C., Stojanovic, D. & Labay, L. 2002. Mother-Child Separations Among Homeless and Housed Families Receiving Public Assistance in New York City. American Journal of Community Psychology 30:5, pp. 711-730.
We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.
Silver, D., Weitzman, B.C. & Brecher, C. 2002. Setting an Agenda for Local Action: The Limits of Expert Opinion and Community Voice. Policy Studies Journal (2002 - Vol. 30, No. 3), pp. 362-278.
Many social programs, funded by government or philanthropy, begin with efforts to improve local conditions with strategic planning. Mandated by funders, these processes aim to include the views of community residents and those with technical expertise. Program leaders are left to reconcile public and expert opinions in determining how to shape their programs. The experience of the Robert Wood Johnson Foundation's Urban Health Initiative suggests that although consultation with experts and the public failed to reveal a clear assessment of the community's problems or their solutions, it did assist in engaging diverse groups. Despite this engagement, however, core leaders wielded substantial power in selecting the agenda.
Duchon, L.M., Weitzman, B.C. & Shinn, M. 1999. The Relationship of Residential Instability to Medical Care Utilization Among Poor Mothers in New York City. Medical Care, 37:12, pp. 1282-1293.
Stojanovic, D., Weitzman, B.C., Shinn, M., Labay, L.E. & Willams, N.P. 1999. Tracing the Path Out of Homelessness: The Housing Patterns of Families After Exiting Shelter. Journal of Community Psychology 27:2 , pp. 199-208.
Brecher, C., Weitzman, B. & Schall, E. 1998. Health Management Education Partnerships: More Than Technology Transfer. Journal of Health Administration Education, Spring.
This article presents the reflections of three faculty members from New York University based on more than two years of experience in a health management education (HME) partnership with institutions in the Republic of Albania. The most significant point to be shared with colleagues considering similar initiatives in other countries is that aiding other professionals in developing health management education programs involves much more than the transfer of technical information among professionals. Based on experience in Albania, we argue that the development of viable management and policy analysis programs will require assistance to counterparts in Central and Eastern Europe in: (1) building constituencies for these activities among influential leaders and sustaining this support through changes in government; (2) providing models of and motivations for using styles of pedagogy that vary significantly from those now common in this part of the world; and (3) reconciling conflicts between pressures for investments in the largely hospital-based activity of health management and the largely public-health-based needs of relatively poor countries.
Shinn, M., Weitzman, B.C. & Hopper, K. 1998. Homelessness. in Encyclopedia of Mental Health, Volume 2, Dr. Howard Friedman (ed.), Academic Press, pp. 393-402.
Weitzman, B.C. 1998. Improving Quality of Care. in Jonas's Health Care Delivery in the United States: Sixth Edition, Anthony R. Kovner (ed.), New York: Springer Publishing Company, (6th edition; 5th edition; 4th edition).
Shinn, M., Weitzman, B.C., Stojanovic, D., Knickman, J.R., Jimenez, L., Duchon, L., James, S. & Krantz, D.H. 1998. Predictors of Homelessness from
Shelter Request to Housing Stability Among Families in New York City. American Journal of Public Health, 88:11, pp. 1651-57.
This study examined predictors of entry onto shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City. Methods. Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later. Families with prior history of shelter use were excluded from the follow-up study. Results. Demographic characteristics and housing conditions were the most important risk factors for shelter entry; enduring poverty and disruptive social experiences also contributed. Five years later, four fifths of sheltered families had their own apartment. Receipt of subsidized housing was the primary predictor of housing stability among formerly homeless families (odd ratio [OR] = 20.6, 95% confidence interval [CI]= 9.9, 42.9). Conclusions. Housing subsidies are critical to ending homelessness among families.
Shinn, M. & Weitzman, B.C. 1996. Homeless Families are Different. in Homelessness in America: A Reference Book, Jim Baumohl (ed.), National Coalition for the Homeless and Oryx Press .
Blustein, J. & Weitzman, B.C. 1995. Access to Hospitals with High-Technology Cardiac Services: How is Race Important? American J Public Health. 1995;85:345-351.
OBJECTIVES. Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS. Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS. Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS. Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.