Inequality

"Where, When, Why, and for whom do Residential Contexts Matter? Moving Away From the Dichotomous Understanding of Neighborhood Effects.

"Where, When, Why, and for whom do Residential Contexts Matter? Moving Away From the Dichotomous Understanding of Neighborhood Effects.
Sharkey, Patrick and Jacob W. Faber. 2014. "Where, When, Why, and for whom do Residential Contexts Matter? Moving Away From the Dichotomous Understanding of Neighborhood Effects." Annual Review of Sociology, 40: 559-579.

Patrick Sharkey and Jacob William Faber
05/05/2014

The literature on neighborhood effects frequently is evaluated or interpreted in relation to the question, “Do neighborhoods matter?” We argue that this question has had a disproportionate influence on the field and does not align with the complexity of theoretical models of neighborhood effects or empirical findings that have arisen from the literature. In this article, we focus on empirical work that considers how different dimensions of individuals' residential contexts become salient in their lives, how contexts influence individuals' lives over different timeframes, how individuals are affected by social processes operating at different scales, and how residential contexts influence the lives of individuals in heterogeneous ways. In other words, we review research that examines where, when, why, and for whom do residential contexts matter. Using the large literature on neighborhoods and educational and cognitive outcomes as an example, the research we review suggests that any attempt to reduce the literature to a single answer about whether neighborhoods matter is misguided. We call for a more flexible study of context effects in which theory, measurement, and methods are more closely aligned with the specific mechanisms and social processes under study.

Unlocking the Right to Build: Designing a More Flexible System for Transferring Development Rights

Unlocking the Right to Build: Designing a More Flexible System for Transferring Development Rights
Furman Center Policy Brief; March 2014

Vicki Been, John Infranca, Josiah Madar, Jessica Yager
03/19/2014

A new report by the NYU Furman Center details the untapped potential for NYC’s transferable air rights program, a critical tool for high-density housing development in New York City. Using case study examples, the report outlines limitations to the city’s current TDR policies and suggests a policy approach that could unlock millions of square feet of unused air rights to help produce more affordable housing.

Do Housing Choice Voucher Holders Live Near Good Schools

Do Housing Choice Voucher Holders Live Near Good Schools
Journal of Housing Economics 23(1), 2014: 28-40. http://dx.doi.org/10.1016/j.jhe.2013.11.005

Ingrid Gould Ellen, Amy Ellen Schwartz, and Keren Horn
03/06/2014

The Housing Choice Voucher program was created, in part, to help low income households reach a broader range of neighborhoods and schools. Rather than concentrating low income households in designated developments, vouchers allow families to choose their housing units and neighborhoods. In this project we explore whether low income households use the flexibility provided by vouchers to reach neighborhoods with high performing schools. Unlike previous experimental work, which has focused on a small sample of voucher holders constrained to live in low-poverty neighborhoods, we look at the voucher population as a whole and explore the broad range of neighborhoods in which they live. Relying on internal data from HUD on the location of assisted households, we link each voucher holder in the country to the closest elementary school within their school district. We compare the characteristics of the schools that voucher holders are likely to attend to the characteristics of those accessible to other households receiving place based housing subsidies, other similar unsubsidized households and fair market rent units within the same state and metropolitan area. These comparisons provide us with a portrait of the schools that children might have attended absent HUD assistance. In comparison to other poor households in the same metropolitan areas, we find that the schools near voucher holders have lower performing students than the schools near other poor households without a housing subsidy. We probe this surprising finding by exploring whether differences between the demographic characteristics of voucher holders and other poor households explain the differences in the characteristics of nearby schools, and whether school characteristics vary with length of time in the voucher program. We also examine variation across metropolitan areas in the relative quality of schools near to voucher holders and whether this variation is explained by economic, socio-demographic or policy differences across cities.

Electronic Health Record Use, Intensity of Hospital Care, and Patient Outcomes

Electronic Health Record Use, Intensity of Hospital Care, and Patient Outcomes
American Journal of Medicine, Vol. 127, no. 3, pp. 123-130. DOI: 10.1016/j.amjmed.2013.11.010

Blecker, S., K. Goldfeld, N. Park, D. Shine, J.S. Austrian, R. Scott Braithwaite, M.J. Radford, and M.N. Gourevitch
03/01/2014

Objective: Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes.

Methods: We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed “electronic health record interactions.” Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates.

Results: Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25).

Conclusions: Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity.

My Brother's Keeper? The Association between Having Siblings in Poor Health and Wealth Accumulation

My Brother's Keeper? The Association between Having Siblings in Poor Health and Wealth Accumulation
Journal of Family Issues, February, Volume 35(3), pp.358-383.

Heflin, C. and N. Chiteji
02/01/2014

When confronted with the economic costs of addressing a serious health problem, many American households do not possess the ability to deal with the crises on their own and may turn to family members for help. Using longitudinal data from the Panel Study of Income Dynamics, we examine if the level of wealth held by individuals is related to the health problems of their siblings. We find evidence that having a sibling who has experienced a health problem decreases the amount of wealth that some families have. The research has implications for the existing literatures on altruism and kin networks, as it sheds some light on the nature of altruism that prevails in U.S. families and on how kinship networks matter. Because of its focus on the consequences of health problems, the research also has implications for public policy discussions about the health care system and social insurance more generally.

The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007

The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007
Population Research and Policy Review, Vol. 33, no. 1 (Feb 2014), pp. 97-126. doi: 10.1007/s11113-013-9309-2

Elo, I.T., H. Beltran-Sanchez, and J. Macinko
02/01/2014

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.

Spatial Segmentation and the Black Middle Class

Spatial Segmentation and the Black Middle Class
American Journal of Sociology, Vol. 119 no. 4, pp. 903-54. The University of Chicago

Sharkey, P.
01/01/2014

Ethnographic studies of the black middle class focus attention on the ways in which residential environments condition the experiences of different segments of the black class structure. This study places these arguments in a larger demographic context by providing a national analysis of neighborhood inequality and spatial inequality of different racial and ethnic groups in urban America. The findings show that there has been no change over time in the degree to which majority-black neighborhoods are surrounded by spatial disadvantage. Predominantly black neighborhoods, regardless of socioeconomic composition, continue to be spatially linked with areas of severe disadvantage. However, there has been substantial change in the degree to which middle- and upper-income African-American households have separated themselves from highly disadvantaged neighborhoods. These changes are driven primarily by the growing segment of middle- and upper-income African-Americans living in neighborhoods in which they are not the majority group, both in central cities and in suburbs.

Hospitalization for ambulatory-care sensitive conditions (ACSC) in Île-de-France: A view from across the Atlantic

Hospitalization for ambulatory-care sensitive conditions (ACSC) in Île-de-France: A view from across the Atlantic
Revue française des affaires sociales; 3(3): 108-125.

Rodwin, VG., Gusmano, MK., and Weisz, D.
12/03/2013

This article presents an indicator used in the United States and other OECD nations (hospitalizations for ambulatory-care sensitive conditions – ACSC) to assess access to primary care services and their capacity to handle a set of medical conditions before they require acute hospital treatment. Based on a study of Ile de France, which relies on residence-based hospital discharge data on patient diagnoses and treatments, the indicator identifies areas where hospitalizations for ACSC appear particularly high. Such hospital stays are considered potentially avoidable. Based on data from the Programme de m.dicalisation des syst.mes d’information (PMSI), disparities are measured. We rely on logistic regression analysis to identify a range of individual factors and neighborhood-level factors that explain these disparities. Access to primary care appears to be worse among residents in areas with average household income in the lowest quartile and among those hospitalized in public hospitals. This raises an important question for the future of health policy. Should areas with higher hospital discharge rates of ACSC be understood as having populations with poor health-seeking behaviors or health care systems not well enough organized to target higher-risk populations?

Mobility and the Metropolis

Mobility and the Metropolis
Washington, D.C.: The Economic Mobility Project, An Initiative of The Pew Charitable Trusts

Graham, B., and P. Sharkey
12/03/2013

In a 2011 public opinion poll, The Pew Charitable Trusts asked Americans how important they thought a number of factors were in determining whether people in the United States get ahead or fall behind economically. More than 80 percent of respondents identified factors such as hard work, ambition, and access to education as key drivers of upward mobility, while less than half viewed growing up in a good neighborhood as an important factor. On the contrary, respondents strongly agreed that a young person with drive, ambition, and creativity growing up in a poor neighborhood is more likely to get ahead economically than someone growing up in a more affluent neighborhood who lacks those attributes.

Contrary to these perceptions, however, evidence is building that location actually matters a great deal and that Americans’ economic mobility prospects vary by state, locality, and even neighborhood.

For example, a 2009 Pew study indicated that a person who experienced high neighborhood poverty throughout childhood had a much higher risk of moving down the economic ladder as an adult. Other recent research examining mobility among metropolitan areas, including nearby towns and rural areas, showed that economic mobility varied widely across these localities. And, in a 2012, first-of-its-kind analysis of Americans’ economic mobility at the state level, Pew found that a number of states, primarily in the Mideast and New England regions, had higher mobility than the national average, and other states, primarily in the South, had lower mobility. 

This report adds to the growing body of research as it examines economic mobility across 96 U.S. metropolitan areas and the role of place in Americans’ prospects of moving up or down the economic ladder. It also offers insight on why and how location matters. Although a host of factors, such as state and local policies and labor market conditions, could influence mobility, this analysis considers one: neighborhood economic segregation, or the degree to which the poor and the wealthy live apart from each other. To begin to answer this question, Pew commissioned original research that, using three longitudinal data sets, measures differences in economic mobility across American metro areas over the last generation and identifies above-average-, average-, and below-average-mobility areas. The analysis then looks at whether metro areas’ rates of economic segregation are related to their rates of economic mobility.

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity
Journal of Hospital Medicine, Vol. 8, no. 9, pp. 513-518. DOI: 10.1002/jhm.2068

Blecker, S., J.S. Austrian, D. Shine, R. Scott Braithwaite, M.J. Radford, and M.N. Gourevitch
09/01/2013

Background: Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR).

Methods: We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time.

Results: EHR interactions were lower on weekend days as compared to weekdays at every hour (P < 0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r = 0.90).

Conclusions: EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.

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