How to House the Homeless

How to House the Homeless
Russell Sage Foundation Press

Ellen, I.G. & O'Flaherty, B. (eds.).

How to House the Homeless, editors Ingrid Gould Ellen and Brendan O’Flaherty propose that the answers entail rethinking how housing markets operate and developing more efficient interventions in existing service programs. The book critically reassesses where we are now, analyzes the most promising policies and programs going forward, and offers a new agenda for future research. How to House the Homeless makes clear the inextricable link between homelessness and housing policy. Contributor Jill Khadduri reviews the current residential services system and housing subsidy programs. For the chronically homeless, she argues, a combination of assisted housing approaches can reach the greatest number of people and, specifically, an expanded Housing Choice Voucher system structured by location, income, and housing type can more efficiently reach people at-risk of becoming homeless and reduce time spent homeless. Robert Rosenheck examines the options available to homeless people with mental health problems and reviews the cost-effectiveness of five service models: system integration, supported housing, clinical case management, benefits outreach, and supported employment. He finds that only programs that subsidize housing make a noticeable dent in homelessness, and that no one program shows significant benefits in multiple domains of life. Contributor Sam Tsemberis assesses the development and cost-effectiveness of the Housing First program, which serves mentally ill homeless people in more than four hundred cities. He asserts that the program’s high housing retention rate and general effectiveness make it a viable candidate for replication across the country. Steven Raphael makes the case for a strong link between homelessness and local housing market regulations—which affect housing affordability—and shows that the problem is more prevalent in markets with stricter zoning laws. Finally, Brendan O’Flaherty bridges the theoretical gap between the worlds of public health and housing research, evaluating the pros and cons of subsidized housing programs and the economics at work in the rental housing market and home ownership. Ultimately, he suggests, the most viable strategies will serve as safety nets—“social insurance”—to reach people who are homeless now and to prevent homelessness in the future. It is crucial that the links between effective policy and the whole cycle of homelessness—life conditions, service systems, and housing markets—be made clear now. With a keen eye on the big picture of housing policy, How to House the Homeless shows what works and what doesn’t in reducing the numbers of homeless and reaching those most at risk.

Neighborhoods and Obesity in New York City

Neighborhoods and Obesity in New York City
Health & Place, Vol. 16, no. 3, pp. 489-499. 10.1016/j.healthplace.2009.12.007

Black, J.L., J. Macinko, L.B. Dixon, and G.E. Fryer, Jr.

Recent studies reveal disparities in neighborhood access to food and fitness facilities, particularly in US cities; but few studies assess the effects of multiple neighborhood factors on obesity. This study measured the multilevel relations between neighborhood food availability, opportunities and barriers for physical activity, income and racial composition with obesity (BMI≥30 kg/m2) in New York City, controlling for individual-level factors. Obesity rates varied widely between neighborhoods, ranging from 6.8% to 31.7%. Obesity was significantly (p<0.01) associated with neighborhood-level factors, particularly the availability of supermarkets and food stores, fitness facilities, percent of commercial land use and area income. These findings are consistent with the growing literature showing that area income and availability of food and physical activity resources are related to obesity.

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?
American Economic Review, May, Volume 100(2): 200-204

Chiteji, N.

No abstract available.

Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices

Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices
Journal of General Internal Medicine, 2010. Volume 25 / Issue 04 / April 2010, pp 357-362, Published online

Dan Ly, Sherry Glied


To examine racial disparities in health care service quality.


Secondary data analyses of visits by primary care service users in the Community Tracking Study household sample.

Sixty communities across the United States.
A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.
Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.
Blacks but not other minorities were more likely to have an appointment lag of more than 1 week (13% white vs. 21% black, p < 0.001). Blacks, Hispanics, and other minorities were more likely to wait more than 30 min before being seen by the physician (16% white vs. 26% black, p < 0.001; vs. 27% Hispanic and 22% other minority, p < 0.001 and p = 0.02, respectively) and were less likely to report that they were very satisfied with their care (65% white vs. 60% black, p = 0.02; vs. 57% Hispanic and 48% other minority, p = 0.004 and p < 0.001, respectively). The differences in appointment lag and wait time remain large and statistically significant after the inclusion of multiple covariates, including geographic controls for CTS site. For all groups, satisfaction with care was affected by objective measures of service quality. Differences in objective measures of service quality explained much of the black-white difference in satisfaction, though not differences for other minority groups.
There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.

The Changing Distribution and Determinants of Obesity in the Neighborhoods of New York City, 2003–2007

The Changing Distribution and Determinants of Obesity in the Neighborhoods of New York City, 2003–2007
American Journal of Epidemiology, Vol. 171, no. 7, pp. 765-775. 10.1093/aje/kwp458


Obesity (body mass index 30 kg/m2 ) is a growing urban health concern, but few studies have examined whether, how, or why obesity prevalence has changed over time within cities. This study characterized the individual- and neighborhood-level determinants and distribution of obesity in New York City from 2003 to 2007. Individual-level data from the Community Health Survey (n ¼ 48,506 adults, 34 neighborhoods) were combined with neighborhood measures. Multilevel regression assessed changes in obesity over time and associations with neighborhood-level income and food and physical activity amenities, controlling for age, racial/ethnic identity, education, employment, US nativity, and marital status, stratified by gender. Obesity rates increased by 1.6% (P < 0.05) each year, but changes over time differed significantly between neighborhoods and by gender. Obesity prevalence increased for women, even after controlling for individual- and neighborhood-level factors (prevalence ratio ¼ 1.021, P < 0.05), whereas no significant changes were reported for men. Neighborhood factors including increased area income (prevalence ratio ¼ 0.932) and availability of local food and fitness amenities (prevalence ratio ¼ 0.889) were significantly associated with reduced obesity (P < 0.001). Findings suggest that policies to reduce obesity in urban environments must be informed by up-to-date surveillance data and may require a variety of initiatives that respond to both individual and contextual determinants of obesity.

Regional Variation in Total Cost per Radical Prostatectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database

Regional Variation in Total Cost per Radical Prostatectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database
Journal of Urology, Vol. 183, no. 4, pp. 1504-1509.DOI: 10.1016/j.juro.2009.12.014

Makarov, D.V., S. Loeb, A.B. Landman, M.E. Nielsen, C.P. Gross, D.L. Leslie, D.F. Penson, and R.A. Desai

Purpose: Surgical treatment for prostate cancer represents a large national health care expenditure. We determined whether state level variation in the cost of radical prostatectomy exists and whether we could explain this variation by adjusting for covariates associated with cost.

Materials and Methods: Using the 2004 Healthcare Cost and Utilization Project National Inpatient Sample of 7,978,041 patients we identified 9,917 who were 40 years old or older with a diagnosis of prostate cancer who underwent radical prostatectomy without cystectomy. We used linear regression to examine state level regional variation in radical prostatectomy costs, controlling for the local area wage index, patient demographics, case mix and hospital characteristics.

Results: The mean ± SD unadjusted cost was $9,112 ± $4,434 (range $2,001 to $49,922). The unadjusted mean cost ranged from $12,490 in California to $4,650 in Utah, each significantly different from the mean of $8,903 in the median state, Washington (p <0.0001). After adjusting for all potential confounders total cost was highest in Colorado and lowest in New Jersey, which were significantly different from the median, Washington ($10,750 and $5,899, respectively, vs $8,641, p <0.0001). The model explained 85.9% of the variance with regional variation accounting for the greatest incremental proportion of variance (35.1%) and case mix variables accounting for an incremental 32.3%.

Conclusions: The total cost of radical prostatectomy varies significantly across states. Controlling for known total cost determinants did not completely explain these differences but altered ordinal cost relationships among states. Cost variation suggests inefficiencies in the health care market. Additional studies are needed to determine whether these variations in total cost translate into differences in quality or outcome and how they may be translated into useful policy measures.

A qualitative analysis of environmental policy and children's health in Mexico

A qualitative analysis of environmental policy and children's health in Mexico
Environ Health. 2010 Mar 23;9:14

Cifuentes E, Trasande L, Ramirez M, Landrigan PJ.


Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards.


We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation.


We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform.


The Mexican government has not sufficiently accounted for children's unique vulnerability to environmental contaminants. If regulation and legislation are not updated and implemented to protect children, increases in preventable exposures to toxic chemicals in the environment may ensue.

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?
JOURNAL OF REGIONAL SCIENCE, VOL. 50, NO. 1, 2010, pp. 363-379

Ellen, I.G. & O'Regan, K.

We argue in this paper that neighborhoods are highly relevant for the types of issues at the heart of regional science. First, residential and economic activity takes place in particular locations, and particular neighborhoods. Many attributes of those neighborhood environments matter for this activity, from the physical amenities, to the quality of the public and private services received. Second, those neighborhoods vary in their placement in the larger region and this broader arrangement of neighborhoods is particularly important for location choices, commuting behavior and travel patterns. Third, sorting across these neighborhoods by race and income may well matter for educational and labor market outcomes, important components of a region's overall economic activity. For each of these areas we suggest a series of unanswered questions that would benefit from more attention. Focused on neighborhood characteristics themselves, there are important gaps in our understanding of how neighborhoods change - the causes and the consequences. In terms of the overall pattern of neighborhoods and resulting commuting patterns, this connects directly to current concerns about environmental sustainability and there is much need for research relevant to policy makers. And in terms of segregation and sorting across neighborhoods, work is needed on better spatial measures. In addition, housing market causes and consequences for local economic activity are under researched. We expand on each of these, finishing with some suggestions on how newly available data, with improved spatial identifiers, may enable regional scientists to answer some of these research questions.


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