Inequality

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.
05/01/2010

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.
05/01/2010

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
04/01/2010

Objective

To examine racial disparities in health care service quality.

Design

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

Setting
Sixty communities across the United States.
Participants
A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.
Measurements
Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.
Results
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.
Conclusion
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


04/01/2010

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
04/01/2010

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.
03/01/2010

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.
01/13/2010

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.

Age of Entry and the High School Performance of Immigrant Youth

Age of Entry and the High School Performance of Immigrant Youth
Journal of Urban Economics 67: 303-314

Stiefel, Leanna, Amy Ellen Schwartz, and Dylan Conger
01/01/2010

In 2005, immigrants exceeded 12% of the US population, with the highest concentrations in large metropolitan areas. While considerable research has focused on how immigrants affect local wages and housing prices, less research has asked how immigrants fare in US urban public schools. Previous studies find that foreign-born students outperform native-born students in their elementary and middle school years, but urban policymakers and practitioners continue to raise concerns about educational outcomes of immigrants arriving in their high school years.

The authors use data on a large cohort of New York City (NYC) public high school students to examine how the performance of students who immigrate during high school (teen immigrants) differs from that of students who immigrate during middle school (tween immigrants) or elementary school (child immigrants), relative to otherwise similar native-born students. Contrary to prior studies, their difference-in-difference estimates suggest that, ceteris paribus, teen immigrants do well compared to native-born migrants, and that the foreign-born advantage is relatively large among the teen (im)migrants. That said, their findings provide cause for concern about the performance of limited English proficient students, blacks and Hispanics and, importantly, teen migrants. In particular, switching school districts in the high school years - that is, student mobility across school districts - may be more detrimental than immigration per se. Results are robust to alternative specifications and cohorts, including a cohort of Miami students.

 

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