Vulnerable Populations

Credit is Not a Right [REVISED]

Credit is Not a Right [REVISED]
Forthcoming in volume edited by Tom Sorell and Luis Cabrera: Microfinance, Rights, and Global Justice. Cambridge University Press.

Gershman, John and Jonathan Morduch
09/15/2014

Muhammad Yunus, the microcredit pioneer, has proposed that access to credit should be a human right. We approach the question by drawing on fieldwork and empirical scholarship in political science and economics. Evidence shows that access to credit may be powerful for some people some of the time, but it is not powerful for everyone all of the time, and in some cases it can do damage. Yunus’s claim for the power of credit access has yet to be widely verified, and most rigorous studies find microcredit impacts that fall far short of the kinds of empirical assertions on which his proposal rests. We discuss ways that expanding the domain of rights can diminish the power of existing rights, and we argue for a right to non-discrimination in credit access, rather than a right to credit access itself.

 

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study
Geospatial Health, Vol. 9, no. 1, pp. 57-70. DOI: http://dx.doi.org/10.4081/gh.2014.6

Duncan, D.T., S.D. Regan, D. Shelley, K. Day, R.R. Ruff, M. Al-Bayan, and B. Elbel
09/01/2014

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Promoting Transportation Flexibility in Extreme Events through Multi-Modal Connectivity

Promoting Transportation Flexibility in Extreme Events through Multi-Modal Connectivity
U.S. Department of Transportation Region II Urban Transportation Research Center, New York, NY: NYU-Wagner, June 2014.

R. Zimmerman, C.E. Restrepo, J. Sellers, A. Amirapu, and Theodore R. Pearson
06/01/2014

Extreme events of all kinds are increasing in number, severity, or impacts. Transportation provides a vital support service for people in such circumstances in the short-term for evacuation and providing supplies where evacuation is not undertaken, yet, transportation services are often disabled in disasters. Nationwide and in New York and New Jersey record-setting weather disasters have occurred and are expected to continue. Disadvantaged populations are particularly vulnerable. Network theories provide insights into vulnerability and directions for adaptation by defining interconnections, such as multi-modality. Multi-modal connectivity provides passenger flexibility and reduces risks in extreme events, and these benefits are evaluated in the NY area. Focusing on public transit, selected passenger multimodal facilities are identified that connect to transit, emphasizing rail-bus connectivity. Publicly available databases are used from MTA, NJ rail, and U.S. DOT’s IPCD. For NYC, statistical analyses suggest there may be some differences by poverty levels. For NYC and three northeastern NJ cities connectivity differs for stations that are terminuses and have high rail convergence. This report provides statistical summaries, cases, and a literature review to characterize multi-modal facilities and their use in extreme events. Recommendations and future research directions are provided for the role of passenger multi-modality to enhance transit flexibility.

The research was funded by a faculty research grant from the U.S. Department of Transportation, Region 2 University Transportation Research Center to NYU-Wagner, 2012-2014.

Functional Performance and Social Relations Among the Elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a Population-Based Epidemiological Study

Functional Performance and Social Relations Among the Elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a Population-Based Epidemiological Study
Cadernos de Saude Publica, Vol. 30, no. 5 (May 2014), pp. 1018-1028. doi: 10.1590/0102-311X00102013

Torres, J.L., R.C. Dias, F.R. Ferreira, J. Macinko, and M.F. Lima-Costa
05/01/2014

This study was conducted in a probabilistic sample of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.

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.

High Stakes in the Classroom, High Stakes on the Street: The Effects of Community Violence on Students’ Standardized Test Performance

High Stakes in the Classroom, High Stakes on the Street: The Effects of Community Violence on Students’ Standardized Test Performance
Sociological Science, forthcoming

Ingrid Gould Ellen, Amy Ellen Schwartz, Patrick Sharkey, and Johanna Lacoe
03/06/2014

This paper examines the effect of exposure to violent crime on students’ standardized test performance among a sample of students in New York City public schools. To identify the effect of exposure to community violence on children’s test scores, we compare students exposed to an incident of violent crime on their own blockface in the week prior to the exam to students exposed in the week after the exam. The results show that such exposure to violent crime reduces performance on English Language Arts assessments, and no effect on Math scores. The effect of exposure to violent crime is most pronounced among African Americans, and reduces the passing rates of black students by approximately 3 percentage points.

The Cost Implications of Prostate Cancer Screening in the Medicare Population

The Cost Implications of Prostate Cancer Screening in the Medicare Population
Cancer, Vol. 120, no. 1, pp. 96-102. DOI: 10.1002/cncr.28373

Ma, X., R. Wang, J.B. Long, J.S. Ross, P.R. Soulos, J.B. Yu, D.V. Makarov, H.T. Gold, and C.P. Gross
01/01/2014

Background: Recent debate about prostate-specific antigen (PSA)-based testing for prostate cancer screening among older men has rarely considered the cost of screening.

Methods: A population-based cohort of male Medicare beneficiaries aged 66 to 99 years, who had never been diagnosed with prostate cancer at the end of 2006 (n = 94,652), was assembled, and they were followed for 3 years to assess the cost of PSA screening and downstream procedures (biopsy, pathologic analysis, and hospitalization due to biopsy complications) at both the national and the hospital referral region (HRR) level.

Results: Approximately 51.2% of men received PSA screening tests during the 3-year period, with 2.9% undergoing biopsy. The annual expenditures on prostate cancer screening by the national fee-for-service Medicare program were $447 million in 2009 US dollars. The mean annual screening cost at the HRR level ranged from $17 to $62 per beneficiary. Downstream biopsy-related procedures accounted for 72% of the overall screening costs and varied significantly across regions. Compared with men residing in HRRs that were in the lowest quartile for screening expenditures, men living in the highest HRR quartile were significantly more likely to be diagnosed with prostate cancer of any stage (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI] = 1.07-1.35) and localized cancer (IRR = 1.30, 95% CI = 1.15-1.47). The IRR for regional/metastasized cancer was also elevated, although not statistically significant (IRR = 1.31, 95% CI = 0.81-2.11).

Conclusions: Medicare prostate cancer screening–related expenditures are substantial, vary considerably across regions, and are positively associated with rates of cancer diagnosis.

Measuring the Degree of Integrated Tuberculosis and HIV Service Delivery in Cape Town, South Africa

Measuring the Degree of Integrated Tuberculosis and HIV Service Delivery in Cape Town, South Africa
Health Policy and Planning, Vol. 29, no. 1 (Jan 2014), pp. 42-55. doi: 10.1093/heapol/czs131

Uyei, J., D. Coetzee, J. Macinko, S.L. Weinberg, and S. Guttmacher
01/01/2014

To address the considerable tuberculosis (TB)/HIV co-infected population in Cape Town, a number of clinics have made an effort of varying degrees to integrate TB and HIV services. This article describes the development of a theory-based survey instrument designed to quantify the extent to which services were integrated in 33 clinics and presents the results of the survey. Using principal factor analysis, eight factors were extracted and used to make comparisons across three types of clinics: co-located TB and antiretroviral therapy (ART) services, clinics with TB services only and clinics with ART only. Clinics with co-located services scored highest on measures related to integrated TB/ART service delivery compared to clinics with single services, but within group variability was high indicating that co-location of TB and ART services is a necessary but insufficient condition for integrated service delivery. In addition, we found almost all clinics with only TB services in our sample had highly integrated pre-ART services, suggesting that integration of these services across a large number of clinics is feasible and acceptable to clinic staff. TB clinics with highly integrated pre-ART services appear to be efficient sites for introducing ART given that co-infected patients are already engaged in care, and may potentially facilitate earlier access to treatment and minimize loss to follow-up.

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