Vulnerable Populations

Banks and Microbanks

Banks and Microbanks
Journal of Financial Services Research (2014) 46:1–53. DOI 10.1007/s10693-013-0177-z

Robert Cull, Asli Demirgüç-Kunt, and Jonathan Morduch
08/01/2014

We combine two datasets to examine whether the presence of banks affects the profitability and outreach of microfinance institutions.We find evidence that competition matters. Greater bank penetration in the overall economy is associated with microbanks pushing toward poorer markets, as reflected in smaller average loans sizes and greater outreach to women. The evidence is particularly strong for microbanks relying on commercial-funding and using traditional bilateral lending contracts (rather than group lending methods favored by microfinance NGOs). We consider plausible alternative explanations for the correlations, including relationships that run through the nature of the regulatory environment and the structure of the banking environment, but we fail to find strong support for these alternative hypotheses.

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.

"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.

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.

How Patients Understand the Term “Nonmedical Use” of Prescription Drugs: Insights from Cognitive Interviews

How Patients Understand the Term “Nonmedical Use” of Prescription Drugs: Insights from Cognitive Interviews
Substance Abuse, Vol. 35, no. 1, pp. 12-20. DOI: 10.1080/08897077.2013.789463

McNeely, J., P.N. Halkitis,A. Horton, R. Khan, and M.N. Gourevitch
03/03/2014

Background: With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. The authors sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care.

Methods: A total of 27 English-speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a 4-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. Detailed field notes were analyzed for overall comprehension of the screening items on illicit drug use and prescription drug misuse, the accuracy with which participants classified drugs into these categories, and whether the screening response correctly captured the participant's substance use behavior.

Results: Based on initial responses to the screening items, 6 (22%) participants screened positive for past-year prescription drug misuse, and 8 (30%) for illicit drug use. The majority (26/27) of participants correctly interpreted the item on illicit drug use, and appropriately classified drugs in this category. Eleven (41%) participants had errors in their understanding of the prescription drug misuse item. The most common error was classifying use of medications without abuse potential as nonmedical use. All cases of misunderstanding the prescription drug misuse item occurred among participants who screened negative for illicit drug use.

Conclusions: The results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical settings could potentially lead to high rates of false-positive results.

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.

Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease

Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease
Health Affairs, 32, no.12 (2013):2099-2108

Billings, John and Maria C. Raven
12/01/2013

Urban legend has often characterized frequent emergency department (ED) patients as mentally ill substance users who are a costly drain on the health care system and who contribute to ED overcrowding because of unnecessary visits for conditions that could be treated more efficiently elsewhere. This study of Medicaid ED users in New York City shows that behavioral health conditions are responsible for a small share of ED visits by frequent users, and that ED use accounts for a small portion of these patients’ total Medicaid costs. Frequent ED users have a substantial burden of disease, and they have high rates of primary and specialty care use. They also have linkages to outpatient care that are comparable to those of other ED patients. It is possible to use predictive modeling to identify who will become a repeat ED user and thus to help target interventions. However, policy makers should view reducing frequent ED use as only one element of more-comprehensive intervention strategies for frequent health system users.

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