Opportunities for making ends meet and upward mobility: differences in organizational deprivation across urban and suburban poor neighborhoods

Urban Neighborhood Characteristics and the Spatial Distribution of Home and Community-Based Service Organizations in Michigan Metropolitan Statistical Areas

Living in a neighborhood with dense HCBS organizations can promote older adults' health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013-2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor's degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.

Health Care In The Suburbs: An Analysis Of Suburban Poverty And Health Care Access

There are 16.9 million Americans living in poverty in the suburbs-more than in cities or rural communities. Despite recent increases in suburban poverty, the perception of the suburbs as areas of uniform affluence remains, and there has been little research into health care barriers experienced by people living in these areas. The objectives of this study were to compare patterns of insurance coverage and health care access in suburban, urban, and rural areas using national survey data from 2005 to 2015 and to compare outcomes by geography before and after the Affordable Care Act took effect. We found that nearly 40 percent of the uninsured population lived in suburban areas. Though unadjusted rates of health care access were better in suburban areas, compared to urban and rural communities, this advantage was greatly reduced after income and other demographics are accounted for. Overall, a substantial portion of the US population residing in the suburbs lacked health insurance and experienced difficulties accessing care. Increased policy attention is needed to address these challenges for vulnerable populations living in the suburbs.

Navigating Networks: How Nonprofit Network Membership Shapes Response to Resource Scarcity

Central to the contemporary American welfare state, nonprofits are increasingly squeezed between declining resources and a simultaneous peak in demand for services. Scholars have outlined a number of ways that nonprofits strategically respond to resource scarcity. Why nonprofits select particular strategies, however, is less clear. This article motivates a network membership perspective via a mixed-methods study of one food bank and its associated food pantries, wherein actors navigate competing network demands that are emblematic of those faced by other nonprofits. Food banks source food from three types of networks - a cartel-like network orchestrated by a national coordinating body, a peer-to-peer inter-food bank network, and a bureaucratic network anchored by the USDA - that place overlapping and conflicting constraints on the organizations. In combination, network demands entangle the food banks within a web of tensions that prevent many forms of adaptation while enabling others, a predicament I refer to in this article as network entrapment. How organizations navigate network demands has implications for the vitality of the organizations and the wellbeing of their beneficiaries. My results suggest that entrapment can lead to organizational burden and the adoption of neoliberal-inspired efficiencies, but also innovations that prioritize citizen rights over cost-benefit ratios.

Neighborhood Isolation in Chicago: Violent Crime Effects on Structural Isolation and Homophily in Inter-Neighborhood Commuting Networks, 2002-2013

Urban sociologists and criminologists have long been interested in the link between neighborhood isolation and crime. Yet studies have focused predominantly on the internal dimension of social isolation (i.e., increased social disorganization and insufficient jobs and opportunities). This study highlights the need to assess the external dimension of neighborhood isolation, the disconnectedness from other neighborhoods in the city. Analyses of Chicago's neighborhood commuting network over twelve years (2002-2013) showed that violence predicted network isolation. Moreover, pairwise similarity in neighborhood violence predicted commuting ties, supporting homophily expectations. Violence homophily affected tie formation most, while neighborhood violence was important in dissolving ties.

Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices

BACKGROUND

Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices.

METHODS

We conducted 23 semistructured interviews with parents of children <4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved.

RESULTS

Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs.

CONCLUSIONS

Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.

Clinicians' Perceptions of Screening for Food Insecurity in Suburban Pediatric Practice

BACKGROUND

National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices.

METHODS

We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement.

RESULTS

Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit.

CONCLUSIONS

We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.

Examining How Prescription Drugs Are Illegally Obtained

The rise in prescription drug abuse is changing crime patterns among drug users and the structure of illegal drug markets. The illegal distribution of prescription drugs is different from traditional street drug markets because prescription drugs can be obtained from multiple sources including doctors, pharmacies, friends, and street-level dealers. Drawing from drug-market research, this article investigates whether there are individual and ecological predictors of how prescription drugs are illegally obtained. Our study uses multilevel analyses to examine a random sample of 366 drug offenders arrested in Maricopa County, Arizona. Our findings indicate that individual-level characteristics such as mental illness and street drug use, as well as residential mobility within neighborhoods, are significant predictors of how prescription drugs are obtained for nonmedical purposes. This research suggests that an individual’s routine activities and neighborhood characteristics are related to their methods for obtaining prescription drugs. Theoretical and policy implications are discussed.

The influence of incarceration and Re-entry on the availability of health care organizations in Arkansas

Background

Studies show that ex-prisoners often experience more health problems than the general population; unfortunately, these issues follow them upon their release from prison. As such, it is possible re-entry rates signal the need for neighborhood-based health care organizations (HCOs). We ask: are incarceration and re-entry rates associated with the availability of HCOs?.

Methods

MethodsUsing 2008 Central Business Pattern data, 2008 prison admissions and release data, and 2000 and 2010 census data, we test whether prison admission and release rates impact the availability of HCOs net of neighborhood characteristics in Arkansas using Logit-Poisson hurdle models with county fixed effects.

Results

We find that the incarceration and re-entry rates – together known as coercive mobility -- are related to whether a neighborhood has one or more HCOs, but not to the number of HCOs in a neighborhood.

Conclusion

Future public policies should aim to locate health care organizations in areas where there is significant churning of individuals in and out of prison.

Electronic supplementary material

The online version of this article (doi:10.1186/s40352-015-0016-4) contains supplementary material, which is available to authorized users.