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Schwartz GL, Leifheit KM, Arcaya MC, Keene D. Eviction as a community health exposure. Soc Sci Med 2024; 340:116496. [PMID: 38091853 PMCID: PMC11249083 DOI: 10.1016/j.socscimed.2023.116496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/23/2024]
Abstract
Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.
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Affiliation(s)
- Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Urban Health Collaborative & Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Kathryn M Leifheit
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariana C Arcaya
- Department of Urban Studies & Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Danya Keene
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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2
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Warner ET, Huguet N, Fredericks M, Gundersen D, Nederveld A, Brown MC, Houston TK, Davis KL, Mazzucca S, Rendle KA, Emmons KM. Advancing health equity through implementation science: Identifying and examining measures of the outer setting. Soc Sci Med 2023; 331:116095. [PMID: 37473542 PMCID: PMC10530521 DOI: 10.1016/j.socscimed.2023.116095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC3) Network Program. OBJECTIVE To describe the development of the Outer Setting Data Resource and characterize the county-level outer context across Centers. METHODS Our Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests. RESULTS ISC3 centers' catchment areas include 458 counties and over 126 million people across 28 states. The median percentage of population living within ½ mile of a park is higher in ISC3 counties (38.0%, interquartile range (IQR): 16.0%-59.0%) compared to nationally (18.0%, IQR: 7.0%-38.0%; p < 0.0001). The median percentage of households with no broadband access is significantly lower in ISC3 counties (28.4%, IQR: 21.4%-35.6%) compared the nation overall (32.8%, IQR: 25.8%-41.2%; p < 0.0001). The median unemployment rate was significantly higher in ISC3 counties (5.2%, IQR: 4.1%-6.4%) compared to nationally (4.9%, 3.6%-6.3%, p = 0.0006). CONCLUSIONS Our results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.
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Affiliation(s)
- Erica T Warner
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Fredericks
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daniel Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meagan C Brown
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Thomas K Houston
- General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kia L Davis
- Washington University School of Medicine, Department of Surgery, St. Louis, Missouri, USA
| | - Stephanie Mazzucca
- Washington University in St. Louis, Brown School, Prevention Research Center, St. Louis, MO, United States
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia Perelman School of Medicine, PA, USA
| | - Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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3
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Gu KD, Faulkner KC, Thorndike AN. Housing instability and cardiometabolic health in the United States: a narrative review of the literature. BMC Public Health 2023; 23:931. [PMID: 37221492 PMCID: PMC10203673 DOI: 10.1186/s12889-023-15875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.
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Affiliation(s)
- Kristine D. Gu
- Division of Endocrinology, Massachusetts General Hospital, 50 Staniford Street, Suite 340, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Katherine C. Faulkner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Anne N. Thorndike
- Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
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Aquino T, Brand JE, Torche F. Unequal effects of disruptive events. SOCIOLOGY COMPASS 2022; 16:e12972. [PMID: 38895138 PMCID: PMC11185416 DOI: 10.1111/soc4.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 06/21/2024]
Abstract
Disruptive events have significant consequences for the individuals and families who experience them, but these effects do not occur equally across the population. While some groups are strongly affected, others experience few consequences. We review recent findings on inequality in the effects of disruptive events. We consider heterogeneity based on socioeconomic resources, race/ethnicity, the likelihood of experiencing disruption, and contextual factors such as the normativity of the event in particular social settings. We focus on micro-level events affecting specific individuals and families, including divorce, job loss, home loss and eviction, health shocks and deaths, and violence and incarceration, but also refer to macro-level events such as recession and natural disasters. We describe patterns of variation that suggest a process of resource disparities and cumulative disadvantage versus those that reflect the impact of non-normative and unexpected shocks. Finally, we review methodological considerations when examining variation in the effect of disruptive events.
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Affiliation(s)
- Taylor Aquino
- University of California, Los Angeles, California, USA
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Friedman EM, Houle JN, Cagney KA, Slaughter ME, Shih RA. The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:956-967. [PMID: 32303760 DOI: 10.1093/geronb/gbaa047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. METHOD This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible. RESULTS We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. DISCUSSION This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults.
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Affiliation(s)
| | - Jason N Houle
- Department of Sociology, Dartmouth College, Hanover, New Hampshire
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Hoke MK, Boen CE. The health impacts of eviction: Evidence from the national longitudinal study of adolescent to adult health. Soc Sci Med 2021; 273:113742. [PMID: 33607393 PMCID: PMC8045672 DOI: 10.1016/j.socscimed.2021.113742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Eviction represents an urgent social and economic issue in the United States, with nearly two million evictions occurring annually in the U.S. Still, the population health impacts of evictions, as well as the pathways linking eviction to health, are not well documented or understood, particularly among young adults. Using nationally-representative, longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (1994-2008) (n = 9029), the present study uses a combination of analytic methods-including prospective lagged dependent variable regression models, inverse probabilities of treatment weighting, longitudinal first difference models, causal mediation techniques-to comprehensively assess whether and how evictions relate to depressive risk and self-rated health across early adulthood, paying particular attention to the stress-related pathways linking eviction and health. Results provide robust evidence of positive longitudinal associations between eviction and depressive risk, in particular. In the prospective regression models, young adults who experienced recent eviction had more depressive symptoms and worse self-rated health than those who were not evicted, net a host of background characteristics. Using treatment weighting techniques, results showed that young adults who experienced eviction had more depressive symptoms than those who were not evicted (5.921 vs. 4.998 depressive symptoms, p = 0.003). Perceived social stress mediated nearly 18 percent of the associations between eviction and the depressive symptoms (p < 0.001). In the first difference models, young people who experienced eviction between survey waves experienced greater increases in depressive symptoms over time compared to those who were not evicted, net of changes in other indicators of socioeconomic status and residential instability. Taken together, our results suggest that the recent surges in evictions in the U.S. serve as a potent threat to population health during the emerging adult period, with especially devastating consequences for low-income individuals and communities of color.
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Affiliation(s)
- Morgan K Hoke
- Population Studies Center, University of Pennsylvania, USA; Department of Anthropology, University of Pennsylvania, USA.
| | - Courtney E Boen
- Population Studies Center, University of Pennsylvania, USA; Department of Sociology, Population Aging Research Center, University of Pennsylvania, USA
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Are Housing Prices Associated with Food Consumption? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113882. [PMID: 32486226 PMCID: PMC7312069 DOI: 10.3390/ijerph17113882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Abstract
Objective: Since January 2010, the U.S. has experienced economic recovery, including a 39% increase in home prices nationally. While higher home prices represent a wealth increase for some homeowners, it may decrease real purchasing power for others. The objective of this study is to examine the relationship between local area housing values and consumption of four food categories. Design: Observational study using data from the Behavioral Risk Factor Surveillance System between 2011 and 2015. Outcomes included number of times per week food was consumed and binary measures denoting consumption ≥2 times per day for four categories: vegetables, fruit, legumes and fruit juice. The primary explanatory variables were metropolitan/micropolitan statistical area home and rental price indices from Zillow. Differential associations by home ownership, age, race/ethnicity and education were examined. Results: Overall, housing values were not associated with intake of vegetables or fruit juice. Among homeowners, a $10,000 increase in home price was associated with small, but statistically significant reductions in fruit and legume consumption. These inverse associations were pronounced among Hispanic and non-Hispanic Black adults. Conclusions: Lower fruit and legume consumption associated with greater housing values may represent one of several explanations including a decrease in purchasing power, given increases in home prices and limited wage growth since 2010.
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Schafer MH, Settels J, Upenieks L. As Goes the City? Older Americans' Home Upkeep in the Aftermath of the Great Recession. SOCIAL PROBLEMS 2020; 67:379-397. [PMID: 32362689 PMCID: PMC7176998 DOI: 10.1093/socpro/spz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The private home is a crucial site in the aging process, yet the upkeep of this physical space often poses a challenge for community-dwelling older adults. Previous efforts to explain variation in disorderly household conditions have relied on individual-level characteristics, but ecological perspectives propose that home environments are inescapably nested within the dynamic socioeconomic circumstances of surrounding spatial contexts, such as the metro area. We address this ecological embeddedness in the context of the Great Recession, an event in which some U.S. cities saw pronounced and persistent declines across multiple economic indicators while other areas rebounded more rapidly. Panel data (2005-6 and 2010-11) from a national survey of older adults were linked to interviewer home evaluations and city-level economic data. Results from fixed-effects regression support the hypothesis that older adults dwelling in struggling cities experienced an uptick in disorderly household conditions. Findings emphasize the importance of city-specificity when probing effects of a downturn. Observing changes in home upkeep also underscores the myriad ways in which a city's most vulnerable residents- older adults, in particular-are affected by its economic fortunes.
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Letarte L, Pomerleau S, Tchernof A, Biertho L, Waygood EOD, Lebel A. Neighbourhood effects on obesity: scoping review of time-varying outcomes and exposures in longitudinal designs. BMJ Open 2020; 10:e034690. [PMID: 32213520 PMCID: PMC7170601 DOI: 10.1136/bmjopen-2019-034690] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
CONTEXT AND OBJECTIVES Neighbourhood effect research on obesity took off in the early 2000s and was composed of mostly cross-sectional observational studies interested in various characteristics of the built environment and the socioeconomic environment. To limit biases related to self-selection and life course exposures, many researchers apply longitudinal designs in their studies. Until now, no review has specifically and exclusively examined longitudinal studies and the specific designs of these studies. In this review, we intend to answer the following research question: how are the temporal measurements of contextual exposure and obesity outcomes integrated into longitudinal studies that explore how neighbourhood-level built and socioeconomic environments impact adult obesity? DESIGN A systematic search strategy was designed to address the research question. The search was performed in Embase, Web of Science and PubMed, targeting scientific papers published before 1 January 2018. The eligible studies reported results on adults, included exposure that was limited to neighbourhood characteristics at the submunicipal level, included an outcome limited to obesity proxies, and reported a design with at least two exposure measurements or two outcome measurements. RESULTS This scoping review identified 66 studies that fit the eligibility criteria. A wide variety of neighbourhood characteristics were also measured, making it difficult to draw general conclusions about associations between neighbourhood exposure and obesity. We applied a typology that classified studies by whether exposure and outcome were measured as varying or fixed. Using this typology, we found that 32 studies reported both neighbourhood exposure and obesity outcomes that were varying in time; 28 reported varying outcomes but fixed exposures; and 6 had fixed outcomes and varying exposures. CONCLUSION Our typology illustrates the variety of longitudinal designs that were used in the selected studies. In the light of our results, we make recommendations on how to better report longitudinal designs and facilitate comparisons between studies.
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Affiliation(s)
- Laurence Letarte
- Planning and Development Research Center, Université Laval, Quebec city, Québec, Canada
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Research Institute, Quebec city, Québec, Canada
| | - Sonia Pomerleau
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Research Institute, Quebec city, Québec, Canada
- School of Nutrition, Université Laval, Quebec city, Québec, Canada
| | - André Tchernof
- School of Nutrition, Université Laval, Quebec city, Québec, Canada
- Quebec Heart and Lung Institute Research Centre, Université Laval, Quebec city, Québec, Canada
| | - Laurent Biertho
- Quebec Heart and Lung Institute Research Centre, Université Laval, Quebec city, Québec, Canada
- Departement of Surgery, Université Laval, Quebec city, Québec, Canada
| | - Edward Owen D Waygood
- Department of Civil, Geological and Mining Engineering, Polytechnique Montreal, Montreal, Québec, Canada
| | - Alexandre Lebel
- Planning and Development Research Center, Université Laval, Quebec city, Québec, Canada
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Research Institute, Quebec city, Québec, Canada
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10
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Jones A, Mamudu HM, Squires GD. Mortgage possessions, spatial inequality, and obesity in large US metropolitan areas. Public Health 2020; 181:86-93. [PMID: 31978778 DOI: 10.1016/j.puhe.2019.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/29/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES As social determinants of health, mortgage possessions (primarily foreclosures in the US context) and housing instability have been associated with certain mental and physical health outcomes at the individual level. However, individual risks of foreclosure and of poor health are spatially patterned. The objective of this study is to examine the extent to which area-specific social and economic characteristics help explain the relationship between mortgage possessions and obesity prevalence in 75 of the 100 most populous US metropolitan areas. STUDY DESIGN This is a cross-sectional study. METHODS The study relies on three sources of data: the Selected Metropolitan/Micropolitan Area Risk Trends (SMART) project, RealtyTrac foreclosure data, and the American Community Survey. Focal social and economic characteristics include foreclosure rates, levels of racial residential segregation, and poverty. Obesity prevalence and several control measures for each metropolitan area are also used. Ordinary least squares regression, weighted using the SMART project data, is used, and statistical significance is set at 0.05. RESULTS The results suggest that mortgage possessions are independently associated with higher obesity prevalence and that foreclosures operate through the specific channel of racial residential segregation and its tie to the racial composition of a metropolitan area. Socio-economic status of an area, and not poverty, is related to foreclosures and obesity prevalence. CONCLUSION Mortgage possessions not only are socio-economic but also have negative health consequences, such as obesity. The findings provide an empirical base for other researchers to uncover the relationships between segregation, mortgage possessions, and obesity at the individual level of analysis. The public health community should be engaged in addressing the issue of foreclosures in the US because the failure to engage may have broad financial and health consequences across large cities.
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Affiliation(s)
- A Jones
- Department of Sociology, The George Washington University, USA; Department of Epidemiology, Department of Biostatistics and Bioinformatics, The George Washington University, USA.
| | - H M Mamudu
- College of Public Health, East Tennessee State University, USA
| | - G D Squires
- Department of Sociology, The George Washington University, USA
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Sealy-Jefferson S, Misra DP. Neighborhood Tax Foreclosures, Educational Attainment, and Preterm Birth among Urban African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E904. [PMID: 30871154 PMCID: PMC6466185 DOI: 10.3390/ijerph16060904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/01/2019] [Accepted: 03/09/2019] [Indexed: 12/03/2022]
Abstract
Ecological evidence suggests that neighborhoods with more tax foreclosures also have more adverse birth outcomes. However, whether neighborhood-level tax foreclosures impact individual-level risk for adverse birth outcomes is unknown. We assessed whether living in a neighborhood with high tax foreclosures is associated with a woman's preterm birth (PTB) risk and tested for effect modification by educational attainment, among urban African American women from the Life Influence on Fetal Environments Study (2009⁻2011; n = 686). We linked survey and medical record data to archival, block-group level tax foreclosure data from the county treasurer. We used Modified Poisson regression with robust error variance and included a foreclosure X education interaction in adjusted models. In the overall sample, neighborhood tax foreclosures did not predict PTB (adjusted relative risk: 0.93, CI: 0.74, 1.16), but the association was modified by educational attainment (interaction p = 0.01). Among women with lower education (n = 227), neighborhood tax foreclosures did not predict PTB risk. The association for women with higher education (n = 401) was statistically significant for a reduction in risk for PTB (adjusted relative risk: 0.74, CI: 0.55, 0.98) among those who lived in neighborhoods with high versus low tax foreclosures. Future studies should seek to identify the mechanisms of this association.
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Affiliation(s)
- Shawnita Sealy-Jefferson
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH 43210, USA.
| | - Dawn P Misra
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI 48202, USA.
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12
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Chambers EC, Hanna DB, Hua S, Duncan DT, Camacho-Rivera M, Zenk SN, McCurley JL, Perreira K, Gellman MD, Gallo LC. Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos. BMC Public Health 2019; 19:77. [PMID: 30654781 PMCID: PMC6335763 DOI: 10.1186/s12889-019-6412-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 01/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods HCHS/SOL participants were age 18–74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). Results Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. Conclusion Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.
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Affiliation(s)
- Earle C Chambers
- Department of Family & Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Harold and Muriel Block Building, Rm. 409, Bronx, NY, 10461, USA. .,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Simin Hua
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Dustin T Duncan
- NYU Spatial Epidemiology Laboratory, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marlene Camacho-Rivera
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, 10031, USA
| | - Shannon N Zenk
- Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, 60610, USA
| | - Jessica L McCurley
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02114, USA
| | - Krista Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, 27599-7240, USA
| | - Marc D Gellman
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, Miami, FL, 33136, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
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13
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Duran AC, Zenk SN, Tarlov E, Duda S, Smith G, Lee JM, Berbaum ML. Foreclosures and weight gain: Differential associations by longer neighborhood exposure. Prev Med 2019; 118:23-29. [PMID: 30026119 PMCID: PMC6322928 DOI: 10.1016/j.ypmed.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.
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Affiliation(s)
- Ana Clara Duran
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA; Center for Food Studies, University of Campinas, Campinas, SP, Brazil.
| | - Shannon N Zenk
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Tarlov
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Sarah Duda
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Geoff Smith
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Jin Man Lee
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Michael L Berbaum
- Institute for Health Research and Policym, University of Illinois at Chicago, Chicago, IL, USA
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14
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McClure E, Feinstein L, Cordoba E, Douglas C, Emch M, Robinson W, Galea S, Aiello AE. The legacy of redlining in the effect of foreclosures on Detroit residents' self-rated health. Health Place 2018; 55:9-19. [PMID: 30448354 DOI: 10.1016/j.healthplace.2018.10.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Historical practices, such as housing discrimination in Detroit, have been shown to have lasting impacts on communities. Perhaps the most explicit example is the practice of redlining in the 1930s, whereby lenders outlined financially undesirable neighborhoods, populated by minority families, on maps and prevented residents from moving to better resourced neighborhoods. Awareness of historical housing discrimination may improve research assessing the impacts of current neighborhood characteristics on health. Using the Detroit Neighborhood Health Study (DNHS), we assessed the association between two-year changes in home foreclosure rates following the 2007-2008 Great Recession, and residents' five-year self-rated health trajectories (2008-2013); and estimated the confounding bias introduced by ignoring historical redlining practices in the city. We used both ecological and multilevel models to make inference about person- and community-level processes. In a neighborhood-level linear regression adjusted for confounders (including percent redlined); a 10%-point slower foreclosure rate recovery was associated with an increase in prevalence of poor self-rated health of 0.31 (95% CI:-0.02 to 0.64). At the individual level, it was associated with a within-person increase in probability of poor health of 0.45 (95% CI:0.15-0.72). Removing redlining from the model biased the estimated effect upward to 0.38 (95% CI:0.07-0.69) and 0.56 (95% CI:0.21-0.84) in the neighborhood and individual-level models, respectively. Stratum-specific foreclosure recovery effects indicate stronger influence in neighborhoods with a greater proportion of residents identifying as white and a greater degree of historic redlining. These findings support earlier theory suggesting a historical influence of structural discrimination on the association between current neighborhood characteristics and health, and suggests that historical redlining specifically may increase vulnerability to contemporary neighborhood foreclosures. Community interventions should consider historical discrimination in conjunction with current place-based indicators to more equitably improve population health.
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Affiliation(s)
- Elizabeth McClure
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lydia Feinstein
- Social & Scientific Systems, Research Triangle Park, NC, United States
| | - Evette Cordoba
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Michael Emch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Whitney Robinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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15
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Crawford ND, Moore K, Christine PJ, Barrientos-Gutierrez T, Seeman T, Diez Roux AV. Examining the Role of Neighborhood-Level Foreclosure in Smoking and Alcohol Use Among Older Adults in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:1863-1870. [PMID: 29961880 DOI: 10.1093/aje/kwy075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
The US Great Recession resulted in an alarming number of home foreclosures that weakened the social and physical environment of thousands of neighborhoods. Few studies have evaluated whether these neighborhood changes were related to changes in individual behaviors. We examined the relationship between changes in neighborhood-level home foreclosure within a quarter-mile (0.4-km) buffer of the residence and changes in cigarette smoking and alcohol use among 3,807 adults enrolled in the Multi-Ethnic Study of Atherosclerosis during 2005-2012, using econometric individual-level fixed-effects models. Increases in neighborhood-level foreclosure were associated with small decreases in the number of cigarettes smoked per day (mean difference = -0.08, 95% confidence interval: -0.11, -0.04) and small increases in the number of alcoholic beverages consumed per week (mean difference = 0.11, 95% confidence interval: 0.05, 0.17). Neighborhood-level foreclosure may not uniformly influence high-risk behaviors. The impact of home foreclosure on adult drinking should be further explored, given its potentially negative implications for health.
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Affiliation(s)
- Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Paul J Christine
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Teresa Seeman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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16
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Widening socio-economic disparities in early childhood obesity in Los Angeles County after the Great Recession. Public Health Nutr 2018; 21:2301-2310. [PMID: 29607794 DOI: 10.1017/s1368980018000666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While economic crises can increase socio-economic disparities in health, little is known about the impact of the 2008-09 Great Recession on obesity prevalence among children, especially low-income children. The present study examined whether socio-economic disparities in obesity among children of pre-school age participating in a federal nutrition assistance programme have changed since the recession. DESIGN A pre-post observational study using administrative data of pre-school-aged programme participants from 2003 to 2014. Logistic regression was used to examine whether the relationship between obesity prevalence (BMI≥95th percentile of the Centers for Disease Control and Prevention's growth charts) and three measures of socio-economic status (household income, household educational attainment, neighbourhood-level median household income) changed after the recession by examining the interaction between each socio-economic status measure and a 5-year time-period variable (2003-07 v. 2010-14), stratified by child's age and adjusted for child's sociodemographic characteristics. SETTING Los Angeles County, California, USA. SUBJECTS Children aged 2-4 years (n 1 637 788) participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. RESULTS The magnitude of the association of household income and household education with obesity increased after 2008-09 among 3- and 4-year-olds and 2- and 3-year-olds, respectively. However, the magnitude of the association of neighbourhood-level median household income with obesity did not change after 2008-09. CONCLUSIONS Disparities in obesity by household-level socio-economic status widened after the recession, while disparities by neighbourhood-level socio-economic status remained the same. The widening household-level socio-economic disparities suggest that obesity prevention efforts should target the most vulnerable low-income children.
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17
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Hall M, Crowder K, Spring A, Gabriel R. Foreclosure migration and neighborhood outcomes: Moving toward segregation and disadvantage. SOCIAL SCIENCE RESEARCH 2018; 70:107-114. [PMID: 29455737 DOI: 10.1016/j.ssresearch.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 10/31/2017] [Accepted: 11/26/2017] [Indexed: 06/08/2023]
Abstract
The US housing crisis during the late 2000s was arguably the most devastating residential disaster of the last century, sending millions of families into foreclosure and destroying billions in household wealth. An understudied aspect of the crisis was the spike in local migration that followed the foreclosure surge. In this paper, we assess the residential consequences of these moves, by exploring how foreclosure-induced migration affected the racial and socioeconomic composition of affected families' neighborhoods. To do so, we use the Panel Study of Income Dynamics to track foreclosure, migration, and neighborhood outcomes for samples of white, black, and Hispanic homeowners. Findings from our analysis show clearly that foreclosure was linked to migration to less white and more residentially disadvantaged neighborhoods, with foreclosed Hispanic householders, in particular, tending to move to poorer and more racially isolated neighborhoods.
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18
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Mui Y, Jones-Smith JC, Thornton RLJ, Pollack Porter K, Gittelsohn J. Relationships between Vacant Homes and Food Swamps: A Longitudinal Study of an Urban Food Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111426. [PMID: 29160811 PMCID: PMC5708065 DOI: 10.3390/ijerph14111426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/04/2022]
Abstract
Research indicates that living in neighborhoods with high concentrations of boarded-up vacant homes is associated with premature mortality due to cancer and diabetes, but the mechanism for this relationship is unclear. Boarded-up housing may indirectly impact residents’ health by affecting their food environment. We evaluated the association between changes in vacancy rates and changes in the density of unhealthy food outlets as a proportion of all food outlets, termed the food swamp index, in Baltimore, MD (USA) from 2001 to 2012, using neighborhood fixed-effects linear regression models. Over the study period, the average food swamp index increased from 93.5 to 95.3 percentage points across all neighborhoods. Among non-African American neighborhoods, increases in the vacancy rate were associated with statistically significant decreases in the food swamp index (b = −0.38; 90% CI, −0.64 to −0.12; p-value: 0.015), after accounting for changes in neighborhood SES, racial diversity, and population size. A positive association was found among low-SES neighborhoods (b = 0.15; 90% CI, 0.037 to 0.27; p-value: 0.031). Vacant homes may influence the composition of food outlets in urban neighborhoods. Future research should further elucidate the mechanisms by which more distal, contextual factors, such as boarded-up vacant homes, may affect food choices and diet-related health outcomes.
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Affiliation(s)
- Yeeli Mui
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Jessica C Jones-Smith
- Department of Health Services & Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA 98195, USA.
| | - Rachel L J Thornton
- Center for Child and Community Health Research, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Keshia Pollack Porter
- Department of Health Policy and Management, Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
- Global Obesity Prevention Center (GOPC) at Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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19
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Landscape care of urban vacant properties and implications for health and safety: Lessons from photovoice. Health Place 2017; 46:219-228. [PMID: 28570993 DOI: 10.1016/j.healthplace.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022]
Abstract
Care of vacant properties in urban environments is of particular interest to planners and residents alike. We report on a photovoice project completed by community leaders, researchers, and residents in two Detroit neighborhoods experiencing longtime systemic disinvestment. Participants photographed and discussed examples of care in a series of three focus groups in each neighborhood. Analyses highlight how acts of landscape care and visible cues to care contribute to changes in physical and social environments, and explore various links to health. We suggest theoretical and practical applications of residents' perspectives on landscape care and identify implications for well-being and neighborhood stability.
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20
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Houle JN, Light MT. The harder they fall? Sex and race/ethnic specific suicide rates in the U.S. foreclosure crisis. Soc Sci Med 2017; 180:114-124. [PMID: 28343110 PMCID: PMC6076432 DOI: 10.1016/j.socscimed.2017.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
Previous work shows suicide rates increase during economic recessions, but little research has examined the extent to which the foreclosure crisis-a unique aspect of the Great Recession-has contributed to disparities in rising suicide rates by race and sex. We develop and test two competing hypotheses regarding the association between foreclosures and race by sex specific suicide rates. We link foreclosure data (RealtyTrac) and suicide data (CDC) from 174 metropolitan areas from 2005 to 2010 (1044 MSA-year observations) and find that-net of time invariant unobserved between-metro area differences, national time trends, and time-varying confounders-a rise in the foreclosure rate is associated with a marginal increase in suicide, but this main effect masks considerable heterogeneity across groups. The association is particularly strong for white males, and weaker or non-existent for other race by sex groups.
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21
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Arcaya MC. Invited Commentary: Foreclosures and Health in a Neighborhood Context. Am J Epidemiol 2017; 185:436-439. [PMID: 28184426 DOI: 10.1093/aje/kww169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022] Open
Abstract
Recent systematic reviews link foreclosure to worse health at both the individual and population levels. In this issue of the Journal, Downing et al. (Am J Epidemiol. 2017;185(6):429-435) add to what is known about foreclosure and health by examining annual measures of glycemic control in relation to local foreclosure activity. They provided evidence that between 2007 and 2010, glycemic control was not associated with rates of completed foreclosure among a continuously insured managed-care population of persons with type 2 diabetes living in 9 California counties. In this commentary, I consider 5 possible interpretations of the null results: 1) foreclosures do not affect health in general, 2) glycated hemoglobin is insensitive to local foreclosure activity, 3) the presence of real estate owned foreclosures (rather than the competed foreclosure rate) affects health, 4) an integrated health-care delivery system buffers patients from the effects of the foreclosure crisis, and 5) community conditions and responses to the foreclosure crisis buffer patients from the effects of the foreclosure crisis. I close by arguing that research on the contextual effects of foreclosure on health should continue despite the ongoing recovery of the housing market.
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22
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Vásquez-Vera H, Palència L, Magna I, Mena C, Neira J, Borrell C. The threat of home eviction and its effects on health through the equity lens: A systematic review. Soc Sci Med 2017; 175:199-208. [DOI: 10.1016/j.socscimed.2017.01.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/22/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Christine PJ, Moore K, Crawford ND, Barrientos-Gutierrez T, Sánchez BN, Seeman T, Diez Roux AV. Exposure to Neighborhood Foreclosures and Changes in Cardiometabolic Health: Results From MESA. Am J Epidemiol 2017; 185:106-114. [PMID: 27986705 DOI: 10.1093/aje/kww186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/11/2016] [Indexed: 11/12/2022] Open
Abstract
Home foreclosures can precipitate declines in health among the individuals who lost their homes. Whether home foreclosures can "spillover" to affect the health of other neighborhood residents is largely unknown. Using longitudinal data from the Multi-Ethnic Study of Atherosclerosis that were linked to foreclosure data from 2005 to 2012, we assessed whether greater exposure to neighborhood foreclosures was associated with temporal changes in 3 objectively measured cardiometabolic risk factors: body mass index, systolic blood pressure, and fasting glucose level. We used fixed-effects models to estimate mean changes in cardiometabolic risk factors associated with changes in neighborhood foreclosures over time. In models in which we controlled for time-varying income, working status, medication use, neighborhood poverty, neighborhood unemployment, and interactions of age, sex, race, and state foreclosure laws with time, a standard-deviation increase in neighborhood foreclosures (1.9 foreclosures per quarter mile) was associated with increases in fasting glucose (mean = 0.22 mg/dL, 95% confidence interval: -0.05, 0.50) and decreases in blood pressure (mean = -0.27 mm Hg, 95% confidence interval: -0.49, -0.04). Changes in neighborhood foreclosure rates were not associated with changes in body mass index. Overall, greater exposure to neighborhood foreclosures had mixed associations with cardiometabolic risk factors over time. Given the millions of mortgages still in default, further research clarifying the potential health effects of neighborhood foreclosures is needed.
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24
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Reeves A, Clair A, McKee M, Stuckler D. Reductions in the United Kingdom's Government Housing Benefit and Symptoms of Depression in Low-Income Households. Am J Epidemiol 2016; 184:421-9. [PMID: 27613659 PMCID: PMC5023793 DOI: 10.1093/aje/kww055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
Housing security is an important determinant of mental ill health. We used a quasinatural experiment to evaluate this association, comparing the prevalence of mental ill health in the United Kingdom before and after the government's April 2011 reduction in financial support for low-income persons who rent private-sector housing (mean reduction of approximately £1,220 ($2,315) per year). Data came from the United Kingdom's Annual Population Survey, a repeated quarterly cross-sectional survey. We focused our analysis on renters in the private sector, disaggregating data between an intervention group receiving the government's Housing Benefit (n = 36,859) and a control group not receiving the Housing Benefit (n = 142,205). The main outcome was a binary measure of self-reported mental health problems. After controlling for preexisting time trends, we observed that between April 2011 and March 2013, the prevalence of depressive symptoms among private renters receiving the Housing Benefit increased by 1.8 percentage points (95% confidence interval: 1.0, 2.7) compared with those not receiving the Housing Benefit. Our models estimated that approximately 26,000 (95% confidence interval: 14,000, 38,000) people newly experienced depressive symptoms in association with the cuts to the Housing Benefit. We conclude that reducing housing support to low-income persons in the private rental sector increased the prevalence of depressive symptoms in the United Kingdom.
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Affiliation(s)
- Aaron Reeves
- Correspondence to Dr. Aaron Reeves, Department of Sociology, Social Sciences Division, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, United Kingdom (e-mail: )
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25
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Oddo VM, Nicholas LH, Bleich SN, Jones-Smith JC. The impact of changing economic conditions on overweight risk among children in California from 2008 to 2012. J Epidemiol Community Health 2016; 70:874-80. [PMID: 27251405 PMCID: PMC5870869 DOI: 10.1136/jech-2015-207117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/14/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The recent economic recession represents an opportunity to test whether decreases in economic resources may have deleterious consequences on childhood overweight/obesity risk. METHODS We investigated the association between indicators of changing macroeconomic conditions from 2008 to 2012 and overweight/obesity risk among school-aged children in California (n=1 741 712) using longitudinal anthropometric measurements. Multivariate regression, with individual and county fixed effects, was used to examine the effects of annual county-level unemployment and foreclosure rates on risk of child overweight/obesity, overall and among subgroups (race/ethnicity, sex, county-level median household income and county-level urban/rural status). RESULTS From 2008 to 2012, ∼38% of children were overweight/obese and unemployment and foreclosure rates averaged 11% and 6.9%, respectively. A 1-percentage point (pp) increase in unemployment was associated with a 1.4 pp (95% CI 1.3 to 1.5) increase in overweight/obesity risk. Therefore, a child of average weight could expect a 14% increase in their body mass index z-score in association with a 1 pp increase in unemployment during the study period. We found some differences in the magnitude of the effects for unemployment among demographic subgroups, with the largest effects observed for unemployment among American Indians and Pacific Islanders. CONCLUSIONS Comparing children to themselves over time, we provide evidence that increases in county-level unemployment are associated with increased overweight/obesity risk. Given that overweight among children with lower economic resources remains a challenge for public health, these findings highlight the importance of policy-level approaches, which aim to mitigate the impact of decreased resources as economic conditions change.
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Affiliation(s)
- Vanessa M. Oddo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
| | - Lauren Hersch Nicholas
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD USA
- Johns Hopkins School of Medicine, Department of Surgery, Baltimore, MD USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Sara N. Bleich
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD USA
| | - Jessica C. Jones-Smith
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
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26
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Abstract
BACKGROUND Investigators of previous studies regarding the correlation between area-level health care resources and obesity have not examined the association between the prevalence of dentists and rates of adult obesity. The authors conducted a study to address that knowledge gap. METHODS Using data compiled in the Robert Wood Johnson County Health Rankings and Roadmaps database, the authors conducted multivariable analyses of the relationship between the prevalence of dentists (from the 2011 Health Resources and Services Administration Area Resource File) and rates of obesity within counties. The authors controlled for prevalence of primary care providers, measures of the built environment (for example, number of recreational facilities per 10,000 population, the percentage of restaurants serving fast food) and county-level sociodemographic and economic factors. RESULTS When the authors conducted a multivariable analysis adjusted for state-level fixed effects, they found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity (P < .001). This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population (P ≤ .009). CONCLUSIONS The association between the prevalence of dentists and obesity, even after adjusting for primary care resources and sociodemographic factors, was evident. Although these data could not be used to assess causality, given the strength of the ecological, cross-sectional association, additional research involving person-level, longitudinal data is warranted. PRACTICAL IMPLICATIONS The correlation between the prevalence of dentists and obesity rates highlights the potential for dental professionals, as well as other primary care providers, to provide meaningful health education and support for improved nutritional behaviors, although the increased obesity rates in counties with fewer dentists per capita present challenges.
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27
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The health effects of the foreclosure crisis and unaffordable housing: A systematic review and explanation of evidence. Soc Sci Med 2016; 162:88-96. [PMID: 27343818 DOI: 10.1016/j.socscimed.2016.06.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/27/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
The foreclosure crisis was detrimental to the financial well-being of many households, yet the non-economic consequences are still poorly understood. This systematic review aims to understand the direct and spillover effect of foreclosures on several health-related outcomes by synthesizing evidence from 40 studies. First, this study identifies research gaps using a schema to organize studies by line of inquiry, health-related outcome, and measure of homeowner financial distress. In order to provide context for the findings, four pathways - stress, effect-budgeting, frustration-aggression, and trust - evoked in the literature are described to explain the relationship between foreclosures and health. The research suggests that experiencing a foreclosure and living near foreclosures are associated with poor psychological and behavioral morbidities, namely anxiety and violent behavior, and declining health utilization. Evidence is sparse on suicide, substance abuse, somatic morbidities, and mortality. Future research is needed to fill the gaps and explicitly test the mechanisms proposed.
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28
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Charters TJ, Harper S, Strumpf EC, Subramanian SV, Arcaya M, Nandi A. The effect of metropolitan-area mortgage delinquency on health behaviors, access to health services, and self-rated health in the United States, 2003-2010. Soc Sci Med 2016; 161:74-82. [PMID: 27261531 DOI: 10.1016/j.socscimed.2016.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 01/08/2023]
Abstract
The recent housing crisis offers the opportunity to understand the effects of unique indicators of macroeconomic conditions on health. We linked data on the proportion of mortgage borrowers per US metropolitan-area who were at least 90 days delinquent on their payments with individual-level outcomes from a representative sample of 1,021,341 adults surveyed through the Behavioral Risk Factor Surveillance System (BRFSS) between 2003 and 2010. We estimated the effects of metropolitan-area mortgage delinquency on individual health behaviors, medical coverage, and health status, as well as whether effects varied by race/ethnicity. Results showed that increases in the metropolitan-area delinquency rate resulted in decreases in heavy alcohol consumption and increases in exercise and health insurance coverage. However, the delinquency rate was also associated with increases in smoking and obesity in some population groups, suggesting the housing crisis may have induced stress-related behavioral change. Overall, the effects of metropolitan-area mortgage delinquency on population health were relatively modest.
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Affiliation(s)
- Thomas J Charters
- Department of Epidemiology, Biostatistics and Occupational Health & Institute for Health and Social Policy, McGill University, Charles Meredith House Room B8, 1030 Pine Ave. West, Montreal, QC H3A 1A3, Canada.
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 34B, 1020 Pine Ave. West, Montreal, QC H3A 1A2, Canada.
| | - Erin C Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 36C, 1020 Pine Ave. West, Montreal, QC H3A 1A2, Canada; Department of Economics, McGill University, Leacock 418, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada.
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Kresge Building 716, 677 Huntington Avenue, Boston, MA 02115-6096, USA.
| | - Mariana Arcaya
- Harvard Center for Population and Development Studies, Harvard School of Public Health, 9 Bow Street, Cambridge, MA 02138, USA.
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health & Institute for Health and Social Policy, McGill University, Charles Meredith House Room 102, 1030 Pine Ave. West, Montreal, QC H3A 1A3, Canada.
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Downing J, Karter A, Rodriguez H, Dow WH, Adler N, Schillinger D, Warton M, Laraia B. No Spillover Effect of the Foreclosure Crisis on Weight Change: The Diabetes Study of Northern California (DISTANCE). PLoS One 2016; 11:e0151334. [PMID: 26985671 PMCID: PMC4795787 DOI: 10.1371/journal.pone.0151334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/26/2016] [Indexed: 11/23/2022] Open
Abstract
The emerging body of research suggests the unprecedented increase in housing foreclosures and unemployment between 2007 and 2009 had detrimental effects on health. Using data from electronic health records of 105,919 patients with diabetes in Northern California, this study examined how increases in foreclosure rates from 2006 to 2010 affected weight change. We anticipated that two of the pathways that explain how the spike in foreclosure rates affects weight gain-increasing stress and declining salutary health behaviors- would be acute in a population with diabetes because of metabolic sensitivity to stressors and health behaviors. Controlling for unemployment, housing prices, temporal trends, and time-invariant confounders with individual fixed effects, we found no evidence of an association between the foreclosure rate in each patient's census block of residence and body mass index. Our results suggest, although more than half of the population was exposed to at least one foreclosure within their census block, the foreclosure crisis did not independently impact weight change.
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Affiliation(s)
- Janelle Downing
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Andrew Karter
- Division of Research, Kaiser Permanente, Oakland, California, United States of America
| | - Hector Rodriguez
- School of Public Health, University of California, Berkeley, California, United States of America
| | - William H Dow
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Nancy Adler
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Dean Schillinger
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Margaret Warton
- Division of Research, Kaiser Permanente, Oakland, California, United States of America
| | - Barbara Laraia
- School of Public Health, University of California, Berkeley, California, United States of America
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Kirsch JA, Ryff CD. Hardships of the Great Recession and health: Understanding varieties of vulnerability. Health Psychol Open 2016; 3:2055102916652390. [PMID: 28070407 PMCID: PMC5193248 DOI: 10.1177/2055102916652390] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Great Recession of 2007-2009 is regarded as the most severe economic downturn since World War II. This study examined relationships between reported recession hardships and physical health in a national survey of American adults (N = 1275). Furthermore, education and psychological resources (perceived control, purpose in life, and conscientiousness) were tested as moderators of the health impacts of the recession. A greater number of hardships predicted poorer health, especially among the less educated. Psychological resources interacted with education and hardships to predict health outcomes. Although typically viewed as protective factors, such resources became vulnerabilities among educationally disadvantaged adults experiencing greater recession hardships.
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Cutshaw CA, Woolhandler S, Himmelstein DU, Robertson C. Medical Causes and Consequences of Home Foreclosures. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:36-47. [DOI: 10.1177/0020731415614249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to elucidate the medical causes and consequences of foreclosure. We surveyed 90 households undergoing foreclosure in 2013–2014 in Maricopa County, Arizona on two occasions approximately five months apart. At baseline, median monthly household income was $3,000, and median mortgage payment $1,350. Only 10% of respondents lacked health insurance when surveyed, although 28% had experienced a gap in coverage within the past two years. Fifty-seven percent identified a medical debt or another medical cause of their foreclosure, and 54% had taken on new debt to pay medical bills; 10% had mortgaged their home for this reason. Although 57% of respondents had a chronic condition requiring ongoing care, more than half reported delaying or skipping a needed medical visit. At follow-up, one-third of respondents had been unable to afford food, and 3 respondents reported becoming homeless; 46% said foreclosure had worsened their health; and 63% had already incurred new medical debts. Medical debt and medical problems frequently contribute to foreclosure, even among insured families. Foreclosure compromises access to care and basic necessities like food and shelter, and worsens self-reported health.
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Affiliation(s)
- Christina A. Cutshaw
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Steffie Woolhandler
- The City University of New York School of Public Health at Hunter College, Harvard Medical School, NY, USA
| | - David U. Himmelstein
- The City University of New York School of Public Health at Hunter College, Harvard Medical School, NY, USA
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Tsai AC. Home foreclosure, health, and mental health: a systematic review of individual, aggregate, and contextual associations. PLoS One 2015; 10:e0123182. [PMID: 25849962 PMCID: PMC4388711 DOI: 10.1371/journal.pone.0123182] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The U.S. foreclosure crisis intensified markedly during the Great Recession of 2007-09, and currently an estimated five percent of U.S. residential properties are more than 90 days past due or in the process of foreclosure. Yet there has been no systematic assessment of the effects of foreclosure on health and mental health. METHODS AND FINDINGS I applied systematic search terms to PubMed and PsycINFO to identify quantitative or qualitative studies about the relationship between home foreclosure and health or mental health. After screening the titles and abstracts of 930 publications and reviewing the full text of 76 articles, dissertations, and other reports, I identified 42 publications representing 35 unique studies about foreclosure, health, and mental health. The majority of studies (32 [91%]) concluded that foreclosure had adverse effects on health or mental health, while three studies yielded null or mixed findings. Only two studies examined the extent to which foreclosure may have disproportionate impacts on ethnic or racial minority populations. CONCLUSIONS Home foreclosure adversely affects health and mental health through channels operating at multiple levels: at the individual level, the stress of personally experiencing foreclosure was associated with worsened mental health and adverse health behaviors, which were in turn linked to poorer health status; at the community level, increasing degradation of the neighborhood environment had indirect, cross-level adverse effects on health and mental health. Early intervention may be able to prevent acute economic shocks from eventually developing into the chronic stress of foreclosure, with all of the attendant benefits this implies for health and mental health status. Programs designed to encourage early return of foreclosed properties back into productive use may have similar health and mental health benefits.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
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Houle JN, Keene DE. Getting sick and falling behind: health and the risk of mortgage default and home foreclosure. J Epidemiol Community Health 2014; 69:382-7. [PMID: 25430548 DOI: 10.1136/jech-2014-204637] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An emerging literature shows that mortgage strain can lead to poor health outcomes, but less work has focused on whether and how health shocks influence mortgage distress. We examine the link between changes in health status and default/foreclosure risk among older middle-aged adults. METHOD We used National Longitudinal Study of Youth 1979 data and multivariate logistic regression models to examine the relationship between changes in health limitations and chronic conditions across survey waves and risk of mortgage default and foreclosure. RESULTS We found that changes in health limitations and chronic conditions increased the risk of default and foreclosure between 2007 and 2010. These associations were partially mediated by changes in family income and loss of health insurance. CONCLUSIONS From a policy perspective, the strong link between the onset of illness and foreclosure suggests a need to re-examine the safety-nets that are available to individuals who become ill or disabled.
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Affiliation(s)
- Jason N Houle
- Department of Sociology, Dartmouth College, Hanover, New Hampshire, USA
| | - Danya E Keene
- Social Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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Houle JN. Mental health in the foreclosure crisis. Soc Sci Med 2014; 118:1-8. [PMID: 25084488 DOI: 10.1016/j.socscimed.2014.07.054] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
Current evidence suggests that the rise in home foreclosures that began in 2007 created feelings of stress, vulnerability, and sapped communities of social and economic resources. Minority and low SES communities were more likely to be exposed to predatory lending and hold subprime mortgages, and were the hardest hit by the foreclosure crisis. Little research has examined whether and how the foreclosure crisis has undermined population mental health. I use data from 2245 counties in 50 U.S. states to examine whether living in high foreclosure areas is associated with residents' mental health and whether the foreclosure crisis has the potential to exacerbate existing disparities in mental health during the recessionary period. I use county-level data from RealtyTrac and other data sources, and individual-level data from the Behavioral Risk Factor Surveillance Survey from 2006 to 2011. I find that - net of time invariant unobserved between-county differences, national time trends, and observed confounders - a rise in a county's foreclosure rate is associated with a decline in residents' mental health. This association is especially pronounced in counties with a high concentration of low SES and minority residents, which supports the perspective that the foreclosure crisis has the potential to exacerbate existing social disparities in mental health.
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Affiliation(s)
- Jason N Houle
- Dartmouth College, 6104 Silsby Hall, Room 111, Hanover, NH 03755, USA.
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Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health 2014; 104:1073-9. [PMID: 24825209 PMCID: PMC4062039 DOI: 10.2105/ajph.2013.301774] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between state-level foreclosure and suicide rates from 2005 to 2010 and considered variation in the effect of foreclosure on suicide by age. METHODS We used hybrid random- and fixed-effects models to examine the relation between state foreclosure rates and total and age-specific suicide rates from 2005 to 2010 (n = 306 state-years). RESULTS Net of other factors, an increase in the within-state total foreclosure rate was associated with a within-state increase in the crude suicide rates (b = 0.04; P < .1), and effects were stronger for the real estate-owned foreclosure rate (b = 0.16; P < .05). Analysis of age-specific suicide rates indicated that the effects were strongest among the middle-aged (46-64 years: total foreclosure rate, b = 0.21; P < .001; real estate-owned foreclosure rate, b = 0.83; P < .001). Rising home foreclosure rates explained 18% of the variance in the middle-aged suicide rate between 2005 and 2010. CONCLUSIONS The foreclosure crisis has likely contributed to increased suicides, independent of other economic factors associated with the recession. Rising foreclosure rates may be partially responsible for the recent uptick in suicide among middle-aged adults.
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Affiliation(s)
- Jason N Houle
- At the time of the study, Jason N. Houle was with the University of Wisconsin-Madison. Michael T. Light is with the Department of Sociology, Purdue University, West Lafayette, IN
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Arcaya M, Glymour MM, Chakrabarti P, Christakis NA, Kawachi I, Subramanian SV. Effects of proximate foreclosed properties on individuals' systolic blood pressure in Massachusetts, 1987 to 2008. Circulation 2014; 129:2262-8. [PMID: 24891622 DOI: 10.1161/circulationaha.113.006205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No studies have examined the effects of local foreclosure activity on neighbors' blood pressure, despite the fact that spillover effects of nearby foreclosures include many known risk factors for increased blood pressure. We assessed the extent to which living near foreclosed properties is associated with subsequent systolic blood pressure (SBP) measurements. METHODS AND RESULTS We used 6590 geocoded observations collected from 1740 participants in the Framingham Offspring Cohort across 5 waves (1987-2008) of the Framingham Heart Study to create a longitudinal record of exposure to nearby foreclosure activity. We distinguished between real estate-owned foreclosures, which typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into productive use. Counts of lender-owned foreclosed properties within 100 m of participants' homes were used to predict measured SBP and odds of being hypertensive. We assessed whether self-reported alcoholic drinks per week and measured body mass index helped to explain the relationship between foreclosure activity and SBP. Each additional real estate-owned foreclosure located within 100 m of a participant's home was associated with an increase in SBP of 1.71 mm Hg (P=0.03; 95% confidence interval, 0.18-3.24) after adjustment for individual- and area-level confounders but not with odds of hypertension. The presence of foreclosures purchased by third-party buyers was not associated with SBP or with hypertension. Body mass index and alcohol consumption attenuated the effect of living near real estate-owned foreclosures on SBP in fully adjusted models. CONCLUSIONS Real estate-owned foreclosed properties may put nearby neighbors at risk for increased SBP, with higher alcohol consumption and body mass index partially mediating this relationship.
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Affiliation(s)
- Mariana Arcaya
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.).
| | - M Maria Glymour
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Prabal Chakrabarti
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Nicholas A Christakis
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Ichiro Kawachi
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - S V Subramanian
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
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