Chronic Diseases and Related Risk Factors among Low-Income Mothers

The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005–2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (≤100% FPL; 101–250% FPL; >250% FPL). Approximately one-third of women were low-income (≤100% FPL), one-third were near-low-income (101–250% FPL), and one-third were higher-income (>250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.     

Is Sprawl Associated with a Widening Urban–Suburban Mortality Gap?

This paper examines whether sprawl, featured by low development density, segregated land uses, lack of significant centers, and poor street connectivity, contributes to a widening mortality gap between urban and suburban residents. We employ two mortality datasets, including a national cross-sectional dataset examining the impact of metropolitan-level sprawl on urban–suburban mortality gaps and a longitudinal dataset from Portland examining changes in urban–suburban mortality gaps over time. The national and Portland studies provide the only evidence to date that (1) across metropolitan areas, the size of urban–suburban mortality gaps varies by the extent of sprawl: in sprawling metropolitan areas, urban residents have significant excess mortality risks than suburban residents, while in compact metropolitan areas, urbanicity-related excess mortality becomes insignificant; (2) the Portland metropolitan area not only experienced net decreases in mortality rates but also a narrowing urban–suburban mortality gap since its adoption of smart growth regime in the past decade; and (3) the existence of excess mortality among urban residents in US sprawling metropolitan areas, as well as the net mortality decreases and narrowing urban–suburban mortality gap in the Portland metropolitan area, is not attributable to sociodemographic variations. These findings suggest that health threats imposed by sprawl affect urban residents disproportionately compared to suburban residents and that efforts curbing sprawl may mitigate urban–suburban health disparities.

A population-based assessment of the health of homeless families in New York City, 2001-2003

Objectives. We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods.Methods. We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001–2003).Results. Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations.Conclusions. Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children''s slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing.Most studies examining the health of homeless populations have involved single adults and have identified higher rates of death, tuberculosis (TB), HIV/AIDS, mental health disorders, substance use, poor birth outcomes, and cardiovascular disease than in the general population.^1–7 Whether these findings can be generalized to homeless families is not known, as the 2 populations differ greatly. Nationally, homeless families overwhelmingly consist of a young female head of household with children, whereas single homeless adults are mostly men aged 31 to 50 years.⁸ Homeless families are also distinct in their reasons for becoming homeless, citing poverty more often and substance use and mental illness less often than is the case for their single adult counterparts.⁹ Based on their demographic and socioeconomic profiles, the health of homeless families may be more like that of other low-income families than that of homeless single adults.Recent economic conditions have led to a rise in the number of homeless families nationwide. Although overall US homelessness held fairly constant from 2007 to 2008, the number of homeless families increased by 9%. According to the latest available national data, an estimated 516 700 adults and children were sheltered as families over a 1-year period in 2008, constituting roughly a third of the overall sheltered homeless population during that time.⁸ More recent data from a sampling of localities found that, as of September 2009, the count of sheltered families had increased 10% from the previous quarter, as foreclosure and unemployment rates continued to rise.¹⁰In New York City (NYC), the Department of Homeless Services (DHS) supplies apartment-style shelters and support services such as childcare, housing assistance, and health care referral to homeless families. Because the city provides emergency shelter to eligible families, virtually all homeless families use shelter facilities. In 7 years of an annual count of street homeless, a family has never been found on the street.¹¹ A small share of homeless families is sheltered by city agencies other than DHS. However, analyses based on DHS shelter registry likely include the vast majority of the NYC homeless family population.Our objective was to systematically characterize the health of adults and children who used the NYC family shelter system. We matched the DHS family shelter registry with 4 health registries managed by the NYC Department of Health and Mental Hygiene, and we compared estimates of morbidity and mortality in the homeless family population with those of the NYC general and lowest-income neighborhood populations.     

The Impact of Public Housing on Social Networks: A Natural Experiment

Objectives. We assessed whether 2 types of public housing—scattered among market-rate housing developments or clustered in small public housing projects—were associated with the perceived health and health behaviors of residents’ social networks.Methods. Leveraging a natural experiment in Montgomery County, Maryland, in which residents were randomly assigned to different types of public housing, we surveyed 453 heads of household in 2011. We asked residents about their own health as well as the perceived health of their network members, including their neighbors.Results. Residents in scattered-site public housing perceived that their neighbors were more likely to exercise than residents of clustered public housing (24.7% of network members vs 14.0%; P < .001). There were no significant differences in the proportion of network members who were perceived to have major health problems, depressed mood, poor diet, or obesity. Having more network members who smoked was associated with a significantly higher likelihood of smoking.Conclusions. Different types of public housing have a modest impact on the health composition of one’s social network, suggesting the importance of housing policy for health.Multiple housing policies aim to reduce concentrated poverty in neighborhoods for low-income residents who receive federal housing subsidies. The US Department of Housing and Urban Development has attempted to disperse concentrated poverty through its Housing Choice Vouchers program and initiatives such as HOPE VI and Choice Neighborhoods, which replace public housing complexes with mixed-income developments.1 Court cases have instigated housing relocation programs intended to increase access to opportunity.2,3 Some municipalities have adopted inclusionary zoning policies in which developers set aside a portion of homes to be sold or rented at below-market rates. Policies that deconcentrate poverty may improve residents’ health and well-being. Most prominently, the Department of Housing and Urban Development’s Moving to Opportunity randomized experiment found that recipients of vouchers to move to low-poverty neighborhoods experienced reduced obesity, diabetes, and psychological distress4,5 and improved mental health and happiness compared with those who remained in public housing developments.6One way that public housing may influence health is by shaping social networks. Social networks represent the web of relationships that exists among people; they consist of social ties that link individuals in a social network.7 Over the past century, social network theories and analytic methods have developed and been increasingly applied in public health.8–10 Research suggests that multiple factors influence the formation of social ties including similarity between individuals (homophily), having relationships in common, and the frequency and duration of contact with one another.11–13Theoretically, public housing may affect social networks by changing the neighbors with whom residents come into contact and the frequency of these contacts. Previous research has shown that residents living in subsidized housing next to more affluent neighbors may have more socioeconomically diverse social networks than individuals living in public housing developments.14,15 Different public housing arrangements such as clustering housing into projects or scattering units among market-rate developments, may affect the supportive quality and emotional intimacy of relationships within public housing residents’ social networks.16–21Social networks and ties have been increasingly shown to influence a wide range of conditions and behaviors including obesity,22–25 physical activity,26–31 alcohol and drug use,32–35 and smoking.36,37 Researchers postulate that social networks may induce changes in health and behavior through altering social norms and beliefs.11,38 Studies suggest that social networks’ influence extends beyond a single degree of separation,22,36 and research on vulnerable populations has highlighted the influence of social network composition on health behaviors.39,40Although social networks may be an important mechanism through which public housing policies affect health, to our knowledge, only 1 study has explicitly examined the connection between social networks and health behaviors among public housing residents. Shelton et al. found social network size to be associated with physical activity among Boston public housing residents.41We sought to address 2 research questions regarding the potential relationship between public housing policy and social networks and health. First, we asked whether the type of public housing (scattered vs clustered) influenced the composition of adult public housing residents’ social networks with a focus on perceived health and health behaviors of respondents’ social network members. Second, we determined whether characteristics of these network members were associated with residents’ health behaviors.Our study was set in Montgomery County, a Maryland suburb of Washington, DC. Unlike earlier studies such as Moving to Opportunity, in which participants initially lived in high-poverty neighborhoods, in this study the public housing residents live in low-poverty neighborhoods in an affluent county. The median household income from 2007 to 2011 in Montgomery County was $96 000 compared with the national average of $72 000, and the poverty rate was 6% compared with 9% nationally.Public housing residents in Montgomery County live in homes that are either scattered among market-rate housing developments or clustered in small public housing projects. The Housing Opportunities Commission (HOC), the county’s public housing authority, has purchased 670 scattered-site public housing homes through Montgomery County’s inclusionary zoning program. Through inclusionary zoning, developers set aside 12% to 15% of homes to be sold or rented at below-market prices in exchange for a density bonus that offsets the financial loss. In the developments where the HOC has purchased homes created through inclusionary zoning, no more than 5% of residents live in public housing. The HOC also operates 321 public housing homes that are clustered within 7 developments ranging in size from 19 to 71 homes. In these developments, all residents live in public housing, creating microneighborhoods of poorer people. Although both scattered and clustered public housing units are located in wealthy neighborhoods (

On the relationship between individual and population health

The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language.

Cost of breast cancer in Sweden in 2002

Breast cancer is the most common cancer among Swedish women and an important cause of illness and death. The aim of this study was to estimate the total cost of breast cancer in Sweden in 2002, using a top-down prevalence-based cost-of-illness approach. The total cost of breast cancer in Sweden in 2002 was estimated at 3.0 billion SEK (1 € = 9.4 SEK). The direct costs were estimated at 895 million SEK and constituted 30% of the total cost. Indirect costs were estimated at 2.1 billion SEK and constituted 70% of the total cost. The main cost driver was production losses caused by premature mortality, amounting to 52% of the indirect costs. The reason that indirect costs were the dominant cost is because most newly detected breast cancers occur in patients aged below 65, thus causing significant production losses due to sick leave, early retirement, and premature mortality.

The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant problem in many healthcare systems. In Germany, few data are available on its economic consequences and, so far, no study has been performed using a large sample of real-life data from several hospitals. We present a retrospective matched-pairs analysis of mortality, length of stay, and cost of MRSA patients based mainly on routine administrative data from 11 German hospitals. Our results show that MRSA patients stay in hospital 11 days longer, exhibit 7% higher mortality, are 7% more likely to undergo mechanical ventilation, and cause significantly higher total costs (€ 8,198).

Is Public Housing the Cause of Poor Health or a Safety Net for the Unhealthy Poor?

Research has shown that public housing residents have the worst health of any population in the USA. However, it is unclear what the cause of that poor health is among this population. The purpose of this paper is to investigate the association between public housing and health conditions: specifically, we ask if residents entered public housing already ill or if public housing may cause the poor health of its residents. The data used for this study come from the GSU Urban Health Initiative, which is a prospective, mixed-methods study of seven public housing communities earmarked for demolition and relocation (N = 385). We used the pre-relocation, baseline survey. We found that, while health was not the main reason residents gave for entering public housing, the majority of public housing residents entered public housing already ill. Substandard housing conditions, long tenure in public housing, and having had a worse living situation prior to public housing were not associated with an increased risk of a health condition diagnosed after entry into public housing. Our findings suggest that public housing may have provided a safety net for the very unhealthy poor.     

Redistributive effects in public health care financing

This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

“Weathering” HOPE VI: The Importance of Evaluating the Population Health Impact of Public Housing Demolition and Displacement

HOPE VI has funded the demolition of public housing developments across the United States and created in their place mixed-income communities that are often inaccessible to the majority of former tenants. This recent uprooting of low-income, urban, and predominantly African American communities raises concern about the health impacts of the HOPE VI program for a population that already shoulders an enormous burden of excess morbidity and mortality. In this paper, we rely on existing literature about HOPE VI relocation to evaluate the program from the perspective of weathering—a biosocial process hypothesized by Geronimus to underlie early health deterioration and excess mortality observed among African Americans. Relying on the weathering framework, we consider the effects of HOPE VI relocation on the material context of urban poverty, autonomous institutions that are health protective, and on the broader discourse surrounding urban poverty. We conclude that relocated HOPE VI residents have experienced few improvements to the living conditions and economic realities that are likely sources of stress and illness among this population. Additionally, we find that relocated residents must contend with these material realities, without the health-protective, community-based social resources that they often rely on in public housing. Finally, we conclude that by disregarding the significance of health-protective autonomous institutions and by obscuring the structural context that gave rise to racially segregated public housing projects, the discourse surrounding HOPE VI is likely to reinforce health-demoting stereotypes of low-income urban African American communities. Given the potential for urban and housing policies to negatively affect the health of an already vulnerable population, we argue that a health-equity perspective is a critical component of future policy conversations.     

Associations between the built environment and physical activity in public housing residents

Background  

Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments.     

Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran’s I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.     

Viagra Selfhood: Pharmaceutical Advertising and the Visual Formation of Swedish Masculinity

Using material from the Pfizer sponsored website providing health information on erectile dysfunction to potential Swedish Viagra customers (), this article explores the public image of masculinity in relation to sexual health and the cultural techniques for creating pharmaceutical appeal. We zoom in on the targeted ideal users of Viagra, and the nationalized, racialized and sexualized identities they are assigned. As part of Pfizer’s marketing strategy of adjustments to fit the local consumer base, the ways in which Viagra is promoted for the Swedish setting is telling of what concepts of masculinity are so stable and unassailable that they can withstand the association with a drug that is, in essence, an acknowledgement of ‘failed’ masculinity and ‘dysfunctional’ sexuality. With comparative national examples, this study presents an interdisciplinary take on the ‘glocalized’ cultural imaginary of Viagra, and the masculine subject positions it engenders.

Who Stays in Treatment? Child and Family Predictors of Youth Client Retention in a Public Mental Health Agency

The present study examined predictors of youth client retention in therapy in a large community-based sample. We used several conceptualizations of retention, including (a) “intake retention” (i.e., returned to treatment after intake session); (b) “mutual termination” (i.e., termination agreed upon by family and therapist), (c) “mean treatment duration” (i.e., completing the mean number of sessions in the agency), and (d) “total treatment duration” (i.e., total number of sessions). Archival data from over 400 children and adolescents who sought treatment at a large public mental health clinic were analyzed using regression analyses. Although different predictors were identified across the various conceptualizations, a few robust predictors emerged including ethnicity and client symptom severity. Clinical implications and future research directions are discussed.

Racial and socioeconomic disparities in viral suppression among persons living with HIV in New York City

PurposeTo examine differences in racial disparities across levels of neighborhood poverty and differences in socioeconomic disparities by race/ethnicity in viral suppression among persons living with HIV (PLWH).MethodsUsing HIV surveillance data, we categorized and geocoded PLWH who were in care in New York City (NYC). Multilevel binomial regression techniques were used to model viral suppression with a two-level hierarchical structure, by including age, transmission risk, year of diagnosis, race/ethnicity, census tract poverty, and an interaction term of race/ethnicity and census tract poverty in the model.ResultsThere were 30,638 Blacks, 22,921 Hispanics, and 11,695 Whites living with HIV and retained in care in NYC, 2014. Compared with Blacks living in the most impoverished neighborhoods (≥30% residents living below the federal poverty level) who had the lowest proportion of viral suppression, with 75% in males and 76% in females, Whites living in the least impoverished neighborhoods (<10% residents living below the federal poverty level) had the highest, with 92% in males (prevalence ratio = 1.16; 95% confidence interval: 1.13, 1.18) and 90% in females (PR = 1.14; 95% CI: 1.09, 1.19).ConclusionsBy examining racial and socioeconomic disparities simultaneously, we were able to detect both disparities in viral suppression among PLWH in NYC.     

International public health law: not so much WHO as why, and not enough WHO and why not?

To state the obvious, “health matters”, but health (or its equitable enjoyment) is neither simple nor easy. Public health in particular, which encompasses a broad collection of complex and multidisciplinary activities which are critical to the wellbeing and security of individuals, populations and nations, is a difficult milieu to master effectively. In fact, despite the vital importance of public health, there is a relative dearth of ethico-legal norms tailored for, and directed at, the public health sector, particularly at the international level. This is a state of affairs which is no longer tenable in the global environment. This article argues that public health promotion is a moral duty, and that international actors are key stakeholders upon whom this duty falls. In particular, the World Health Organization bears a heavy responsibility in this regard. The article claims that better health can and must be better promoted through a more robust interpretation of the WHO’s role, arguing that neither the WHO nor international law have yet played their necessary part in promoting health for all.

Walkability,Transit Access,and Traffic Exposure for Low-Income Residents With Subsidized Housing

Objectives. We assessed the spatial distribution of subsidized housing units provided through 2 federally supported, low-income housing programs in Orange County, California, in relation to neighborhood walkability, transit access, and traffic exposure.Methods. We used data from multiple sources to examine land-use and health-related built environment factors near housing subsidized through the Housing Choice Voucher Program and the Low Income Housing Tax Credit (LIHTC) program, and to determine these patterns’ associations with traffic exposure.Results. Subsidized projects or units in walkable, poorer neighborhoods were associated with lower traffic exposure; higher traffic exposure was associated with more transit service, a Hispanic majority, and mixed-use areas. Voucher units are more likely than LIHTC projects to be located in high-traffic areas.Conclusions. Housing program design may affect the location of subsidized units, resulting in differential traffic exposure for households by program type. Further research is needed to better understand the relationships among subsidized housing locations, characteristics of the built environment, and health concerns such as traffic exposure, as well as which populations are most affected by these relationships.Smart growth development strategies, which promote high-density, walkable neighborhoods with mixed land-use patterns, high accessibility to public transportation, and convenient local amenities, could encourage walking, cycling, and more active lifestyles and may be associated with potential health benefits such as a lower body mass index.1–4 Such compact communities provide local amenities close to residences and can be associated with reduced vehicle travel and associated air pollution.1,5 However, smart growth strategies also could exacerbate exposure to localized air pollution6–9 because vehicle-related air pollutants, which are associated with health impacts such as heightened respiratory ailments, reduced lung function, and increased mortality, tend to be highly localized during the day in areas approximately 200 to 300 meters downwind of major roadways.10,11The health implications of smart growth for disadvantaged groups remain unclear. Although many existing low-income urban neighborhoods are highly walkable, their built environments are less consistently associated with positive health outcomes and lower body mass index.12 These suboptimal outcomes may be attributable to other neighborhood characteristics, such as higher levels of deprivation, crime, and safety concerns and fewer clean streets with trees, which may inhibit physical activity13,14; more traffic; and exposure to elevated, near-roadway concentrations of vehicle-related pollution.15,16 Furthermore, smart growth developments that enhance local built environment amenities may increase market demand for nearby housing and decrease the availability of affordable housing.3Although previous research examined the impact of overcrowding and poor housing conditions on the health of low-income residents of public housing,17,18 few studies have examined the extent to which publicly subsidized housing for low-income residents is distributed in relation to health-related built environment factors such as neighborhood walkability, transit access, and traffic exposure. Furthermore, the spatial distribution of affordable units and their proximity to these amenities and hazards could vary systematically by whether the requirements and regulations of affordable housing programs seek to incentivize housing developers to provide low-rent units in new residential buildings or to disperse residents by providing them vouchers to obtain subsidized housing in the wider rental market.We conducted the first comparative analysis of the spatial implications of 2 programs that provide housing units for low-income residents of Orange County in Southern California. Although historically a traditional suburban community, Orange County is rapidly becoming ethnically and socioeconomically diverse, with increasing income inequality.19 The county does not have traditional public housing, which concentrates low-income residents in projects owned and managed by public housing authorities, but rather depends largely on 2 housing programs for low-income residents, which could result in different spatial distributions of units depending on programmatic approach and local conditions.The Low Income Housing Tax Credit (LIHTC) program is a supply-side program that uses tax credits to raise capital for affordable housing developments. LIHTC development proposals receive points in a competitive process for access to local amenities. Thus, they may be more sensitive to site feasibility considerations and may tend to be located in transportation corridors with lower property values and higher traffic because, in California, the LIHTC program considers access to public transportation in the evaluation of applications.20,21The Housing Choice Voucher Program is not place based and instead promotes poverty deconcentration and dispersal by allowing participants to locate a housing unit in the private rental market; the unit must be affordable within program guidelines (according to fair market rent as established by the US Department of Housing and Urban Development) and must pass a housing authority inspection. Furthermore, the landlord must be willing to participate in the program. Previous research identified some health, accessibility, and employment implications of relocating poor residents to nonpoor areas,22–24 but we know very little about the built environment of neighborhoods chosen by voucher holders. Because many voucher households that move relocate to other poor communities,25,26 we suspect that their new neighborhoods may be older, dense, and walkable and that they differ spatially from areas prioritized by developers leveraging capital through the LIHTC program.     

Sense of Place among Atlanta Public Housing Residents

For almost two decades now, cities around the country have been demolishing traditional public housing and relocating residents to subsidized private market rental housing. In this paper, we examine sense of place, consisting of both community and place attachment, among a sample of Atlanta public housing residents prior to relocation (N = 290). We find that 41% of the residents express place attachment, and a large percentage express some level of community attachment, though residents of senior public housing are far more attached than residents of family public housing. Positive neighborhood characteristics, such as collective efficacy and social support, are associated with community attachment, and social support is also associated with place attachment. Negative neighborhood characteristics, such as social disorder and fear of crime, are not consistently associated with sense of place. We argue that embodied in current public housing relocation initiatives is a real sense of loss among the residents. Policy makers may also want to consider the possibilities of drawing upon residents’ sense of place as a resource for renovating and revitalizing public housing communities rather than continuing to demolish them and relocating residents to other neighborhoods.     

Measuring the Food Environment: Shelf Space of Fruits,Vegetables, and Snack Foods in Stores

Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.

Physical activity, obesity, and educational attainment in 50- to 70-year-old adults

Aim  The purpose of the study is to investigate, in subpopulations with varying levels of education, firstly, the extent to which older adults with an otherwise sedentary lifestyle perform simple everyday physical activities such as cycling for transport or taking a walk, and the extent to which older adults perform everyday physical activities in addition to exercise; and secondly, to explore correlations between physical activity and obesity. Methods  The study is based on a representative, Baden-Württemberg State Foundation-funded study in 50- to 70-year-old residents of Baden-Württemberg (n = 2,002). Results  Subjects who say they ride a bike for transport or take a walk are significantly more likely to exercise than subjects who do not walk or cycle regularly. This holds even after controlling for sociodemographic and lifestyle-relevant variables. However, the correlation between walking and exercise, and the positive correlation between walking and obesity, is retained only for subjects with a low level of education. Both for subjects with a low level of education and for subjects with a high level of education, multivariate analysis discloses a negative correlation between regular cycling and obesity. Conclusions  People who do not exercise regularly are also less active on a day-to-day basis and are less likely to take a walk or ride a bike for transport. Given the health-preserving effects attributed to leisure-time physical activity from a biological and medical point of view, it is particularly important to encourage older adults and disadvantaged sectors of the population to be more physically active.