Jason Booza

The rise of the bipolar neighborhood

Abstract Problem: Although planners aim to provide for income diversity in the communities they serve, too little is known about how income distributions in metropolitan neighborhoods are changing. Purpose: We investigate whether neighborhood income diversity has increased since 1970 by examining neighborhoods in the 100 largest U.S. metropolitan areas. Methods: We analyze neighborhoods in the 100 largest U.S. metropolitan areas from 1970 to 2000 using a combination of nominal (H) and ordinal (E) entropy indices. We focus on neighborhoods we call bipolar, (where E/H > 1), in which very low- and very high-income groups predominate. We investigate these with tract-level statistics and by using a counterfactual. Results and conclusions: We find a dramatic increase in the number and incidence of these bipolars since 1970. Compared to other neighborhoods, we find that, on average, bipolars have significantly greater shares of very high-income families, racial diversity, shares of middle-aged persons, and shares of renters. We use a counterfactual to reveal that much of the growth in bipolars over the last three decades has been fueled by income distributions at the metropolitan scale becoming more bimodal, with fewer middle-income families. Gentrification appears to explain only a minor share of growth in bipolars. Takeaway for practice: Metropolitan census tracts with pronounced bimodal income distributions have become more common since 1970. This appears to reflect changing metropolitan income distributions more than spatial rearrangement, although planning policies may be responsible in some instances. Whether residence in bipolar. neighborhoods will benefit very low-income households by reducing stereotyping and expanding social opportunities is unclear, but such places should be monitored.

Mortality Rates Among Arab Americans in Michigan

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.

Geospatial relationships of air pollution and acute asthma events across the Detroit-Windsor international border: Study design and preliminary results

The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.

Racial Differences in the Use of Adjuvant Chemotherapy for Breast Cancer in a Large Urban Integrated Health System

Background. Racial differences in breast cancer survival may be in part due to variation in patterns of care. To better understand factors influencing survival disparities, we evaluated patterns of receipt of adjuvant chemotherapy among 2,234 women with invasive, nonmetastatic breast cancer treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Methods. Sociodemographic and clinical information were obtained from linked datasets from the HFHS, Metropolitan Detroit Cancer Surveillance Systems, and U.S. Census. Comorbidity was measured using the Charlson comorbidity index (CCI), and economic deprivation was categorized using a neighborhood deprivation index. Results. African American (AA) women were more likely than whites to have advanced tumors with more aggressive clinical features, to have more comorbidity and to be socioeconomically deprived. While in the unadjusted model, AAs were more likely to receive chemotherapy (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.02–1.46) and to have a delay in receipt of chemotherapy beyond 60 days (OR 1.68, 95% CI, 1.26–1.48), after multivariable adjustment there were no racial differences in receipt (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.73–1.43), or timing of chemotherapy (OR 1.18, 95 CI, 0.8–1.74). Conclusions. Societal factors and not race appear to have an impact on treatment delay among African American women with early breast cancer.

Racial differences in breast cancer survival in a large urban integrated health system

African American (AA) women are known to have poorer breast cancer survival than whites, and the differences may be related to underlying disparities in their clinical presentation or access to care. This study evaluated the relationship between demographic, treatment, and socioeconomic factors and breast cancer survival among women in southeast Michigan.

Income Diversity within Neighborhoods and Very Low-Income Families

The past decades have witnessed increasing concern over the family ills engendered by neighborhoods inhabited overwhelmingly by families with limited resources. This study focuses on a different sort of residential context-neighborhoods with substantial income mixing - and the extent to which very low-income (VLI) families - those earning less than 50 percent of the area median income (AMI)-live in them. The studys primary units of analysis are the 100 largest metropolitan areas in the United States, according to the 2000 Census, and the secondary units of analysis are census tracts. The study specifies six mutually exclusive income groups based on the ratios relative to AMI, as defined by the U.S. Department of Housing and Urban Development. It also specifies four groups of neighborhoods according to their diversity of the six income groups, as measured by an entropy index. The descriptive results show that in 2000 (1) most neighborhoods had high diversity, although a decline is apparent in the overall income diversity of neighborhoods and in the share comprising high-diversity neighborhoods; (2) no neighborhoods with median incomes of less than 50 percent of AMI had high diversity; (3) 19 percent of all high-diversity neighborhoods (on average) consist of VLI families and 65 percent of all VLI families live in high-diversity neighborhoods, although both percentages have declined since 1970; (4) 5 percent of VLI families live in neighborhoods with median incomes of less than 50 percent of AMI, twice the percentage of 1970 but lower than in 1990; and (5) exposure of VLI families to other VLI families and moderate-income groups has steadily fallen since 1970 and concomitantly increased for families that have very high incomes (VHIs); indeed, the exposure to VHI families is approximately the same as exposure to other VLI families. This article addresses the mixed implications of these trends for the potential socioeconomic mobility of VLI families.

The Impact of Medical School on Student Mental Health

The pace of medical school is extremely rigorous. Students commonly report high stress due to feelings of lack of control, problems without solutions, and exposure to death and dying for the first time. Medical student’s tendency to be a perfectionist and their struggle to re-identify as patients only add to this stress. Stress has negative physiological and psychological effects on individuals which could result in poor mental health, substance use, and the need to develop healthy coping strategies. Poor mental health can also lead to other negative outcomes including medical school dropout [1] and suicidal ideation and burnout [2]. Previous studies show that students begin medical school with similar rates of depression as their non-medical peers [3, 4]. However, various studies suggest that the mental health of students worsens throughout medical school [3, 5]. Other studies have reflected on factors which impact student success, such as the use of alcohol and illicit substances [6]. A study fromWebb et al. revealed that university students experiment with illicit drugs and that medical students do not differ markedly from other student groups despite their knowledge of the potential hazards of illicit drugs [7]. Additionally, the culture of medicine has created expectations of physicians to always put patients first and ignore their own needs. As a result, it may be difficult for physicians to accept help. The impact of depression and anxiety, as well as marijuana and cocaine use, needs to be understood so students, who experience difficulty, seek help. Additionally, this could assist in the integration of preventive health programs to help medical students remain mentally healthy and prevent the long-term consequences of mental illness and substance use. The purpose of this study is to understand the current rates of depression, anxiety, use of marijuana and cocaine, and help-seeking behavior in medical students.

ARE HOME AND AUTO INSURANCE POLICIES EXCESSIVELY PRICED IN CITIES? RECENT EVIDENCE FROM MICHIGAN

ABSTRACT: Our study contributes to the growing literature on how insurance industry practices vary across space in ways that may unfairly penalize central cities. We utilize a unique, comprehensive database that allows us to examine the spatial patterns of premiums collected and claims paid out to policyholders for all home and auto insurance companies in Michigan during 2001–2002. As a result, we can test whether higher premiums typically charged in urban areas are justified by the higher claims losses incurred there. Territories that persistently evince low ratios of losses to premiums for a given policy type, all else equal, provide prima facie evidence of excessive premium-setting. We analyze three groups of homeowners’ policies, delineated by the comprehensiveness of perils covered and the nature and level of compensation provided in case of loss, and three auto policy types—mandatory, collision, and comprehensive coverage. We find that both premiums and claims losses are higher in urban than suburban areas of Michigan, on average. However, the mean loss ratios for all segments of the home insurance market are not systematically lower in urban areas, even after a host of proxies for transactions costs are employed as controls. The same results appertain in the case of auto insurance across all but one policy type, comprehensive, where loss ratios are 16% lower in urban compared to suburban territories statewide, all else equal.

Brief report: Neighborhood disadvantage and hair cortisol among older urban African Americans

Previous studies have shown that living in poor neighborhoods is associated with increased morbidity and mortality. However, researchers are now investigating the biological pathways responsible for the deleterious effects of neighborhood disadvantage on health. This study investigated whether neighborhood disadvantage (i.e., a measure of relative neighborhood quality derived by combining social and built environmental conditions) was associated with hair cortisol-a retrospective indicator of long-term hypothalamic pituitary adrenal (HPA) axis activation-and whether this link would be mediated by self-reported neighborhood satisfaction. Forty-nine older African Americans were recruited from thirty-nine Detroit census tracts across five strata of census tract adversity. Participants were interviewed face-to-face to collect psychosocial measures. Each provided a hair sample for analysis of cortisol. Multiple regression analyses revealed that higher neighborhood disadvantage was associated with higher levels of hair cortisol levels and that neighborhood satisfaction partially explained this association. These results are the first to our knowledge to demonstrate a direct link between neighborhood disadvantage and hair cortisol in a sample of older adults and to show that self-reported neighborhood satisfaction may be a psychological intermediary of this association.

Influence of clinical, societal, and treatment variables on racial differences in ER−/PR− breast cancer survival

BackgroundAfrican American (AA) women with breast cancer have persistently higher mortality compared to whites. We evaluated racial disparities in mortality among women with estrogen receptor (ER)/progesterone receptor (PR)-negative breast cancer.MethodsThe study population included 542 women (45% AA) diagnosed with ER/PR-negative Stage I through III breast cancer treated at the Henry Ford Health System (HFHS) between 1996 and 2005. Linked datasets from HFHS, Metropolitan Detroit Cancer Surveillance System, and the U.S. Census Bureau were used to obtain demographic, socioeconomic, and clinical information. Economic deprivation was categorized using a previously validated deprivation index, which included 5 categories based on the quintile of census tract socioeconomic deprivation. Cox proportional hazards models were used to assess the relationship between race and mortality.ResultsAA women were more likely to have larger tumors, have higher Charlson Comorbidity Indices (CCI), and to reside in economically deprived areas. In an unadjusted analysis, AA women demonstrated a significantly higher risk of death compared to whites [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.09–2.00]. Following adjustment for clinical factors (age, stage, CCI) and treatment (radiation and chemotherapy), AA race continued to have a significant impact on mortality (HR 1.51, CI 1.10–2.08 and HR 1.63, CI 1.20–2.21). Only after adjusting for deprivation was race no longer significant (HR 1.26, CI 0.84–1.87).ConclusionsSocial determinants of health play a large role in explaining racial disparities in breast cancer outcomes, especially among women with aggressive subtypes.