Matt Ruther

Sexual Minority Health and Health Risk Factors: Intersection Effects of Gender, Race, and Sexual Identity

INTRODUCTION Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities. METHODS Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (n=62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care. RESULTS Conditional on sociodemographic factors, all sexual, gender, and racial minority groups, except straight white women, gay white men, and bisexual non-white men, reported worse self-rated health than straight white men (p<0.05). Some of these gaps were attributable to differences in behaviors and healthcare access. All female groups, as well as gay non-white men, were more likely to report a functional limitation than straight white men (p<0.05), and these gaps largely remained when behavioral risks and access to care were accounted for. The study also discusses health disparities within sexual, gender, and racial minority groups. CONCLUSIONS Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities.

Comparing the effects of an NLCD-derived dasymetric refinement on estimation accuracies for multiple areal interpolation methods

Comparability among population data enumerated within different time periods may be complicated by changing enumeration boundaries over time. Areal interpolation methods are commonly used to solve such zoning incompatibilities, but are frequently based on the questionable assumption of homogeneous population density within the different zones. To achieve more accurate estimates, land cover or other ancillary data may be used to better characterize the underlying source zone population density surface prior to areal interpolation. Although dasymetric techniques such as these are well documented, their effectiveness across different areal interpolation methods are not well established. This research compares the accuracy of a number of areal interpolation methods used to support temporal analysis of population data, and evaluates the effect of dasymetric mapping on interpolation accuracy. Our findings demonstrate that dasymetric refinement noticeably improves interpolation accuracy for the areal weighting, pycnophylactic, and target density weighting (TDW) methods of areal interpolation. A fourth method in which land cover densities are inherently incorporated, the expectation–maximization algorithm (EM), performs equally well. Our results show that the dasymetrically refined TDW method outperforms other areal interpolation methods in most instances, but suggest that the EM algorithm may be preferred as the interval between enumeration periods grows large.

Exploring the impact of dasymetric refinement on spatiotemporal small area estimates

Comparing demographic small area estimates across multiple time periods is hindered by boundary changes in census enumeration units. Areal interpolation can resolve temporal incompatibilities, but underlying assumptions of uniform population density within units is sometimes flawed and results in distorted estimates. Dasymetric modeling refines spatial precision by limiting areal interpolation to the most likely residential areas. Here, a systematic examination of the impacts of dasymetric refinement on temporal interpolation accuracy compares errors that emerge as a consequence of differing time spans. This paper compares the accuracy of three commonly utilized methods of areal interpolation for temporal analysis of population data over the 1990–2010 decades. It examines whether multi-temporal dasymetric refinement prior to areal interpolation improves the accuracy of small area estimates, comparing two different demographic contexts. Data sets include tract-level demography exhibiting dramatic growth (Las Vegas, Nevada), and relative stability (Pittsburgh, Pennsylvania). Areal interpolation with and without the dasymetric refinement is validated using block level data. The dasymetrically refined target density weighting (TDW) provides the overall best performance for the 2000 source data and the expectation maximization (EM) method gives the overall best performance for the 1990 source data; effects of refinement are more prominent in areas of faster population change.

Placemaking as an Economic Development Strategy for Small and Midsized Cities

Economic development strategies aimed at attracting highly skilled workers through investment in urban amenities are gaining momentum throughout the United States. However, most of the foundational research for the approach was tested in very large cities, both in the United States and abroad. Based on quality of place (QOP) variables suggested from previous research, confirmatory factor analysis was used to generate a set of factors for a selection of small and midsized U.S. cities, and linear regression was used to relate these factors to the presence of college-educated populations, younger college-educated populations, and adult population growth. The results indicated that some of the QOP factors associated with better human capital outcomes in prior literature focusing on larger cities were also significant predictors of better human capital outcomes in midsized cities. The relationship between these factors and development outcomes for small cities was much weaker.

Gayborhoods: Economic Development and the Concentration of Same-Sex Couples in Neighborhoods Within Large American Cities

This paper uses census tract data from the 2000 and 2010 U.S. Censuses and the 2005–2009 American Community Survey to examine the locations of gay male and lesbian partnerships in 38 large U.S. cities. Gay men and lesbians are less segregated than African Americans and lesbians are less spatially concentrated than gay men. There is little evidence to support the common assertion that gays concentrate in more racially and ethnically diverse neighborhoods. We find evidence supporting the popular notion that concentrations of gay men lead to more rapid development of central city neighborhoods. Census tracts that start the decade with more gay men experience significantly greater growth in household incomes (and, therefore, presumably housing prices) and greater population growth over the next decade than those census tracts with fewer gay men. Census tracts with more lesbians at the start of the decade see no difference in population or income growth.

Foreign-born population concentration and neighbourhood growth and development within US metropolitan areas:

Immigrant populations are a major driver of growth in many US metropolitan areas, and considerable research has focused on the effects of immigrant populations on neighbourhood outcomes. However, much of this research is based on data from 1990 or earlier, prior to substantial growth in the diversity of the immigrant population and to changes in immigrants’ US settlement patterns. This research uses tract-level data from the 2000 Decennial Census and the 2009–2013 American Community Survey to explore the relationship between an existing immigrant population and future changes in neighbourhood characteristics within the 100 largest US metropolitan areas. Spatial regression models are used to identify the neighbourhood features that predict future proportional growth in a neighbourhood’s foreign-born population. In addition, the associations between a neighbourhood’s initial foreign-born concentration and future neighbourhood relative income and population growth are investigated. Consistent with previous work, our results indicate that foreign-born populations of all races tend to move towards existing immigrant population clusters. All of the immigrant minority racial groups are also attracted to neighbourhoods with existing same-race US-born populations. Overall proportional population growth is positively associated with the initial presence of the white and Asian immigrant population; black and Hispanic immigrant concentrations are associated with proportional population loss. While immigrants do not contribute to neighbourhood relative income growth, a greater presence of immigrants – relative to their US-born co-racial group – is associated with lower rates of neighbourhood relative income decline.

Despite Increased Insurance Coverage, Nonwhite Sexual Minorities Still Experience Disparities In Access To Care

Previous studies suggest that members of sexual minority groups have poorer access to health services than heterosexuals. However, few studies have examined how sexual orientation interacts with gender and race to affect health care experience. Moreover, little is known about the role in health care disparities played by economic strains such as unemployment and poverty, which may result from prejudice and discrimination based on sexual orientation. Using data for 2013-15 from the National Health Interview Survey, we found that most members of sexual minority groups no longer have higher uninsurance rates than heterosexuals, but many continue to experience poorer access to high-quality care. Gay nonwhite men, bisexual white women, and bisexual and lesbian nonwhite women are disadvantaged in multiple aspects of access, compared to straight white men. Only some of these disparities are attributable to economic factors, which implies that noneconomic barriers to care are substantial. Our results suggest that the intersection of multiple social identities can reveal important gaps in health care experience. Making culturally sensitive services available may be key to closing the gaps.

Deriving Small Area Mortality Estimates Using a Probabilistic Reweighting Method

Small area health estimates are important for studying environmental exposure, disease transmission, and health outcomes at the local scale. Yet, to protect privacy, the majority of publicly available health data are aggregated within larger spatial units such as states or counties. This article describes a method to generate small area mortality estimates from individual microdata that are available only for larger geographic entities. The mortality estimates are based on the probabilistic reweighting and spatial allocation of a population constructed by combining the individual-level microdata with census tract–level summary data. The generated mortality counts can be used to explore local mortality patterns and identify clusters of mortality from various causes. Validation of the allocated death counts against actual restricted-use census tract–level death counts suggests that the estimated counts reliably duplicate the total mortality patterns found in the actual data. The allocations of cause-specific mortality outcomes are less accurate, however.

There Goes the Gayborhood

Prior to a recent university colloquium on the topic of population and income growth in gayborhoods, two posted flyers describing the event were improved by anonymous passerby. On the first flyer, the word gayborhood had been circled and the comment ‘‘Why does this matter? This isn’t even a thing!’’ added. Across the top of the second flyer, a progressive (and possibly different) individual had scrawled ‘‘I’m gay and I just live in a neighborhood.’’ Although one may argue with the medium through which these critics chose to express their thoughts, the underlying critiques of the value and meaning of gay neighborhoods are valid and deserve further consideration. Amin Ghaziani provides such a consideration in There Goes the Gayborhood?, a well-written, thoroughly researched, and engaging book. In the introduction, Ghaziani lays out the primary research motivation: to explore how and why gay neighborhoods are changing and to evaluate whether the forces that are changing gay neighborhoods may lead to the eventual disappearance of such places. While the point is made that economic factors matter, the book’s main focus is on the sociopolitical dynamics that influence gayborhood transformation. To that end, much of the evidence that is presented to support the book’s arguments comes from the author’s personal interviews with gayborhood residents and stakeholders in Chicago, media reports about—and transcribed interviews with—gay and lesbian individuals and commentators, and preexisting survey data. This methodological approach paints a much richer portrait of gay neighborhoods than would a more traditional focus on census data only, although such data is used here to complement the qualitative findings. The book is divided into two main sections, with the first section detailing the reasons gayborhoods may be disappearing and the second challenging these original impressions. This structure may be frustrating to the more impatient reader, who may take issue with the author about some of the unchallenged positions taken in the first section. The earliest chapters describe how the gayborhood, historically a place in which gays and lesbians could be themselves and a safe space to express sexuality, may be becoming passé. As society has increasingly become more accepting of homosexuality, homosexuals may feel that they no longer require the protections afforded by the gayborhood. Thus much of the first section is focused on the role of the gayborhood in our ‘‘post-gay’’ society. I found myself somewhat irritated with the post-gay utopia that many of the interviewees seemed to inhabit and was waiting for some alternative viewpoints on whether ‘‘being gay still matters.’’ However, the selected interviewees, all residents of Chicago neighborhoods with existing large gay populations, may be unlikely to express such views. Ghaziani notes the discordance between the attitudes of some of his respondents and the institutional, legal, and social biases that are still present in society, but this admission seems to weaken the postgay argument against the importance of gayborhoods. Arguments for the continued relevance and significance of gayborhoods are presented in the second section, thus providing the complete picture of the future of these places. One of the more thought-provoking discourses in this section is Ghaziani’s description of the components necessary for the persistence of a gayborhood. While these components—property ownership by gay or lesbian individuals, relevant institutional anchors, and historic preservation of meaningful sites—are presented as they pertain to gayborhoods, the parallels to neighborhoods comprised of other social, racial, or ethnic groups are quite easy to realize. In doing so, the broader themes of neighborhood succession and accession are embodied, and this constitutes a major contribution of the work. While a spoiler alert may be warranted here, the conclusion—which even a casual observer could deduce from the table of 176 Reviews