In a Bad Place

Kevin Lewis

December 14, 2009

The Economic Cost of Environmental Factors Among North Carolina Children Living in Substandard Housing

David Chenoweth, Chris Estes & Christopher Lee
American Journal of Public Health, November 2009, Pages S666-S674

Objectives: We quantified the economic cost of selected environmental factors among North Carolina children living in substandard housing.

Methods: We gathered data on direct medical care costs for specific childhood medical conditions associated with environmental factors commonly found in substandard housing. Medical claims data for 2006 and 2007 were obtained from BlueCross BlueShield of North Carolina and the North Carolina Department of Health and Human Services. Indirect costs were based in part on nonmedical data obtained from several previous studies.

Results: Total (direct and indirect) costs for the conditions assessed exceeded $92 million in 2006 and $108 million in 2007. Neurobehavioral conditions contributed to more than 52% of all costs, followed by lead poisoning (20%) and respiratory conditions (12%). Neurobehavioral conditions were the largest contributor to direct medical costs (44%), followed by respiratory conditions (38%) and accidental burns and falls (10%).

Conclusions: Direct and indirect costs associated with environmental factors appear to be increasing at about twice the rate of medical inflation. More aggressive policies and funding are needed to reduce the substantial financial impact of childhood illnesses associated with substandard housing in North Carolina.


No Place Like Home: Home Tours Correlate With Daily Patterns of Mood and Cortisol

Darby Saxbe & Rena Repetti
Personality and Social Psychology Bulletin, forthcoming

The way people describe their homes may reflect whether their time at home feels restorative or stressful. This article uses linguistic analysis software (Linguistic Inquiry and Word Count) to analyze 60 dual-income spouses' self-guided home tours by calculating the frequency of words describing clutter, a sense of the home as unfinished, restful words, and nature words. Based on a principal components analysis, the former two categories were combined into the variable stressful home and the latter two into restorative home. Over 3 weekdays following the home tours, wives with higher stressful home scores had flatter diurnal slopes of cortisol, a profile associated with adverse health outcomes, whereas women with higher restorative home scores had steeper cortisol slopes. These results held after controlling for marital satisfaction and neuroticism. Women with higher stressful home scores had increased depressed mood over the course of the day, whereas women with higher restorative home scores had decreased depressed mood over the day.


Socioeconomic Status, Neighborhood Disadvantage, and Poverty-related stress: Prospective Effects on Psychological Syndromes Among Diverse Low-income Families

Catherine DeCarlo Santiago, Martha Wadsworth & Jessica Stump
Journal of Economic Psychology, forthcoming

Living with persistent poverty is toxic for one's psychological health. This study examined SES, income, neighborhood disadvantage, and poverty-related stress as predictors of a wide range of psychological problems including anxiety, depression, aggression, relationship problems, physical problems, and trouble with the law. Longitudinal analyses were conducted with a low-income multiethnic sample of 98 families recruited from the greater Denver, CO metropolitan area (300 family members: 136 adults, 82 preadolescents, 82 adolescents) using hierarchical linear modeling to predict all eight ASEBA narrow band syndromes. Analyses showed that poverty-related stress was directly related to anxious/depressed symptoms and social problems and interacted with prior symptoms, contributing to worsening symptoms for delinquency, attention problems, somatic complaints, and anxious/depressed symptoms. Hollingshead SES also had direct predictive effects for certain syndromes, though these effects were in the opposite direction predicted. In contrast, lower income-to-needs predicted more problems as expected. Neighborhood disadvantage also predicted psychological syndromes. Developmental differences are discussed. Our data show that parents are not the only family members who are affected by stress from living in poverty. SES, neighborhood disadvantage and poverty-related stress take a toll on children, adolescents, and adults.


The Increasing Risk of Poverty Across the American Life Course

Daniel Sandoval, Mark Rank & Thomas Hirschl
Demography, November 2009, Pages 717-737

This article extends the emerging body of life course research on poverty by empirically identifying the incidence, chronicity, and age pattern of American poverty and how these dimensions have changed during the period 1968-2000. Using the Panel Study of Income Dynamics, we construct a series of life tables that estimate the risk of poverty for adults during their 20s, 30s, 40s, 50s, 60s, and 70s, and compare these estimates for Americans in the 1970s, 1980s, and 1990s. Our empirical results suggest that the risk of acute poverty increased substantially, particularly in the 1990s. This observed increase was especially pronounced for individuals in their 20s, 30s, and 40s; for all age groups with respect to extreme poverty; and for white males. On the other hand, the risk of chronic poverty declined during the 1990s (as measured by the percentage of the poor who experienced five or more years of poverty within a 10-year interval). The results in this article tell a very different story than the Census Bureau's yearly cross-sectional rates, which have shown little overall change in the U.S. poverty rate during this 30-year period. In contrast, a life course approach reveals a rising economic risk of acute poverty for individuals, one that is consistent with recent observations and research suggesting that a growing number of Americans will eventually find themselves in an economically precarious position.

Income, Material Hardship, and the Use of Public Programs Among the Elderly

Helen Levy
University of Michigan Working Paper, September 2009

I use data from the 2006 Health and Retirement Study to analyze the determinants of material hardship among individuals ages 65 and older. Ten percent of the elderly report hardship - defined here as cutting back on food or medications because of cost - in 2006. Although hardship is more likely for poorer individuals and, to some extent, for recipients of public transfer programs (Medicaid, Food Stamps, and/or Supplemental Security Income), the majority of those experiencing hardship are not poor and do not participate in these programs. In multivariate models, I find that self-reported health and activity limitations are significant predictors of hardship.


Life-Course Socioeconomic Position and Incidence of Diabetes Mellitus Among Blacks and Whites: The Alameda County Study, 1965-1999

Siobhan Maty, Sherman James & George Kaplan
American Journal of Public Health, January 2010, Pages 137-145

Objectives: We examined associations between several life-course socioeconomic position (SEP) measures (childhood SEP, education, income, occupation) and diabetes incidence from 1965 to 1999 in a sample of 5422 diabetes-free Black and White participants in the Alameda County Study.

Methods: Race-specific Cox proportional hazard models estimated diabetes risk associated with each SEP measure. Demographic confounders (age, gender, marital status) and potential pathway components (physical inactivity, body composition, smoking, alcohol consumption, hypertension, depression, access to health care) were included as covariates.

Results: Diabetes incidence was twice as high for Blacks as for Whites. Diabetes risk factors independently increased risk, but effect sizes were greater among Whites. Low childhood SEP elevated risk for both racial groups. Protective effects were suggested for low education and blue-collar occupation among Blacks, but these factors increased risk for Whites. Income was protective for Whites but not Blacks. Covariate adjustment had negligible effects on associations between each SEP measure and diabetes incidence for both racial groups.

Conclusions: These findings suggest an important role for life-course SEP measures in determining risk of diabetes, regardless of race and after adjustment for factors that may confound or mediate these associations.


Social Stress Desensitizes Lymphocytes to Regulation by Endogenous Glucocorticoids: Insights from In Vivo Cell Trafficking Dynamics in Rhesus Macaques

Steve Cole, Sally Mendoza, & John Capitanio
Psychosomatic Medicine, July/August 2009, Pages 591-597

Objective: To determine whether chronic social stress can desensitize leukocytes to normal physiologic regulation by endogenous glucocorticoids.

Methods: We analyzed the longitudinal relationship between plasma cortisol levels and peripheral blood lymphocyte counts over 16 monthly assessments in 18 rhesus macaques randomized to recurrent social encounters with a stable set of conspecifics or continually varying social partners (unstable socialization).

Results: Animals socialized under stable conditions showed the expected inverse relationship between plasma cortisol concentrations and circulating lymphocyte frequencies. That relationship was significantly attenuated in animals subject to unstable social conditions. Differences in leukocyte redistributional sensitivity to endogenous glucocorticoids emerged within the first week of differential socialization, persisted throughout the 60-week study period, and were correlated with other measures of glucocorticoid desensitization (blunted hypothalamic-pituitary-adrenal (HPA) axis response to acute stress and redistributional response to dexamethasone challenge). Effects of unstable social conditions on leukocyte sensitivity to cortisol regulation were not related to physical aggression.

Conclusion: Chronic social stress can impair normal physiologic regulation of leukocyte function by the HPA axis in ways that may contribute to the increased physical health risks associated with social adversity.


Poverty, Material Hardship, and Depression

Colleen Heflin & John Iceland
Social Science Quarterly, December 2009, Pages 1051-1071

Objective: Mental health disorders are of great social, economic, and policy concern. A higher incidence of major depressive disorder has been reported among women living in or near poverty. Our study examines the extent to which the relationship between income and depression is mediated by measures of material hardship.

Methods: We use measures of depression at two points in time from the longitudinal Fragile Families Survey to better discern the causal direction of the relationship between income poverty, hardship, and depression. More specifically, we use conditional logistic fixed-effect models that control for time-invariant unmeasured heterogeneity in the sample.

Results: We found a strong relationship between hardships and depression. The most prominent hardships were problems paying bills and phone turned off. We also found that hardship helped mediate much, though not all, of the link between poverty and depression in the conditional fixed-effects logistic regression models.

Conclusion: Our policy simulations suggest that public health efforts to reduce depression may be enhanced from efforts that focus on specific forms of material hardship.


Chronic disaster syndrome: Displacement, disaster capitalism, and the eviction of the poor from New Orleans

Vincanne Adams, Taslim Van Hattum & Diana English
American Ethnologist, November 2009, Pages 615-636

Many New Orleans residents who were displaced in 2005 by Hurricanes Katrina and Rita and the subsequent levee failures and floods are still displaced. Living with long-term stress related to loss of family, community, jobs, and social security as well as the continuous struggle for a decent life in unsettled life circumstances, they manifest what we are calling "chronic disaster syndrome." The term refers not only to the physiological and psychological effects generated at the individual level by ongoing social disruption but also to the nexus of socioeconomic and political conditions that produce this situation as a long-term and intractable problem. Chronic disaster syndrome emerges from the convergence of three phenomena that create displacement: long-term effects of personal trauma (including near loss of life and loss of family members, homes, jobs, community, financial security, and well-being); the social arrangements that enable the smooth functioning of what Naomi Klein calls "disaster capitalism," in which "disaster" is prolonged as a way of life; and the permanent displacement of the most vulnerable populations from the social landscape as a perceived remedy that actually exacerbates the syndrome.


Out of the Projects, Still in the Hood: The Spatial Constraints on Public-Housing Residents' Relocation in Chicago

Deirdre Oakley & Keri Burchfield
Journal of Urban Affairs, December 2009, Pages 589-614

Public housing, usually located in predominantly poor, minority neighborhoods, has long been associated with concentrated poverty and spatially constraining opportunities for upward mobility. The federal government created HOPE VI in 1992 to transform the physical and social shape of public housing, demolishing existing projects and replacing them with mixed-income developments. To accomplish this public-housing residents are relocated with housing voucher subsidies to the private market and only a small portion will be able to return to the new mixed income developments. To what extent do these voucher subsidies simply reinforce a stratified housing market by limiting the types of neighborhoods available to former public-housing residents? Using spatial analytic techniques, this study examines the spatial patterns and neighborhood conditions of voucher housing and how these patterns link to public-housing relocatees' destinations. Findings indicate that voucher housing tends to be clustered in poor African-American neighborhoods where the majority of relocated public-housing residents settle. Thus, there appear to be spatial constraints on relocatees' residential options.


Opportunities for Making Ends Meet & Upward Mobility: Differences in Organizational Deprivation Across Urban & Suburban Poor Neighborhoods

Alexandra Murphy & Danielle Wallace
Social Science Quarterly, forthcoming

Given the recent rise of poverty in American suburbs, this study asks: What poor neighborhoods are most disadvantageous, those in the city or those in the suburbs? Building upon recent urban sociological work demonstrating the importance of neighborhood organizations for the poor, we are concerned with one aspect of disadvantage - the lack of availability of organizational resources oriented towards the poor. By breaking down organizations into those that promote mobility versus those that help individuals meet their daily subsistence needs we seek to explore potential variations in the type of disadvantage that may exist. Methods. We test whether poor urban or suburban neighborhoods are more likely to be organizationally deprived by breaking down organizations into three types: hardship resources, educational resources, and employment resources. We use data from the 2000 County Business Patterns and the 2000 Census and test neighborhood deprivation using logistic regression models. Results. We find that suburban poor neighborhoods are more likely to be organizational deprived than urban poor neighborhoods, especially with respect to organizations that promote upward mobility. Interesting racial and ethnic composition factors shape this more general finding. Conclusion. Our findings suggest that if a poor individual is to live in a poor neighborhood, with respect to access to organizational resources, he or she would be better off living in the central city. Suburban residence endears isolation from organizations that will help meet one's daily needs and more so, from those offering opportunities for mobility.


Estimating the "Impact" of Out-of-Home Placement on Child Well-Being: Approaching the Problem of Selection Bias

Lawrence Berger, Sarah Bruch, Elizabeth Johnson, Sigrid James & David Rubin
Child Development, November/December 2009, Pages 1856-1876

This study used data on 2,453 children aged 4-17 from the National Survey of Child and Adolescent Well-Being and 5 analytic methods that adjust for selection factors to estimate the impact of out-of-home placement on children's cognitive skills and behavior problems. Methods included ordinary least squares (OLS) regressions and residualized change, simple change, difference-in-difference, and fixed effects models. Models were estimated using the full sample and a matched sample generated by propensity scoring. Although results from the unmatched OLS and residualized change models suggested that out-of-home placement is associated with increased child behavior problems, estimates from models that more rigorously adjust for selection bias indicated that placement has little effect on children's cognitive skills or behavior problems.


from the


A weekly newsletter with free essays from past issues of National Affairs and The Public Interest that shed light on the week's pressing issues.


to your National Affairs subscriber account.

Already a subscriber? Activate your account.


Unlimited access to intelligent essays on the nation’s affairs.

Subscribe to National Affairs.