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1.  Homelessness and Housing Insecurity Among Former Prisoners 
The United States has experienced dramatic increases in both incarceration rates and the population of insecurely housed or homeless persons since the 1980s. These marginalized populations have strong overlaps, with many people being poor, minority, and from an urban area. That a relationship between homelessness, housing insecurity, and incarceration exists is clear, but the extent and nature of this relationship is not yet adequately understood. We use longitudinal, administrative data on Michigan parolees released in 2003 to examine returning prisoners’ experiences with housing insecurity and homelessness. Our analysis finds relatively low rates of outright homelessness among former prisoners, but very high rates of housing insecurity, much of which is linked to features of community supervision, such as intermediate sanctions, returns to prison, and absconding. We identify risk factors for housing insecurity, including mental illness, substance use, prior incarceration, and homelessness, as well as protective “buffers” against insecurity and homelessness, including earnings and social supports.
PMCID: PMC4762459  PMID: 26913294
reentry; homelessness; housing instability; intermediate sanctions
2.  Making Ends Meet After Prison 
Former prisoners are at high risk of economic insecurity due to the challenges they face in finding employment and to the difficulties of securing and maintaining public assistance while incarcerated. This study examines the processes through which former prisoners attain economic security, examining how they meet basic material needs and achieve upward mobility over time. It draws on unique qualitative data from in-depth, unstructured interviews with a sample of former prisoners followed over a two to three year period to assess how subjects draw upon a combination of employment, social supports, and public benefits to make ends meet. Findings reveal considerable struggle among our subjects to meet even minimal needs for shelter and food, although economic security and stability could be attained when employment or public benefits were coupled with familial social support. Sustained economic security was rarely achieved absent either strong social support or access to long-term public benefits. However, a select few were able to leverage material support and social networks into trajectories of upward mobility and economic independence. Policy implications are discussed.
PMCID: PMC4288962  PMID: 25584015
3.  Romantic Relationships and Criminal Desistance: Pathways and Processes 
In dominant theories of criminal desistance, marital relationship formation is understood to be a key “turning point” away from deviant behavior. Empirical studies supporting this claim have largely focused on the positive role of marriage in men's desistance from crime, and relatively few studies have examined the role that non-marital relationships may play in desistance. Drawing on 138 longitudinal in-depth interviews with 22 men and women reentering society from prison, this paper extends the scope of desistance research by additionally considering the significance of more fleeting and fluid relationships, and the diverse processes through which romantic relationships of all sorts are linked with criminal behaviors. We present an empirically-based typology detailing six processes, grouped within three conceptual categories, through which romantic relationships had their effects. These pathways include material circumstances, social bonds and interactions, and emotional supports and stressors. We also consider gender differences in these processes. While more tenuous bonds to marginally conventional partners would seem to exert little effect, as one of the few relationships and social roles available to many former prisoners, we found that they wielded important influence, if not always in a positive direction.
PMCID: PMC4254819  PMID: 25484489
criminal desistance; prisoner reentry; romantic relationships; social control
4.  Incarceration, Prisoner Reentry, and Communities 
Annual review of sociology  2014;40:411-429.
Since the mid-1970s the United States has experienced an enormous rise in incarceration and accompanying increases in returning prisoners and in post-release community correctional supervision. Poor urban communities are disproportionately impacted by these phenomena. This review focuses on two complementary questions regarding incarceration, prisoner reentry, and communities:(1) whether and how mass incarceration has affected the social and economic structure of American communities, and (2) how residential neighborhoods affect the social and economic reintegration of returning prisoners. These two questions can be seen as part of a dynamic process involving a pernicious “feedback” loop, in which mass incarceration undermines the structure and social organization of some communities, thus creating more criminogenic environments for returning prisoners and further diminishing their prospects for successful reentry and reintegration.
PMCID: PMC4231529  PMID: 25400321
prisoner reintegration; community corrections; neighborhood effects; recidivism; race; urban poverty
5.  Contextualizing nativity status, social ties, and ethnic enclaves: Implications for understanding immigrant and Latino health paradoxes 
Ethnicity & health  2013;18(6):586-609.
Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their U.S.-born counterparts, may be the strength of their social ties and social support among immigrants.
We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study’s Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used Ordinary Least Squares [OLS] regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed effects regression models, we estimated the association between Latino/immigrant neighborhood composition on our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants’ length of time in the United States.
After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their U.S.-born counterparts for all our outcomes, except for informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for U.S.-born Latinos than for immigrant Latinos. U.S.-born Latinos maintained a significant socialties advantage compared to immigrants—regardless of length of time in the United States—for informal social integration, network diversity, and network size.
At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their U.S.-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.
PMCID: PMC4176765  PMID: 23947776
Social support; Social networks; Latinos; Immigrants; Nativity; Immigrant Status; Length of Time in the United States; Ethnic Enclaves; Neighborhood Context; USA
6.  Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study 
Social science & medicine (1982)  2012;75(6):1038-1047.
Neighborhood disadvantage has consistently been linked to increased rates of morbidity and mortality, but the mechanisms through which neighborhood environments may get “under the skin” remain largely unknown. Differential exposure to chronic environmental stressors has been identified as a potential pathway linking neighborhood disadvantage and poor health, particularly through the dysregulation of stress-related biological pathways such as cortisol secretion, but the majority of existing observational studies on stress and neuroendocrine functioning have focused exclusively on individual-level stressors and psychosocial characteristics. This paper aims to fill that gap by examining the association between features of the neighborhood environment and the diurnal cortisol patterns of 308 individuals from Chicago, Illinois, USA. We found that respondents in neighborhoods with high levels of perceived and observed stressors or low levels of social support experienced a flatter rate of cortisol decline throughout the day. In addition, overall mean cortisol levels were found to be lower in higher stress, lower support neighborhoods. This study adds to the growing evidence of hypocortisolism among chronically stressed adult populations and suggests hypocortisolism rather than hypercortisolism as a potential mechanism linking social disadvantage to poor health.
PMCID: PMC3556931  PMID: 22698925
USA; cortisol; neighborhood effects; health inequalities; multi-level modeling; stress
7.  Cognitive Function in the Community Setting: The Neighborhood as a Source of “Cognitive Reserve”? 
Existing research has found a positive association between cognitive function and residence in a socioeconomically advantaged neighborhood. Yet, the mechanisms underlying this relationship have not been empirically investigated. This study tests the hypothesis that neighborhood socioeconomic structure is related to cognitive function partly through the availability of neighborhood physical and social resources (e.g. recreational facilities, community centers and libraries), which promote cognitively beneficial activities such as exercise and social integration.
Using data from a representative survey of community-dwelling adults in the City of Chicago (N = 949 adults age 50 and over) we assessed cognitive function with a modified version of the Telephone Interview for Cognitive Status (TICS) instrument. Neighborhood socioeconomic structure was derived from US Census indicators. Systematic Social Observation was used to directly document the presence of neighborhood resources on the blocks surrounding each respondent’s residence.
Using multilevel linear regression, residence in an affluent neighborhood had a net positive effect on cognitive function after adjusting for individual risk factors. For white respondents, the effects of neighborhood affluence operated in part through a greater density of institutional resources (e.g. community centers) that promote cognitively beneficial activities such as physical activity. Stable residence in an elderly neighborhood was associated with higher cognitive function (potentially due to greater opportunities for social interaction with peers), but long term exposure to such neighborhoods was negatively related to cognition.
Neighborhood resources have the potential to promote “cognitive reserve” for adults who are aging in place in an urban setting.
PMCID: PMC3387518  PMID: 21515547
cognitive function; neighborhood; urban health; elderly
8.  Reducing Violence by Transforming Neighborhoods: A Natural Experiment in Medellín, Colombia 
American Journal of Epidemiology  2012;175(10):1045-1053.
Neighborhood-level interventions provide an opportunity to better understand the impact that neighborhoods have on health. In 2004, municipal authorities in Medellín, Colombia, built a public transit system to connect isolated low-income neighborhoods to the city’s urban center. Transit-oriented development was accompanied by municipal investment in neighborhood infrastructure. In this study, the authors examined the effects of this exogenous change in the built environment on violence. Neighborhood conditions and violence were assessed in intervention neighborhoods (n = 25) and comparable control neighborhoods (n = 23) before (2003) and after (2008) completion of the transit project, using a longitudinal sample of 466 residents and homicide records from the Office of the Public Prosecutor. Baseline differences between these groups were of the same magnitude as random assignment of neighborhoods would have generated, and differences that remained after propensity score matching closely resembled imbalances produced by paired randomization. Permutation tests were used to estimate differential change in the outcomes of interest in intervention neighborhoods versus control neighborhoods. The decline in the homicide rate was 66% greater in intervention neighborhoods than in control neighborhoods (rate ratio = 0.33, 95% confidence interval: 0.18, 0.61), and resident reports of violence decreased 75% more in intervention neighborhoods (odds ratio = 0.25, 95% confidence interval 0.11, 0.67). These results show that interventions in neighborhood physical infrastructure can reduce violence.
PMCID: PMC3353133  PMID: 22472117
causality; economic development; environment; neighborhood; residence characteristics; violence
9.  Variations in Hypertension-Related Outcomes Among Blacks, Whites and Hispanics in Two Large Urban Areas and in the United States 
Ethnicity & disease  2012;22(4):391-397.
This study compared the hypertension prevalence, awareness, treatment and control in Chicago, Illinois and Detroit, Michigan to that of the general United States population (aged ≥ 25 years) for the period 2001–2003. We examined whether and how much 1) urban populations have less favorable hypertension-related outcomes and 2) the rates of racial/ethnic minorities lag behind those of Whites in order to determine if the national data understate the magnitude of hypertension-related outcomes and racial/ethnic disparities in two large cities in the Midwestern region of the United States and perhaps others.
Unstandardized and standardized hypertension-related outcome rates were estimated.
The hypertension-related outcomes among Chicago and Detroit residents lag behind the United States by 8%–14% and 10%–18% points, respectively. Additionally, this study highlights the complexity of the racial/ethnic differences in hypertension-related outcomes, where within each population, Blacks were more likely to have hypertension and to be aware of their hypertension status than Whites, and no less likely to be treated. Conversely, Hispanics were less likely to have hypertension and also less likely to be aware of their status when they do have hypertension when compared to Whites.
At a time when efficacious treatment for hypertension has been available for more than 50 years, continued racial/ethnic differences in the prevalence, awareness, treatment and control of hypertension is among public health’s greatest challenges. To achieve the proposed national hypertension-related goals, future policies must consider the social context of hypertension within central cities of urban areas. (Ethn Dis. 2012;22[4]:391–397)
PMCID: PMC3579519  PMID: 23140067
Hypertension; Minority Health; Population; Urban Health
10.  Language of Interview, Self-Rated Health, and the Other Latino Health Puzzle 
American journal of public health  2010;101(7):1306-1313.
Despite lower rates of mortality and some forms of morbidity, Latinos report worse self-rated health (SRH) than Whites. These inconsistencies have raised questions about the validity of SRH for cross-ethnic comparisons and its use as a measure of health disparities. We examine whether the translation of this measure into Spanish helps explain these patterns.
We analyzed levels of SRH under different language conditions using cross-sectional data from the 2002 Chicago Community Adult Health Study and the 2003 Behavioral Risk Factor Surveillance System.
Being interviewed in Spanish was associated with significantly higher odds of rating one’s health as fair/poor in both data sets, and adjusting for language of interview substantially reduced the SRH gap between whites and Latinos. Spanish-language interviewees were also more likely to rate their health as “fair” (“regular” in Spanish) than any other response category, after adjusting for age, sex, socioeconomic position, health conditions, and other factors. The association between being interviewed in Spanish and reporting “fair”/“regular” health was strongest when contrasted against response categories representing better health (good, very good, and excellent).
The findings support the hypothesis that the translation of the English word “fair” to “regular” induces Spanish-speaking respondents to report worse levels of health than they otherwise would in English. We recommend caution in interpreting this widely used instrument—especially when making racial/ethnic comparisons—and propose experimental research using different translations of this measure to arrive at one that better equates its meaning in Spanish and English.
PMCID: PMC3110226  PMID: 21164101
11.  Neighborhood Context and Social Disparities in Cumulative Biological Risk Factors 
Psychosomatic medicine  2011;73(7):572-579.
This study examines the role of neighborhood context in the accumulation of biological risk factors and racial/ethnic and socioeconomic disparities.
Data come from face-to-face interviews and blood collection on a probability sample of adults (n=549) in the 2002 Chicago Community Adult Health Study. Following the approach of prior studies, we constructed an index of cumulative biological risk (CBR) by counting how many of eight biomarkers exceeded clinically defined criteria for “high risk”: systolic and diastolic blood pressure, resting heart rate, hemoglobin A1c, C-reactive protein, waist size, and total and HDL cholesterol. Data are presented as incidence rate ratios (IRR) based on generalized linear models with a Poisson link function and population-average estimates with robust standard errors.
Non-Hispanic blacks (n=200), Hispanics (n=149), and people with low (n=134) and moderate (n=275) education had significantly higher numbers of biological risks than their respective reference groups (IRR=1.48, 1.59, 1.62, and 1.48, respectively, with p-values <0.01). Black-white (p<0.001) and Hispanic-white (p<0.003) disparities in CBR remained significant after adjusting for individual-level socioeconomic position and behavioral factors, while individual-level controls substantially diminished the low/high (p<0.069) and moderate/high (p<0.042) educational differences. Estimating “within-neighborhood” disparities to adjust for neighborhood context fully explained the black-white gap in CBR (p<0.542) and reduced the Hispanic-white gap to borderline significance (p<0.053). Neighborhood affluence predicted lower levels of CBR (IRR=0.82, p<0.027), but neighborhood disadvantage was not significantly associated with CBR (IRR=1.00, p<0.948).
Neighborhood environments appear to play a pivotal role in the accumulation of biological risk and disparities therein.
PMCID: PMC3216672  PMID: 21862824
social environment; health disparities; cumulative biological risk; allostatic load; risk factor
12.  Socioeconomic and Behavioral Risk Factors for Mortality in a National 19-Year Prospective Study of U.S. Adults 
Social science & medicine (1982)  2010;70(10):1558-1566.
Many demographic, socioeconomic, and behavioral risk factors predict mortality in the United States. However, very few population-based longitudinal studies are able to investigate simultaneously the impact of a variety of social factors on mortality. We investigated the degree to which demographic characteristics, socioeconomic variables and major health risk factors were associated with mortality in a nationally-representative sample of 3,617 U.S. adults from 1986-2005, using data from the 4 waves of the Americans’ Changing Lives study. Cox proportional hazard models with time-varying covariates were employed to predict all-cause mortality verified through the National Death Index and death certificate review. The results revealed that low educational attainment was not associated with mortality when income and health risk behaviors were included in the model. The association of low-income with mortality remained after controlling for major behavioral risks. Compared to those in the “normal” weight category, neither overweight nor obesity was significantly associated with the risk of mortality. Among adults age 55 and older at baseline, the risk of mortality was actually reduced for those were overweight (hazard rate ratio=0.83, 95% C.I. = 0.71 – 0.98) and those who were obese (hazard rate ratio=0.68, 95% C.I. = 0.55 – 0.84), controlling for other health risk behaviors and health status. Having a low level of physical activity was a significant risk factor for mortality (hazard rate ratio=1.58, 95% C.I. = 1.20 – 2.07). The results from this national longitudinal study underscore the need for health policies and clinical interventions focusing on the social and behavioral determinants of health, with a particular focus on income security, smoking prevention/cessation, and physical activity.
PMCID: PMC3337768  PMID: 20226579
Mortality; socioeconomic factors; health behavior; Unites States; obesity
13.  Neighborhood Stressors and Social Support as Predictors of Depressive Symptoms in the Chicago Community Adult Health Study 
Health & place  2010;16(5):811-819.
There is a growing interest in understanding the effects of specific neighborhood conditions on psychological wellbeing. We examined cross-sectional associations of neighborhood stressors (perceived violence and disorder, physical decay and disorder) and social support (residential stability, family structure, social cohesion, reciprocal exchange, social ties) with depressive symptoms in 3105 adults in Chicago. Subjects lived in 343 neighborhood clusters, areas of about two census tracts. Depressive symptoms were assessed with an 11-item version of the CES-D scale. Neighborhood variables were measured using rater assessments, surveys, and the US Census. We used two-level gender-stratified models to estimate associations of neighborhood conditions with depressive symptoms after adjusting for individual-level covariates. Most social support variables were associated with lower levels of depressive symptoms in women but not men, while stressors were moderately associated with higher levels in all subjects. Adjusting concurrently for stressors and social support did not change results. This suggests both neighborhood stressors and social support are associated with depressive symptoms.
PMCID: PMC2918682  PMID: 20434941
depression; residence characteristics; neighborhoods; stressors; social support
14.  Measurement of the Local Food Environment: A Comparison of Existing Data Sources 
American Journal of Epidemiology  2010;171(5):609-617.
Studying the relation between the residential environment and health requires valid, reliable, and cost-effective methods to collect data on residential environments. This 2002 study compared the level of agreement between measures of the presence of neighborhood businesses drawn from 2 common sources of data used for research on the built environment and health: listings of businesses from commercial databases and direct observations of city blocks by raters. Kappa statistics were calculated for 6 types of businesses—drugstores, liquor stores, bars, convenience stores, restaurants, and grocers—located on 1,663 city blocks in Chicago, Illinois. Logistic regressions estimated whether disagreement between measurement methods was systematically correlated with the socioeconomic and demographic characteristics of neighborhoods. Levels of agreement between the 2 sources were relatively high, with significant (P < 0.001) kappa statistics for each business type ranging from 0.32 to 0.70. Most business types were more likely to be reported by direct observations than in the commercial database listings. Disagreement between the 2 sources was not significantly correlated with the socioeconomic and demographic characteristics of neighborhoods. Results suggest that researchers should have reasonable confidence using whichever method (or combination of methods) is most cost-effective and theoretically appropriate for their research design.
PMCID: PMC2842213  PMID: 20123688
Chicago; geographic information systems; reproducibility of results; residence characteristics; social environment
15.  Mobility Disability and the Urban Built Environment 
American Journal of Epidemiology  2008;168(5):506-513.
Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001–2003), the authors examined the effect of built environment characteristics on mobility disability among adults aged 45 or more years (n = 1,195) according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent's residence in the city of Chicago (Illinois). Using multinomial logistic regression, the authors found that street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment. However, among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterized by cracks, potholes, or broken curbs). When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment. If street quality could be improved, even somewhat, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.
PMCID: PMC2727170  PMID: 18667526
aging; lower extremity; mobility limitation; social environment; urban health

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