Activating social ties is a critical mechanism for satisfying individuals’ social, emotional, and material needs. Researchers have offered a number of hypotheses around tie activation about when and why particular supporters step in to help, ranging from strategic activation via functional specificity to opportunistic mobilization. To date, few studies have examined multiple tie activation strategies in tandem. This project focuses on people facing complex, compounding health and social problems, who may have to rely on multiple forms of activation to get their support needs met. We draw on a sample of 92 participants who are affiliated with one of two Care Management programs in the Western United States. Using name generators in a survey, we elicit participants’ social networks and find they utilize a number of methods to secure critical support needs, including calling on kin ties to borrow money and help with daily tasks, relying on strong and proximal ties for almost all types of support, and using functional specificity for health support. We then draw on qualitative interviews to gain a deeper understanding of the ways alters provide support and why egos elicit support from some alters and not others. Future research should continue assessing this population’s social networks with the aim of leveraging social support to help manage chronic conditions, provide access to resources, and increase their sense of belonging.
Recent Selected Publications
In this article, we explore the experiences of older adults living in public housing undergoing renovations and its associated impacts on their perceived sense of well-being. We also consider the ways in which affordable housing developers contemplate residents’ health and wellness into renovation plans and processes. Following the conventions of hermeneutic analysis, we conducted open-ended in-depth interviews with older adults living in public housing undergoing renovations (n = 21) and representatives of a variety of affordable housing developers (n = 12). Our analysis demonstrates that residents had strong attachments to their individual living spaces prior to renovations and were fiercely protective of them. Renovations created a sense of unease among older residents as the familiar features of their homes were altered. The processes and the outcomes of renovations and new management strategies raised fears that their lived environments were becoming institutionalized. Developers acknowledged that a tension exists between residents’ desires for personalized private space, and their responsibilities as landlords to prioritize the physical safety of residents and the fiduciary obligations to maintain building longevity.
As part of a larger project focused on the intersection of educational and health trajectories over the life course, we use in-depth interviews with 28 adults who experienced multiple non-promotional school changes during the course of their K-12 schooling in three U.S. urban centers to advance understanding of frequent student mobility. Prior research focuses predominantly on isolating the impact of student mobility while saying little about processes through which mobility influences educational trajectories in particular contexts. Frequent student mobility was intertwined with adverse childhood experiences and access to coping resources, and these forces shaped participants’ trajectories in patterned ways. Supporting frequently mobile students, almost a third of school-age children in the United States, will require greater attention to the reasons for, processes of, and contexts of student mobility.
The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = −0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = −0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.
As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers’ extension of medical stabilization into social, economic, and political realms, even as they remained caught in the structural dynamics they sought to address.
Background: Higher educational attainment predicts lower hypertension. Yet, associations between nontraditional educational trajectories (e.g., interrupted degree programs) and hypertension are less well understood, particularly among structurally marginalized groups who are more likely to experience these non-traditional trajectories.
Methods: In National Longitudinal Survey of Youth 1979 cohort data (N = 6 317), we used sequence and cluster analyses to identify groups of similar educational sequences—characterized by timing and type of terminal credential—that participants followed from age 14–48 years. Using logistic regression, we estimated associations between the resulting 10 educational sequences and hypertension at age 50. We evaluated effect modification by individual-level indicators of structural marginalization (race, gender, race and gender, and childhood socioeconomic status [cSES]).
Results: Compared to terminal high school (HS) diploma completed at traditional age, terminal GED (OR: 1.32; 95%CI: 1.04, 1.66) or Associate degree after <HS (OR: 1.93; 95%CI: 1.11, 3.35) was associated with higher hypertension. There was some evidence of effect modification. Hypertension associated with delayed HS diploma versus HS diploma at a traditional age (the reference) was lower for Black men than White men (interaction term: 0.44; 95%CI: 0.21, 0.91); similarly, hypertension associated with <HS versus completing HS at a traditional age was lower for people with low cSES than people with high cSES (interaction term: 0.52; 95%CI: 0.30, 0.90).
Conclusions: Both type and timing to terminal credential matter for hypertension but effects may vary by experiences of structural marginalization. Documenting the nuanced ways in which complex educational trajectories are associated with health could elucidate underlying mechanisms and inform systems-level interventions for health equity.
Higher educational attainment has been linked to better health and economic outcomes. However, little is known about how family caregiving responsibilities influence individuals’ educational trajectories in the United States (U.S.). Currently, 26% of U.S. undergraduates have at least one dependent child. While some literature describes the experiences of college-student parents, few studies examine the myriad ways family caregiving may singly or simultaneously present, including caregiving for children, relatives, household members, and older adults. The literature shows that caregiving for relatives, household members, and older adults is a common experience, with 20% of Americans providing care for an adult. Guided by social reproduction theory and reproductive labor, this paper examined qualitative interviews (n=31) from the Educational Trajectories & Health study to understand how caregiving responsibilities, broadly defined, influenced educational trajectories. Participants who identified as women discussed bearing disproportionate expectations to take on family caregiving responsibilities, including caregiving for siblings and aging parents. For most participants, family caregiving responsibilities substantially influenced educational decisions. Some experienced additional caregiving responsibilities but still attained their educational goals; others with family caregiving responsibilities discussed stretching and substituting resources in an effort to manage but ultimately having to step back from their stated educational pursuits. Situating these findings within broader social and structural contexts, this analysis examines educational disruption when family caregiving responsibilities arise. Findings have implications for policies that support students with family caregiving responsibilities at school, state, and federal levels.
Keywords: Family caregiving, reproductive labor, qualitative research.
Objective: To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities.
Methods: In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events.
Results: Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%).
Conclusion: Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities.
Background: Low-income U.S. adults experiencing food insecurity have a disproportionately high prevalence of cigarette smoking, and quantitative studies suggest that food insecurity is a barrier to quitting. To guide effective tobacco control strategies, this study aimed to understand the experiences, perceptions, and context of tobacco use and cessation among low-income populations experiencing food insecurity. Methods: We conducted in-depth, semi-structured interviews with 23 adults who were currently smoking cigarettes and were experiencing food insecurity, mostly living in rural settings. Participants were recruited through food-pantry-based needs assessment surveys and study flyers in community-based organizations. The interview guide explored participants’ histories of smoking, the role and function of tobacco in their lives, their interest in and barriers to quitting, as well as lived experiences of food insecurity. We used reflexive thematic analysis to analyze transcribed interviews. Results: Within a broader context of structural challenges related to poverty and financial strain that shaped current smoking behavior and experiences with food insecurity, we identified the following five themes: smoking to ignore hunger or eat less; staying addicted to smoking in the midst of instability; smoking being prioritized in the midst of financial strain; life stressors and the difficulty of quitting smoking and staying quit; and childhood adversity at the intersection of food insecurity and tobacco use. Conclusion: The context of tobacco use among adults with food insecurity was highly complex. To effectively address tobacco-related disparities among those who are socially and economically disadvantaged, tobacco control efforts should consider relevant lived experiences and structural constraints intersecting smoking and food insecurity. Findings are applied to a conceptualization of clustering of conditions contributing to nicotine dependence, food insecurity, and stress.
Keywords: tobacco use, food insecurity, poverty, disparities, qualitative
Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15–44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women’s long-term health trajectories.
Keywords: housing, reproductive health, health care utilization, racial/ethnic disparities, social determinants