The United States government website is an authoritative source of information. It is essential to ensure that any sensitive data is shared on a federal government website. Research has indicated that the characteristics of a neighborhood and access to transportation are an unmet requirement for medical care. This longitudinal analysis examines the connections between changes in neighborhood socioeconomic disadvantage and access to transportation with unmet health care needs.
A study was conducted to analyze seven waves of data from African-American adults who moved from severely distressed public housing complexes in Atlanta, Georgia. The surveys yielded data at the individual level and administrative data characterized the census sections. Generalized hierarchical linear models were used to explore relationships. People living in public housing have some of the poorest health profiles of all groups in the U.
S. In addition, residents may belong to highly stigmatized groups, which can create greater barriers to healthcare. Our own research suggests that people who moved did not experience significant improvements in unmet health care needs immediately after relocation. However, the relocations also brought people to qualitatively different neighborhoods, which were mostly less violent and less impoverished than the neighborhoods containing the complexes.
These communities may have more resources and prosocial norms that support seeking health care and preventive behaviors. A conceptual framework for the relationships between neighborhood disadvantage, access to transportation, and the unmet need for health care was used for this multilevel, longitudinal study. The study followed a cohort of predominantly substance-abusing African-American adults who moved from seven demolished public housing complexes in Atlanta, Georgia. All residents of these complexes were relocated to rental units subsidized with vouchers from the private market, and the empty complexes were demolished. Baseline (wave data captured pre-relocation conditions; waves 2-7 captured post-relocation conditions at nine-month intervals).
Approval from the Institutional Review Board and a certificate of confidentiality were obtained prior to the implementation of the study. The study methods included recruiting on-site at each complex; community and religious organizations near each complex distributed flyers; and participants could refer people for examination. To keep attrition low and random, intensive retention methods were implemented, including calling participants monthly to maintain relationships and update contact information, incentives to stay in touch and contact network members when it was difficult to contact participants. The reference data described the characteristics of the census district before the location. The data at the stage level of waves 2 to 7 varied over time and reflected the data collection period for that wave or the closest year for which data were available.
The unmet need for health care, the binary outcome of interest, was measured as a “yes” answer to the question “During the past six months, were there any times when you wanted to receive medical care but were unable to get it at that time? 47. Enabling exposure variables included socioeconomic disadvantage at the census district level and access to transportation at the individual and census district levels. To avoid multicollinearity in multivariable models, principal component analysis (PCA) was used to condense these correlated variables into components. The resulting component captured “socioeconomic disadvantage at the district level (median household income, poverty rate, percentage of residents over 25 without a high school diploma or GED, violent crime rate, and percentage of residents who are black). District-level transportation access was created using data from the U.
S. UU. In addition to exploring the independent relationships of these two variables with unmet health care needs, they were also combined to form a district-level measure of “any access to transportation”.Effect modifiers included self-identification as a woman and substance dependence (drugs or alcohol), as measured by the Texas Christian University Drug Test II. Fifty distributions of all variables were evaluated between waves.
Graphs were used to visualize the proportion of unmet health care needs over time and whether trajectories varied by gender and drug dependence status. The findings from this study support the importance of neighborhood environments and access to transportation in shaping unmet needs for healthcare in vulnerable populations. Improvements in these exposures can reduce unmet need for health care in this vulnerable population. This research highlights how important it is for communities to have adequate transportation systems that enable people living in disadvantaged neighborhoods access healthcare services when needed. It is essential that governments invest in public transportation systems that are reliable and accessible so that people can get medical care when they need it without having to worry about transportation issues. In conclusion, this research shows how important it is for governments to invest in public transportation systems that are reliable and accessible so that people can get medical care when they need it without having to worry about transportation issues.
