Supermarket Proximity and Price: Food Insecurity and Obesity in the United States

Where we live matters for our health. The social, economic, and physical features of neighborhoods can play a powerful role in health and longevity. Neighborhood concentration of poverty and poor health have been shown to be linked. Residing in low-income neighborhoods has been associated with diet related chronic diseases such as obesity and diabetes

The Effect of the Foreclosure Crisis on Health

Foreclosure rates reached unprecedented levels in the United States during the Great Recession. During 2010, one in 45 housing units nationwide received a foreclosure filing. Residents who lived near properties in foreclosure from 2007 to 2012 lost an estimated collective $2.2 trillion in property values, local governments tax base declined, and affected communities experienced an increase in crime and blight. In the aftermath of the foreclosure crisis, little is known about how the foreclosure crisis affected the health of homeowners who lost their homes to foreclosure and the health of residents living in communities hit hard by the crisis. This dissertation, made up of three papers, first explores the explicit and implicit theories evoked by the literature in this space, and then empirically tests the hypothesis that the foreclosure crisis had spillover effects on health. The first paper systematically reviews the existing, early-stage research on foreclosures and health by presenting an organizational schema based on level of analysis, type of housing distress measure, and health outcome. In addition, the review describes the specific mechanisms linking foreclosures and health, and how this field aligns and departs from the larger body of work on recessions and health. The second and third papers empirically test if the foreclosure crisis has an impact on glycemic control (hemoglobin A1c) and weight change of patients in a large clinical population of continuously insured patients with diabetes living in the Bay Area of California during 2007 to 2010. The three primary conclusions from this work are: 1) there was no evidence of a spillover effect of the foreclosure crisis on A1c or weight change among patients in a managed care system; 2) the pathways by which health is influenced by experiencing a foreclosure compared to living near a foreclosure are distinct and vary based on the manner in which the exposure and outcome are operationalized; 3) housing and labor market factors appear to have related yet discrete repercussions on health and healthcare

The Effect of the Foreclosure Crisis on Health

Foreclosure rates reached unprecedented levels in the United States during the Great Recession. During 2010, one in 45 housing units nationwide received a foreclosure filing. Residents who lived near properties in foreclosure from 2007 to 2012 lost an estimated collective $2.2 trillion in property values, local governments tax base declined, and affected communities experienced an increase in crime and blight. In the aftermath of the foreclosure crisis, little is known about how the foreclosure crisis affected the health of homeowners who lost their homes to foreclosure and the health of residents living in communities hit hard by the crisis. This dissertation, made up of three papers, first explores the explicit and implicit theories evoked by the literature in this space, and then empirically tests the hypothesis that the foreclosure crisis had spillover effects on health. The first paper systematically reviews the existing, early-stage research on foreclosures and health by presenting an organizational schema based on level of analysis, type of housing distress measure, and health outcome. In addition, the review describes the specific mechanisms linking foreclosures and health, and how this field aligns and departs from the larger body of work on recessions and health. The second and third papers empirically test if the foreclosure crisis has an impact on glycemic control (hemoglobin A1c) and weight change of patients in a large clinical population of continuously insured patients with diabetes living in the Bay Area of California during 2007 to 2010. The three primary conclusions from this work are: 1) there was no evidence of a spillover effect of the foreclosure crisis on A1c or weight change among patients in a managed care system; 2) the pathways by which health is influenced by experiencing a foreclosure compared to living near a foreclosure are distinct and vary based on the manner in which the exposure and outcome are operationalized; 3) housing and labor market factors appear to have related yet discrete repercussions on health and healthcare

Pathways to Pregnancy for Sexual Minority Women in Same-sex Marriages

Objective In August 2018, the American Congress of Obstetricians and Gynecologists reaffirmed its support for marriage equality for all adults and its intent to “understand, recognize, and address the challenges the [lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual and many other terms (such as nonbinary and pansexual)] and gender nonconforming communities experience in accessing reproductive health care, including family building.”1 There are more than 280,000 women in same-sex marriages in the United States,2 yet little is known about how they build families. Specifically, no research we are aware of has documented the prevalence of fertility treatments and technologies used by this population. Prior work found sexual minority women have worse pregnancy outcomes compared with heterosexual women.3 While more work is needed to confirm and better understand this finding, it is important to identify and consider how sexual minority women conceive their pregnancies. Our objective was to describe fertility technologies and treatments used by women with live births in same-sex marriages. Study Design We estimated the prevalence of types of fertility treatments for women in same-sex and different-sex marriages using birth certificate data from Massachusetts for all live births from 2012 to 2016. Our unit of analysis was pregnancies with live births, which included all births per mother in a given pregnancy (n = 234,597 pregnancies). Use of fertility services and technologies was identified from the hospital data and the birth certificate worksheet completed by the parents. Pregnancies were identified as resulting from 1 or more of the following: any infertility treatment, fertility-enhancing drugs, assisted reproductive technology, intrauterine insemination, intracervical insemination, and anonymous donor sperm. These data could have been underreported or misreported, yet it is unclear whether accuracy of reports differed between pregnancies of same- and different-sex couples. Results Compared with pregnancies of women in different-sex couples (n = 233,158), the proportion of pregnancies to women in same-sex couples (n = 1439) was 12 times higher for use of any type of fertility treatments, 9 times higher for fertility-enhancing drugs and assisted reproductive technology (in vitro fertilization), 33 times higher for intrauterine insemination, and 44 times higher for intracervical insemination (Table). Among all pregnancies using anonymous donor sperm, 4 in 5 were to women in same-sex couples (854 of 1081)

Subprime Babies: The Foreclosure Crisis and Initial Health Endowments

The subprime mortgage crisis was a devastating financial shock for many homeowners. This research uses a probabilistic matching strategy to link foreclosure records with birth certificate records from 2006 to 2010 in California to identify birth parents who experienced a foreclosure. Among mothers who did, those issued a loan during the peak of subprime lending from 2005 to 2007 were more Hispanic and socioeconomically disadvantaged than mothers with loans originating before 2005. We use a mother fixed-effects analyses of ever-foreclosed mothers issued a loan during 2006 and 2007 and find that infants in gestation during or after the foreclosure had a lower birth weight for gestational age than those born earlier, suggesting that the foreclosure crisis was a plausible contributor to disparities in initial health endowments

Same-Sex Marriage and Gains in Employer-Sponsored Insurance for US Adults, 2008-2017

Objectives. To estimate the effects of same-sex marriage recognition on health insurance coverage. Methods. We used 2008–2017 data from the American Community Survey that represent 18 416 674 adult respondents in the United States. We estimated changes to health insurance outcomes using state–year variation in marriage equality recognition in a difference-in-differences framework. Results. Marriage equality led to a 0.61 percentage point (P =.03) increase in employer-sponsored health insurance coverage, with similar results for men and women. Conclusions. US adults gained employer-sponsored coverage as a result of marriage equality recognition over the study period, likely because of an increase in dependent coverage for newly recognized same-sex married partners