A Driver in Health Outcomes: Developing Discrete Categories of Transportation Insecurity.

Research suggests that transportation is an important social determinant of health, because the ability to get around is consequential for accessing health care and nutritious food and for making social connections. We used an inductive mixed-methods approach and a quantitative k-means clustering approach to identify 5 categories of transportation insecurity using the validated 16-item Transportation Security Index. The resulting 5-category measure distinguished among respondents with qualitatively different experiences of transportation insecurity. Analyzing data from 2018 that were representative of the US adult population aged 25 years or older, we demonstrated a nonparametric association between transportation insecurity and 2 different health measures (self-rated health and depressive symptoms). There was a threshold relationship between self-rated health and any level of transportation insecurity. High transportation insecurity had a very strong relationship with depressive symptoms. The categorical Transportation Security Index will be useful for clinicians who wish to screen for transportation-related barriers to health care. It will also facilitate research investigating the influence of transportation insecurity on health outcomes and provide the basis for interventions designed to address health disparities.

Opportunities for making ends meet and upward mobility: differences in organizational deprivation across urban and suburban poor neighborhoods.

Objectives. Given the recent rise of poverty in U.S. suburbs, this study asks: What poor neighborhoods are most disadvantageous, those in the city or those in the suburbs? Building on recent urban sociological work demonstrating the importance of neighborhood organizations for the poor, we are concerned with one aspect of disadvantage­the lack of availability of organizational resources oriented toward 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 organizations, educational organizations, and employment organizations. We use data from the 2000 U.S. County Business Patterns and the 2000 U.S. Census and test neighborhood deprivation using logistic regression models.Results. We find that suburban poor neighborhoods are more likely to be organizationally deprived than are 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 engenders isolation from organizations that will help meet one's daily needs and even more so from those offering opportunities for mobility.