Neighborhood Context and the Health of Older Adults

描述（由申请人提供）：社区支持和维持居民个人福祉的能力对老年人尤为突出；他们的日常活动很可能依赖于社区的基础设施和社会资源，特别是在健康已经受到损害的情况下。虽然长期以来人们一直认为，一个人居住的社区会影响一个人的健康，但很难描述为什么，以及在什么情况下，社区环境有助于健康。我们带来了一个重要的社会学新概念，集体效能，承担邻里关系和老年人健康的研究。利用来自芝加哥社区人类发展项目——社区调查、大都会社区信息中心——地铁调查、医疗保险索赔、门诊、住院和地理编码医疗服务数据的数据，我们提出以下问题：1)城市社区的结构特征——集中贫困、

DESCRIPTION (provided by applicant): The capacity of communities to bolster and sustain the well being of individual residents is particularly salient for older adults; their daily activities are likely dependent on the infrastructure and social resources of their communities, particularly if health is already compromised. Although it has long been believed that the neighborhood one lives in affects one's health, it has been difficult to delineate why, and under what circumstances, neighborhood context contributes to health. We bring an important new sociological concept, collective efficacy, to bear on the study of neighborhood and the health of older persons. Using data from the Project on Human Development in Chicago Neighborhoods-Community Survey, the Metropolitan Community Information Center-Metro Survey, Medicare Claims, and out-patient, hospitalization, and geocoded health services data, we ask: 1) Are structural features of urban neighborhoods--concentrated poverty, concentrated affluence, residential stability, ethnic heterogeneity, and age structurel associated with the health status of older residents?; 2) Are neighborhood social processes--collective efficacy, social networks, social norms, and physical/social disorder associated with the health of older residents?; 3) is the health services infrastructure of the neighborhood associated with the health of older residents?; and 4) Does the health of older residents affect the ability of the community to sustain social networks and develop collective efficacy? This project goes beyond current research in four ways. First, it extends existing research on neighborhood context and the health of older adults by exploring theoretically informed mechanisms with multi-level statistical tools. Second, it incorporates an understudied area in the neighborhood effects literature--the role of health services and access to care. Simultaneously examining the effects of neighborhood context and health services could enhance our understanding of individual-level racial/ethnic and socioeconomic disparities in health. Third, it acknowledges that the relationship between neighborhood and health is both reciprocal and dynamic. Fourth, it provides a unique opportunity to examine interactions across a number of levels (e.g., individual-neighborhood, neighborhood-health services infrastructure). This project combines perspectives from sociology and health services research; it bridges these disciplines to formulate research that addresses a set of questions vital to both fields and to aging-related policy.