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The University of Chicago Population Research Center

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Health

The theoretical model that guides our research on health considers the demographic determinants and implications of health outcomes and behaviors. This model is used in the varied research that is bound together within or influenced by Chicago's urban center. Associations with the University of Chicago Medical Center – primarily serving a low income, urban community – direct our research to address and develop effective health care at the community level. This commitment is realized in the Urban Health Initiative which connects the University of Chicago Medical Center with community organizations and healthcare providers to research, educate and provide health care.


Within the last twenty years, major developments have solidified the clear connection between the social sciences and medicine in urban health studies. One was the creation of the Harris School of Public Policy Studies with its focus on health policy; the other was the creation of the Department of Health Studies within the Pritzker School of Medicine/Biological Sciences. Each houses several social scientists conducting research on health at the interface between the physician and the family. The creation of the Center for Health and the Social Sciences (CHeSS) in the Biological Sciences Division has cultivated another connection. CHeSS is currently developing a program that addresses community-based research and health disparities. This program will clearly connect the urban research of the PRC to CHeSS's work on health studies.

Within the health research conducted at the PRC, there are three predominant research fields:

 

Health Promotion Across the Life Course

We have several Associates, both junior and senior, studying issues that involve health and health promotion. Kate Cagney studies a range of factors that impact health outcomes, especially how neighborhoods affect health. In a series of papers she has examined how neighborhood social factors (e.g., network density, collective efficacy) and structural features (e.g., poverty, affluence) impact a variety of health outcomes. Cagney has new work examining "activity space" for older adults and across the life course (the range of space individuals traverse for routine activities) and its implications for social network integration and heath. Cagney and David Meltzer started a suite of projects this fall focused on oral health. Cagney will examine the role of oral health in self-presentation and service sector labor market success (with Michael Reynolds through her Lakeside project) and Meltzer will examine oral health for hospitalized patients. Meltzer has undertaken a major inquiry of the new medical specialty of hospitalists, those physicians whose practices are more than one-quarter in hospital inpatient care. He is the recipient of a Robert Wood Johnson Foundation Investigator award to write a book on the evolution of hospitalists (modeled after Robert Fogel's analysis of the railroads) which focuses heavily on physician travel costs as drivers of the evolution of hospitalists, especially in urban contexts. He also has underway a multimillion dollar AHRQ-funded, multi-site study of their effectiveness, the cost implications of their handling of patients, and their influence on both the culture of hospitals and the interplay between the doctor and the patient/family as managers of health care. He is now mounting a Chicago-area research network to study the care provided to patients in a diverse set of urban hospitals. Louise Hawkley studies how social factors, and perceived social isolation in particular, affect physiology, health, and well-being. She is pursuing this research using NSHAP, and also developing a line of research which examines the extent to which country-level differences in health can be explained by country-level differences in social isolation and social relationships. Michael Davern recently led a large inter-agency workgroup (including representatives from the Census Bureau, CMS, AHRQ, NCHS and the Office of the Assistant Secretary for Planning and Evaluation) to examine why survey estimates of the number of people enrolled in Medicaid were well below administrative enrollment counts. The group linked survey data from the CPS, the NHIS, and the MEPS with the Medicaid Statistical Information System (MSIS) administrative data from CMS. This project greatly improved the research communities understanding of why survey Medicaid enrollment estimates are lower than administrative data enrollment counts. Marshall Chin also investigates strategies that are health promoting, focusing on the advisory role of the physician in guiding the individual's choices about those strategies. Chin studies issues of diabetes, especially differences in white and African-American populations, how different physician-specialists treat older diabetic patients differently, and how community health centers handle health care for elderly diabetics. Milda Saunders also examines the role of race in service provision, focusing most recently on End Stage Renal Disease and the role of neighborhood segregation in the location of quality dialysis facilities. Bruce Meyer, whose primary research interests lie in assessment of federal welfare programs, completed a provocative assessment of the crowd-out effects on private health insurance of programs such as the free health care provided by Federally Qualified Health Centers. He and a colleague show that matched CPS data indicates that while hospital care does not have a crowd-out effect, clinic care does substantially crowd out private health insurance coverage. Meyer is also examining disability prevalence and the extent to which it impacts employment, earnings, income and consumption. Daniel Bennett studies behavioral determinants of public health in developing countries. He focuses on the way that people and markets process information, and therefore how the provision of information impacts public health. Anjali Aduki's work is motivated by the fact that one in five children worldwide does not complete upper-primary school, with particularly high drop-out rates among pubescent-age girls. In a recent paper, she examines how improving the health, privacy, and safety of the school environment through sanitation influences the educational decisions of children across different ages. Harold Pollack's research contributions center on poverty policy and public health. He also has a large body of research on drug abuse and dependence among welfare recipients and HIV prevention among injection drug users. Michael Greenstone examines health in the context of environmental exposures; his paper in the Proceedings of the National Academy of Sciences (2013) demonstrated that high levels of particulate air pollution from coal combustion are causing the 500 million residents of Northern China to lose more than 2.5 billion years of life expectancy. Dan Black's very recent work has already received great attention; Black, with colleagues, found that, on average, African Americans who migrated during the Great Migration died 1.5 years sooner than their peers who stayed in the South (American Economic Review, 2015).

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Sexual Health

The second health concentration is sexual health. This is a central research focus of several of our scholars. Waite, with Cagney, Hawkley, Lauderdale, Laumann, McClintock, and O'Muircheartaigh, examines sexual health and social factors at older ages through NSHAP. This collaboration has led to 86 articles and to two special issues in the Journals of Gerontology: Social Sciences. The NICHD- supported "Chicago Health and Social Life Survey" undertaken in 1995 by Edward Laumann and his students, including Michael Reynolds and Stuart Michaels, provided some of the fundamental underpinnings for NSHAP (it resulted in several papers and a 2004 book that includes investigations of the behaviors and social structures that influence transmission of HIV in Chicago). Michaels collaborates with John Schneider on a landmark population-based survey of younger Black men who have sex with men (PDB NICHD). This includes a longitudinal survey of a large cohort (n=622) from Chicago. Built into this is also an assessment of Facebook use and network generation using an embedded application to obtain data directly from Facebook among respondents. Ongoing work aims to turn these findings into interventions to limit onwards HIV/STI transmission. Melissa Gilliam's research focuses on contraceptive use among teens and women who are at risk for unintended pregnancy, and she has developed a new center on campus, the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health. Her current PDB NICHD R21 attempts to address racial disparities in sexual health by framing behavioral targets in terms of risk reduction and promoting dual protection strategies. Stacy Lindau was involved in Wave 1 of NSHAP and focused on sexual activity at later ages and how sexuality is affected by illness. Using other data, Lindau published a paper examining the prevalence and correlates of HPV infection among a population-based sample of older women. Sexual dysfunction has been a topic of several papers by Laumann who has also been a principal investigator on an 11-country comparative analysis of sexual dysfunction. Our researchers are also strongly committed to research on the positive outcomes of sexual behavior. Much of the book by Laumann and his students looks at the social dimensions of sexuality and its expression. In the NSHAP project there is much attention to the positive aspects of sexual behavior for the health and well-being of older men and women.

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Chronic and Infectious Disease

Edward Laumann and Martha McClintock are working with NSHAP data to determine the correlates of metabolic syndrome, a cluster of comorbidities (obesity, dyslipidemia, hypertension, insulin resistance and dysglycemia) predisposing individuals to cardiovascular disease. In other work, McClintock has documented in animal studies that social factors like isolation are linked to mammary tumors, and she speculates that this may be so in human populations as well. Addressing how the social behaviors and exposures interact with and affect the regulation of genes is associated with the burgeoning area of childhood precursors of adult health. This work is a component of McClintock's Center for Interdisciplinary Health Disparities Research which is in large part devoted to understanding breast cancer incidence among black women. In both the US and West Africa Black women develop breast cancers that occur at a younger age and are more aggressive and lethal then those experienced by White women of Northern European ancestry – her team is studying the biological, social, and environmental factors that might explain such differences with a particular emphasis on urban location. Diane Lauderdale works with experts in complex systems at Argonne National Laboratories, infectious disease researchers and a team of social scientists to create an agent-based model of an urban population in order to understand factors that have contributed to the recent spread of Methicillin resistant Staphylococcus aureus (MRSA) and to evaluate how effective different control strategies may be. She also focuses on the assessment of sleep in large-scale social surveys and its relationship to chronic disease. Stacy Lindau is spearheading the Chicago Southside Heath and Vitality Studies, a component of the Urban Health Initiative that is meant to generate knowledge about health and the impact of interventions to create and maintain good health. Marshall Chin is involved in several on-going research programs in diabetes outcomes and care, many in collaboration with NORC.

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