The past decade has seen a surge of interest in the walkable neighborhood, motivated by environmental, health, economic, and communitarian goals. We take stock of this literature by linking together the various strands of research in which the "walkable neighborhood" is a primary concern. We organize the literature into three broad categories: measurement, criticism, and tests of the benefits of walkable neighborhoods. The latter category involves three primary claims. We find that claims about social impacts are the weakest in terms of research support, in part, because there continues to be a problem of self-selection and an inability to assign causality.

Social science research, public and private sector decisions, and allocations of federal resources often rely on data from the American Community Survey (ACS). However, this critical data source has high uncertainty in some of its most frequently used estimates. Using 2006-2010 ACS median household income estimates at the census tract scale as a test case, we explore spatial and nonspatial patterns in ACS estimate quality. We find that spatial patterns of uncertainty in the northern United States differ from those in the southern United States, and they are also different in suburbs than in urban cores. In both cases, uncertainty is lower in the former than the latter. In addition, uncertainty is higher in areas with lower incomes. We use a series of multivariate spatial regression models to describe the patterns of association between uncertainty in estimates and economic, demographic, and geographic factors, controlling for the number of responses. We find that these demographic and geographic patterns in estimate quality persist even after we account for the number of responses. Our results indicate that data quality varies across places, making cross-sectional analysis both within and across regions less reliable. Finally, we present advice for data users and potential solutions to the challenges identified.

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Three new contributions are added to the literature on subsidized rental housing impacts on nearby property values: (1) a primary focus on the spatial heterogeneity of these effects that warrants caution regarding citywide results, (2) an analysis by zoning area, and (3) a comparison of impacts with unsubsidized apartments. An adjusted-interrupted time-series (difference-indifference) model is estimated with a comprehensive data set for Seattle, Washington (1987-1997. Contrary to not in my backyard (NIMBY) expectations, the predominant impact is an upgrading effect of lower-value areas. However, spillover effects are very sensitive to how data are pooled across space: the citywide upgrading effects are driven by poorer pockets adjacent to affluent areas with no or small effects in more diverse low-and medium-income areas. They only occur in single-family, not multifamily zones. The only negative effects were associated with vouchers in one of the affluent areas. Impacts of unsubsidized rentals are very similar to those of subsidized ones, suggesting an independent effect beyond subsidy status. These findings are explained with Seattle's dispersion and good neighbor policies, with gentrification pressures as a possible alternative explanation. Site visits confirmed the location of subsidized sites in lower-value areas and the higher maintenance quality of subsidized units compared to neighboring unsubsidized units.

BackgroundAdmissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance) are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates.ResultsWe examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas.ConclusionThe relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly who reside in sprawling urban areas have access impediments about equal to residents of poor rural communities is new, and demonstrates the value of conceptualizing and modelling impedance based on place and local context.

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Objective To determine whether Medicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee-for-service (FFS) Medicare population during 2001–2006. Methods We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county-area utilization rates over two time intervals (2001–2003–2004–2006) following Medicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross-sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. Results Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS Medicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology.