This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non‐White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non‐White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long‐term care programs.

Despite being newcomers, immigrants often exhibit better health relative to native-born populations in industrialized societies. We extend prior efforts to identify whether self-selection and/or protection explain this advantage. We examine migrant height and smoking levels just prior to immigration to test for self-selection; and we analyze smoking behavior since immigration, controlling for self-selection, to assess protection. We study individuals aged 20–49 from five major national origins: India, China, the Philippines, Mexico, and the Dominican Republic. To assess self-selection, we compare migrants, interviewed in the National Health and Interview Surveys (NHIS), with nonmigrant peers in sending nations, interviewed in the World Health Surveys. To test for protection, we contrast migrants’ changes in smoking since immigration with two counterfactuals: (1) rates that immigrants would have exhibited had they adopted the behavior of U.S.-born non-Hispanic whites in the NHIS (full —assimilation ); and (2) rates that migrants would have had if they had adopted the rates of nonmigrants in sending countries (no-migration scenario). We find statistically significant and substantial self-selection, particularly among men from both higher-skilled (Indians and Filipinos in height, Chinese in smoking) and lower-skilled (Mexican) undocumented pools. We also find significant and substantial protection in smoking among immigrant groups with stronger relative social capital (Mexicans and Dominicans).

Recent studies of migration and the left-behind have found that elders with migrant children actually experience better health outcomes than those with no migrant children, yet these studies raise many concerns about self-selection. Using three rounds of panel survey data from the Indonesian Family Life Survey, we employ the counterfactual framework developed by Rosenbaum and Rubin to examine the relationship between having a migrant child and the health of elders aged 50 and older, as measured by activities of daily living (ADL), self-rated health (SRH), and mortality. As in earlier studies, we find a positive association between old-age health and children's migration, an effect that is partly explained by an individual's propensity to have migrant children. Positive impacts of migration are much greater among elders with a high propensity to have migrant children than among those with low propensity. We note that migration is one of the single greatest sources of health disparity among the elders in our study population, and point to the need for research and policy aimed at broadening the benefits of migration to better improve health systems rather than individual health.

Reed Beall and Randall Kuhn describe their findings from an analysis of use of compulsory licenses for pharmaceutical products by World Trade Organization members since 1995.

Administrative data on public shelter utilization among homeless adults from New York City (1987–1994) and Philadelphia (1991–1994) are analyzed to identify the relative proportion of shelter users by length of stay and rate of readmission, and to identify the characteristics that predict an exit from shelter. Survival analyses reveal that half of adult shelter users will stay fewer than 45 days over a two‐year period (combined stays), and that approximately one half of men and one third of women will experience a readmission within two years of the first admission. Results also document the size and relative resource consumption of a long‐term sheltered population, finding that 18.2 percent of New York shelter users stay 180 days or more in their first year, consuming 53.4 percent of the system days for first‐time shelter users. Discrete‐time logistic hazard regression analyses reveal that, in general, being older, of black race, having a substance abuse or mental health problem, or having a physical disability, significantly reduces the likelihood of exiting shelter. In both cities, people entering shelter in later years are staying longer, although individuals have shorter episodes on subsequent admissions. The implications of this study for the analysis and management of emergency shelter system utilization are discussed.