Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an "emergent characteristic " of those areas that predicts the ability of residents to obtain health care.

A core axiom of sociology is that social structure affects and is affected by human behavior. The term "social structure" conveys two quite different meanings. One meaning is relational, involving networks of ties between individuals or groups of individuals. A second meaning refers to the contexts containing these individuals. Studies of neighborhood and community effects depend on variability in both types of social structure. Using data from multiple villages in Nang Rong, Thailand, this article documents substantial variability in network structure and shows that network structure covaries with context in meaningful ways, suggesting reciprocal effects of changes in both. Finally, it considers implications of variability in network structure, showing that social cohesion affects the likelihood of finding and interviewing former village residents.A core axiom of sociology is that social structure affects and is affected by human behavior, but exactly what this means is not always clear. The term "social structure" has come to symbolize quite different aspects of the larger world in which people live. One meaning is relational, involving ties between individuals or groupings of individuals such as households. These ties may involve kinship, friendship, neighbor relations, social sup- 1 The research reported in this article was supported by grants R01-HD37896 and R01-HD25482 from the National Institute of Child Health and Human Development. We would like to thank Erika Stone and Rick O'Hara for computer programming, Tom Swasey for graphics, Kammi Schmeer for assistance with literature, and Bridget Riordan for manuscript preparation. Helpful comments on earlier versions of this article were received from

There is great differentiation in economic and social life between urban and rural China, and this appears to be negatively influencing survival chances of older adults in rural areas. The policy implications are fairly clear: Investment in rural China is needed to reduce health inequalities.

Millions of people in the United 2002a;Osteen et al. 1994;Roetzheim et al. 1999). Being uninsured also poses serious fi nancial threats to Americans, with millions carrying a large burden of debt from medical expenses ( Himmelstein et al. 2005). Although public programs-such as Medicaid and the State Children's Health Insurance Program (SCHIP)-provide health insurance to many who would otherwise not be able to afford coverage, millions are without health insurance.In this article, we argue that current research offers a limited description of health insurance coverage in the United States, especially with respect to racial disparities. More specifi cally, the literature to date does not give a sense of the duration of exposure to being uninsured over a typical lifetime, nor does it address the joint risk of being uninsured and being unhealthy. Yet, having an estimate of the duration of time that individuals typically live with these risks is essential in assessing the magnitude of the insurance-related challenges facing the United States. Moreover, having durational measures of the joint risk of being uninsured and in different health states is particularly important when examining disparities between whites and blacks because blacks are not only more likely to be uninsured but also more likely to experience adverse health events. In this study, we use a life table approach to examine racial differences in health insurance coverage in the United States by calculating health-and insurance-specifi c life expectancies for whites and blacks. These measures capture the duration of exposure to different insurance and health states during a typical lifetime. In the absence of individual data on lifetime insurance coverage, life table analysis is a valuable tool that enables us to simulate life course experiences with health insurance coverage and health. By creating measures with a focus on the lifetime exposure to the joint risks of being uninsured and less healthy, we hope not only to provide a better understanding of issues related to health insurance coverage in the United States but also to elucidate racial disparities in the current U.S. health care system. Specifi cally, we address three important questions. First, how does the proportion of time spent in different health and insurance states over the course of one year differ by age and race? Second, given current age-specifi c mortality, subjective health, and health insurance rates in the United States, how many years can individuals expect to live with different types of insurance coverage and in different health states over a typical lifetime? Third, how large are the differences between blacks and whites in the expected number of years lived in different health-specifi c insurance states? BACKGROUND

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers individual responses to be embedded within communities. Data come from the 2004 and 2006 rounds of the Chinese Health and Nutrition Survey. The study considers the functional transitions of 2,944 individuals living across 209 communities in nine Chinese provinces. Functioning is measured at baseline as being able or not being able to conduct all of the following: walking, standing, climbing stairs, lifting, kneeling. Outcomes include having or not having a functional limitation, measured the same way, dying, or not responding. Outcomes are modeled adjusted for baseline functional status. Findings indicate urbanites have substantial advantages. They are less likely to have a limitation at follow-up and less likely to die over the study period. Some of this is explained by socioeconomic indicators measured at two levels. Cross-level interactions suggest education and having insurance operate differently in urban and rural areas. Community-level indicators are somewhat less predictive, and much of the urban advantage is unexplained. In conclusion, the study suggests differences in the influences of socioeconomic indicators in China versus what has been found in the past, and that place of residence in China is a particularly robust predictor of functional health transitions.