Publications by Author

Gunnar Almgren

Research

Almgren, G., (Forthcoming), Demographics: An Overview, Encyclopedia of social work.

An abstract for this article is not available.

Almgren, G., (2007). Health care politics, policy, and services: a social justice analysis, Springer Publishing Company, New York.

Who has a right to health care? How can the idea of Social Justice inform health care? What are the roles of government and personal responsibility toward providing health care? Can we reform the U.S. health care system? These issues are often debated in health care policy or public health courses, yet without the proper knowledge of the true structure of the U.S. health care system or the various social justice models that can inform change. According to the President's New Freedom Commission, our social and public health workers are ill-prepared to address the issues faced in direct healthcare practice, precisely because they are under informed in these areas. In this innovative text, accessible to those in health care policy, social work, public policy, nursing, or public administration, the author provides all the tools necessary to launch a successful attack on what most see as an inadequate health care policy.

Bell, J. F.; Zimmerman, F. J.; Mayer, J. D.; Almgren, G. R.; Huebner, C. E., (2007). Associations between residential segregation and smoking during pregnancy among urban African-American women, Journal of Urban Health :Bulletin of the New York Academy of Medicine, 84(3), 372.

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n?=?403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Bell, J, Zimmerman, F. and Almgren, G. (2006). Birth Outcomes among Urban African-American Women: A Multilevel Analysis of the Role of Racial Residential Segregation. Social Science & Medicine, 63(12), 3030.

Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. Declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies.

Almgren, G. (2005). The Ecological Context of Interpersonal Violence: From Culture to Collective Efficacy. Journal of Interpersonal Violence, 20(2), 218-224.

This brief essay outlines the progression over the last 20 years of ecological theories of interpersonal violence. The period between the present and the early 1980s began with a revival of cultural explanations of violence that paralleled the introduction of the neo-conservative social science and then witnessed a rediscovery of deficitsbased structural explanations of interpersonal violence under the broad rubric of social disorganization theory. The essay concludes with a more optimistic appraisal of recent refinements of social disorganization theory that consider the mediating effects of collective efficacy on urban crime and interpersonal violence.

Lorella Palazzo , Avery Guest, and Gunnar Almgren. (2003). "Economic Distress and Cause of Death Patterns for Black and Non-black Men in Chicago, 1990: Reconsidering the Relevance of Classic Epidemiological Theory. Social Biology, 50(1), 102-125.

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Almgren G., Yamashiro G, and Ferguson M. (2002) Beyond Welfare or Work: Teen Mothers, Household Subsistence Strategies, and Child Development Outcomes. Journal of Sociology and Social Welfare, 29(3), 125-149.

There is probably no aspect of the work versus welfare debate that is more contested than the effects of welfare use on child development outcomes. Liberals tend to emphasize the detrimental effects of poverty and welfare stigma on children, while conservatives cite the negative socialization that occurs regarding the value of work within welfare dependent families. However, large scale longitudinal studies that have been used to address this question only indirectly measure critical influences on child development such as maternal mental health and do not consider the effect that a range of economic strategies that low-income mothers might undertake may have on their children. In this analysis, we employ data from a longitudinal study of 173 teen-mothers to assess the relative effects of maternal characteristics and economic strategies on the developmental outcomes of their children at time of school entry. Two principal findings emerge. First, over the period from their first teen birth to the reference child's entry into school, the sample subjects used a variety of household economic strategies aside from the simple welfare versus work dichotomy that is commonly used to depict the choices of teen-mothers. Second, while maternal depression appears linked to the prevalence of problem behaviors in early childhood, the particular economic strategies used by the mothers in the sample do not explain any variation in either the prevalence of problem behaviors or in children's learning preparation for school entry. These findings support the perspective that the influence of teen mothers' parenting qualities on child development cannot be assessed through an analysis of their labor force participation, use of welfare, or other strategies of household subsistence.

Almgren G and Marcenko, M. (2001). Emergency Room Use Among A Foster Care Sample: The Influence of Placement History, Psychiatric Diagnosis, Chronic Illness and Care Factors. Brief Treatment and Crisis Intervention Journal, 1(1).

Despite the physical, mental, and social health risks of foster children, relatively little attention has been paid to how they interact with emergency medicine. To address the need for more empirical research on this topic, we tested whether demographic characteristics, chronic health conditions, psychiatric disorders, and placement factors predicted ER use among children in Washington State's foster care system in fiscal year 1999. Medicaid claim records and Child Welfare administrative records for 8,716 children were used to extract data on the dependent variables of interest. Contrary to findings with general pediatric samples, the results showed that psychiatric conditions were the strongest predictors of ER use, followed by some chronic health problems. Children diagnosed with personality disorders or depression were 9.5 and 5.4 times more likely to be seen in the ER than children without a psychiatric diagnosis. Possible explanations for these findings are explored and implications for the health care and child welfare systems are discussed.

Kemp S., Almgren G., Gilchrist L and Eisinger A. (2001). Serving "the Whole Child": Prevention Practice and the U.S. Children's Bureau. Smith College Studies in Social Work, June, 475-499.

Social work's early contributions in the domain of prevention are explored through an examination of the United States Children's Bureau campaign to prevent infant mortality in the first quarter of the twentieth century. The article brings into sharper focus the distinctive amalgam of ideology, research, and practice activities at the core of the Children's Bureau prevention paradigm, and presents evidence for the effectiveness of this approach in preventing infant mortality. In conclusion, the implications of this contribution and its legacy are discussed in relation to the shape and direction of social work's investments in contemporary prevention science. At the beginning of this century, as at the beginning of the last, there is increasing interest in prevention as a focus of social work practice and research (Bloom, 1996; Fraser, 1997; Smokowski, 1998; Whittaker, 1996). Social work's rich legacy in prevention practice is however largely overlooked in current prevention discourse. As the profession positions itself as a core discipline in contemporary prevention science, it is both timely and instructive to revisit this legacy, which encompasses prevention as both a philosophy of practice and an empirically driven approach to intervention.

Almgren G, Kemp S, and Eisinger A. (2000). The Legacy of Hull House and the Children's Bureau in the American Mortality Transition. Social Service Review, 74 (1).

The major advances in American life expectancy achieved during the twentieth century began with the remarkable decline in infant mortality between 1910 and 1930. Until the 1990s, explanations of this demographic event centered on improvements in nutrition, public health, and medical science. Recent causal reappraisals emphasize the importance of changes in household-level health behaviors in reducing infant deaths, changes that are consistent with the maternal education campaigns engineered by Progressive Era reformers at the U.S. Children's Bureau. Through qualitative and quantitative analyses of bureau reports and Public Use Micro Sample census data, we link the reformers' philosophy and science to new evidence and conclusions about early improvements in infant survival.

Avery Guest and Gunnar Almgren. (2000). "Demographic Transition". The Encyclopedia of Sociology, Second Edition. Borgatta, Edgar and Rhonda Montgomery (eds.). New York: Macmillan.

The abstract for this article is not available.

Gunnar Almgren. "Community". (2000). The Encyclopedia of Sociology, Second Edition. Borgatta, Edgar and Rhonda Montgomery(eds.). New York: Macmillan.

The abstract for this article is not available.

Almgren G and Ferguson M. (1999). The Urban Ecology of Hospital Failure: Hospital Closures in the City of Chicago, 1970-1991. Journal of Sociology and Social Welfare, 25(4).

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Almgren G, Guest A, Immerwahr G and Spittel M. (1998) Joblessness, Family Disruption, and Violent Death in Chicago 1970-1990. Social Forces, 76 (4).

Violent deaths, defined as homicides, suicides, and accidents, are leading causes of death among working-age populations. While large-scale population studies and community case studies have established common linkages between race, sex, age, joblessness, and all three forms of violent death, they have tended to be cross-sectional and to be focused on one cause of violent death to the exclusion of others. Utilizing 1970 and 1990 census data and vital records for 75 Chicago community areas, this article examines the relationships between joblessness, family disruption, and all three forms of violent death across the black and nonblack community-area populations of Chicago at two distinct time points corresponding to William Julius Wilson's theory of the evolution of urban underclass communities. The findings suggest that both homicide rates and accidental death rates are similarly predicted by high rates of joblessness and family disruption, and that these relationships have strengthened in both black and nonblack communities over time. Variations in racial segregation among black community-area populations appeared to have no consistent direct effects on black rates of violent death. We also found that, contrary to historical patterns, suicide rates for young adult black males and young adult nonblack males appear similarly responsive to a secular decline in the economic opportunity structure. Finally, through the use of multiple- decrement life-table analysis techniques across racial communities, we observed a growth trend in the racial disparities between life expectancies of black and nonblack populations that is linked to relative levels of joblessness.

Guest A, Almgren G, and Hussey J. (1998). The Ecology of Socio-economic Distress: Infant and Working Age Mortality in Chicago. Demography, 35(1).

We examine the effects of education, unemployment, and racial segregation on age-, sex-, and race-specific mortality rates in racially defined Chicago community areas from 1989 to 1991. Community socioeconomic factors account for large observed areal variations in infant and working-age mortality, but especially working-age mortality for the black population. For black men, the mortality consequences of living in economically distressed communities are quite severe. Segregation effects on mortality are more modest and largely operate through neighborhood socioeconomic conditions, although some direct effects of segregation on mortality for blacks are apparent. Almgren G.(1992). Overpopulation in India and the Educational Imperative: A Theoretical Critique. Social Service Review, 66(2). The abstract for this article is not available.