Search

Community receptivity, a critical component in integration processes, is a place's collective response to newcomers. It is a constructed context in which the experiences of settlement and adjustment for both immigrants and non-immigrants occur. Receptivity is fluid, shaped by multi-scalar components of a community's political, economic, social, and cultural spheres. In traditional gateways, the evolving interplay of long-established forces guides receptivity. But in new gateways, front line providers that encounter the initial settlement needs of immigrants are the vanguard of constructing the broader community's warmth of immigrant welcome. This case study of three elementary schools in Charlotte, NC demonstrates the role of public schools as a site of receptivity's early construction within an emerging gateway. We argue that teachers are creating receptivity building blocks within their classrooms, guiding the construction of receptivity within their schools, among the school board, the school district, and the city as a whole. [ABSTRACT FROM AUTHOR]

The article reports on the condition of settlement of Latino immigrants, service provision and social justice in Charlotte, North Carolina. Public universities do not accept in-state applications from immigrants with undocumented status. A critical health service was withdrawn because of perceived over-utilization by Latinas. Ethinicity and immigrant status are added to deny both intentionally and unintentionally service and access to opportunity.

In keeping with calls for gentrification research to show greater sensitivity to contextuality, this article uses Charlotte, North Carolina as a case study to illustrate a geography of gentrification in which motivations to gentrify and stage trajectories do not quite fit traditional expectations. In this mid-sized Southern city, gentrification was first introduced in the early 1970s when corporate leaders recognized the importance of revitalizing central city space in a manner that would enhance their corporate identity and advance their strategic goals. Early stage gentrification in Charlotte was characterized by the production of gentrifiable space in one of the city's most deteriorated districts, the absence of marginal gentrifiers and traditional urban pioneers, unconventional profit motives, and significant deviations from traditional stage theory. Beyond providing an analysis of gentrification at a level of the urban hierarchy (and in a region) that has long been overlooked, the article contributes a critical and contextual perspective to our understanding of gentrification's causality and process. [ABSTRACT FROM AUTHOR]

Over the past decade, Charlotte, North Carolina has been socially and economically transformed by incipient Latino migration. Labeled one of the nation's Hispanic ''hyper-growth'' cities, Charlotte may be seen as illustrative of the new Latino immigrant and settlement geographies. Traditional models of immigrant settlement in central city neighborhoods have not been followed here. Latino migrants to this new south city have moved directly to maturing suburbs at a distance from both the urban core and its sprawling fringe. The availability of apartment style rental housing is an important factor steering residential choice. Ethnic self-selectivity in housing location and the social reproduction of place among maledominated immigrant streams may also play a role. As Charlotte's Latino population grows and matures, the development of expansive, suburban enclaves seems plausible. [ABSTRACT FROM AUTHOR]

Hispanic immigrant communities across the U.S. experience persistent health disparities and barriers to primary care. We examined whether community-based participatory research (CBPR) and geospatial modeling could systematically and reproducibly pinpoint neighborhoods in Charlotte, North Carolina with large proportions of Hispanic immigrants who were at-risk for poor health outcomes and health disparities. Using a CBPR framework, we identified 21 social determinants of health measures and developed a geospatial model from a subset of those measures to identify neighborhoods with large proportions of Hispanic immigrant populations at risk for poor health outcomes. The geospatial model included four measures-poverty, English ability, acculturation and violent crime-which comprised our Hispanic Health Risk Index (HHRI). We developed a Primary Care Barrier Index (PCBI) to determine (1) how well the HHRI correlated with a statistically derived composite measure incorporating all 21 measures identified through the CBPR process as being associated with access to primary care; (2) whether the HHRI predicted primary care access as well as the statistically-derived composite measure in a statistical model; and (3) whether the HHRI identified similar neighborhoods as the statistically derived composite measure. We collapsed 17 of the 21 social determinants using principal components analysis to develop the PCBI. We determined the correlation of each index with inappropriate emergency department (ED) visits, a proxy for primary care access, using logistic generalized estimating equations. Results from logistic regression models showed positive associations of both the HHRI and the PCBI with the use of the ED for primary care treatable conditions. Enhanced by the knowledge of the local community, the CBPR process with geospatial modeling can guide the multi-tiered validation of social determinants of health and identify neighborhoods that are at-risk for poor health outcomes and health disparities.

Hispanic populations experience disparities in health outcomes and health care. Using participatory methods, we evaluated 4 systems of primary care delivery for an uninsured Hispanic population. Best practices were determined that could be translated back to the partner clinics and the community. The assessment included patient service areas, provider discussion groups, patient surveys, calculation of travel distances, and costs. The following best practices were identified: improved proximity to services, enhanced bilingual services, affordable services, and integrated services. Researchers and providers not only identified translatable service delivery practices but also laid the foundation for ongoing research partnerships.

Background: Individual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants., Methods/design: This project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services., Discussion: The results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.

Background: The Charlotte-Mecklenburg region has one of the fastest growing Hispanic communities in the country. This population has experienced disparities in health outcomes and diminished ability to access healthcare services. This city is home to an established practice-based research network (PBRN) that includes community representatives, health services researchers, and primary care providers. The aims of this project are: to use key principles of community-based participatory research (CBPR) within a practice-based research network (PBRN) to identify a single disease or condition that negatively affects the Charlotte Hispanic community; to develop a community-based intervention that positively impacts the chosen condition and improves overall community health; and to disseminate findings to all stakeholders., Methods/design: This project is designed as CBPR. The CBPR process creates new social networks and connections between participants that can potentially alter patterns of healthcare utilization and other health-related behaviors. The first step is the development of equitable partnerships between community representatives, providers, and researchers. This process is central to the CBPR process and will occur at three levels -- community members trained as researchers and outreach workers, a community advisory board (CAB), and a community forum. Qualitative data on health issues facing the community -- and possible solutions -- will be collected at all three levels through focus groups, key informant interviews and surveys. The CAB will meet monthly to guide the project and oversee data collection, data analysis, participant recruitment, implementation of the community forum, and intervention deployment. The selection of the health condition and framework for the intervention will occur at the level of a community-wide forum. Outcomes of the study will be measured using indicators developed by the participants as well as geospatial modeling.On completion, this study will: determine the feasibility of the CBPR process to design interventions; demonstrate the feasibility of geographic models to monitor CBPR-derived interventions; and further establish mechanisms for implementation of the CBPR framework within a PBRN.

Background: Hispanics are the largest and fastest growing minority group in the United States. Charlotte, NC, had the 4th fastest growing Hispanic community in the nation between 1990 to 2000. Gaining understanding of the patterns of health care use for this changing population is a key step toward designing improved primary care access and community health., Methods: The Multiple Attribute Primary Care Targeting Strategy process was applied to key patient- and community-level attributes describing the Charlotte Hispanic community. Maps were created based on socioeconomic status, population density, insurance status, and use of the emergency department as a primary care safety net. Each of these variables was weighed and added to create a single composite map., Results: Individual attribute maps and the composite map identified geographic locations where Hispanic community members would most benefit from increased access to primary care services., Conclusions: Using the Multiple Attribute Primary Care Targeting Strategy process we were able to identify geographic areas within our community where many Hispanic immigrants face barriers to accessing appropriate primary care services. These areas can subsequently be targeted for interventions that improve access to primary care and reduce emergency department use. The geospatial model created through this process can be monitored over time to determine the effectiveness of these interventions.