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PubMedDate not supplied

Welfare reform: loss of supplemental security income (SSI) for children with disabilities.

PURPOSE: To describe the changes the new welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, makes in children's eligibility for Supplemental Security Income (SSI) and the implications of the changes for low-income children with disabilities and their families. POPULATION: Low-income children and youth, 18 years of age and younger, who have one or more limitations in physical or mental function in performing age-appropriate skills. CONCLUSIONS: The tightened federal standards for determining whether children are disabled place thousands of children at risk for losing SSI cash benefits. This loss of necessary financial support has the potential to adversely affect the physical and psychological health of low-income children with disabilities and their families. The new law represents a step backward from the long awaited gains the 1990 Zebley v. Sullivan U. S. Supreme Court decision legislated for children with disabilities. PRACTICE IMPLICATIONS: Knowledge of the legal changes in children's SSI enables nurses to implement interventions that help low-income families maintain SSI eligibility for their children with disabilities and to advocate with the public and policymakers on behalf of this vulnerable population.

Child↗
PubMed2005

Title VII funding and physician practice in rural or low-income areas.

CONTEXT: Whether Title VII funding enhances physician supply in underserved areas has not clearly been established. PURPOSE: To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities. METHODS: A retrospective cross sectional analysis was carried out using the 2000 American Academy of Family Physicians physician database, Title VII funding records, and 1990 U.S. Census data. Included were 9,107 family physicians practicing in 9 nationally representative states in the year 2000. FINDINGS: Physicians exposed to Title VII funding through medical school and residency were more likely to have their current practice in low-income communities (11.9% vs 9.9%, P< or =.02) and rural areas (24.5% vs 21.8%, P< or =.02). Physicians were more likely to practice in rural communities if they attended medical schools (24.2% vs 21.4%; P =.009) and residencies (24.0% vs 20.3%; P =.011) after the school or program had at least 5 years of Title VII funding vs before. Similar increases were not observed for practice in low-income communities. In a multivariate analysis, exposure to funding and attending an institution with more years of funding independently increased the odds of practicing in rural or low-income communities. CONCLUSIONS: Title VII funding is associated with an increase in the family physician workforce in rural and low-income communities. This effect is temporally related to initiation of funding and independently associated with effect in a multivariate analysis, suggesting a potential causal relationship. Whereas the absolute 2% increase in family physicians in these underserved communities may seem modest, it can represent a substantial increase in access to health care for community members.

Career Choice↗
PubMed2004

Residence, income and cancer hospitalizations in British Columbia during a decade of policy change.

BACKGROUND: Through the 1990s, governments across Canada shifted health care funding allocation and organizational foci toward a community-based population health model. Major concerns of reform based on this model include ensuring equitable access to health and health care, and enhancing preventive and community-based resources for care. Reforms may act differentially relative to specific conditions and services, including those geared to chronic versus acute conditions. The present study therefore focuses on health service utilization, specifically cancer hospitalizations, in British Columbia during a decade of health system reform. METHODS: Data were drawn from the British Columbia Linked Health Data resource; income measures were derived from Statistics Canada 1996 Census public use enumeration area income files. Records with a discharge (separation) date between 1 January 1991 and 31 December 1998 were selected. All hospitalizations with ICD-9 codes 140 through 208 (except skin cancer, code 173) as principal diagnosis were included. Specific cancers analyzed include lung; colorectal; female breast; and prostate. Hospitalizations were examined in total (all separations), and as divided into first and all other hospitalizations attributed to any given individual. Annual trends in age-sex adjusted rates were analyzed by joinpoint regression; longitudinal multivariate analyses assessing association of residence and income with hospitalizations utilized generalised estimating equations. Results are evaluated in relation to cancer incidence trends, health policy reform and access to care. RESULTS: Age-sex adjusted hospitalization rates for all separations for all cancers, and lung, breast and prostate cancers, decreased significantly over the study period; colorectal cancer separations did not change significantly. Rates for first and other hospitalizations remained stationary or gradually declined over the study period. Area of residence and income were not significantly associated with first hospitalizations; effects were less consistent for all and other hospitalizations. No interactions were observed for any category of separations. CONCLUSIONS: No discontinuities were observed with respect to total hospitalizations that could be associated temporally with health policy reform; observed changes were primarily gradual. These results do not indicate whether equity was present prior to health care reform. However, findings concur with previous reports indicating no change in access to health care across income or residence consequent on health care reform.

Journal Article↗
PubMed1998

Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer.

PURPOSE: Diagnosis of advanced prostate cancer is a major health problem, especially among low-income men. Opportunities vary for early detection of prostate cancer for low-income black and white men because of financial, cultural, and social factors. In this study, we evaluated the association of poor literacy skills with higher rates of presentation of advanced stages of prostate cancer among low-income black and white men who received care in equal-access medical systems. PATIENTS AND METHODS: Literacy and stage at diagnosis of prostate cancer were evaluated in 212 low-income men who received medical care in Shreveport, LA, and Chicago, IL. The patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading screening test designed specifically for use in the medical setting. Logistic regression models were used to evaluate predictors of metastatic disease at presentation as a function of patient age, race, literacy, and city. RESULTS: Whereas black men were almost twice as likely to present with stage D prostate cancer (49.5% v 35.9%; P < .05), they were significantly more likely to have literacy levels less than sixth grade (52.3% v 8.7%; P < .001). However, after adjustment for differences in literacy, age, and city, race was not a significant predictor of advanced-stage prostate cancer. CONCLUSION: Low literacy may be an overlooked but significant barrier to the diagnosis of early-stage prostate cancer among low-income white and black men. The development of culturally sensitive, low-literacy educational materials may improve patient awareness of prostate cancer and improve the frequency of diagnosis of early-stage cancer.

Adult↗
PubMed1997

Prenatal care for low-income women and the health belief model: a new beginning.

Low-income women are among those at risk for delivering low-birth-weight babies (Lia-Hoagberg et al., 1990; Miller, Magolis, Schwethelm, & Smith, 1989; St. Clair, Smeriglio, Alexander, Connell, & Niebyl, 1990). These women tend to use prenatal care less often, perceive more barriers to care, have less positive reinforcement for receiving care, have less access to care, have lower education levels, maintain less healthy lifestyles, and have lower compliance with recommendations (Henderson, 1994; Koska, 1990; Lia-Hoagberg et al., 1990; Miller et al., 1989). This article will highlight three attributes of the problem of low-income women and prenatal care. First, low-income pregnant women are at risk for delivering low-birth-weight and preterm babies, which usually leads to expensive subsequent care. Second, an unhealthy maternal lifestyle increases the risk of delivering a low-birth-weight or preterm baby. Third, there are social, programming, and lifestyle barriers that low-income women face in receiving prenatal care. Finally, this article examines the use of the Health Belief Model as a theoretical basis for future prenatal care programming for low-income women.

Attitude to Health↗
PubMed1997

Infant feeding practices of low-income African American women in a central city community.

It is a well-established fact that nutrition is central to the growth and development of all infants. Yet it has been observed that health care professionals are frequently unfamiliar with the most typical infant feeding practices of the clients within the communities they attempt to serve. This observation was apparent during the development of a program in an inner-city community of Wisconsin to support the feeding practices of low-income African American women with low-birth-weight infants. As a result of initial encounters with prospective clients and health care and social service professionals from the targeted community, it was apparent that professionals and staff involved in this project needed to gain an understanding of common infant feeding practices of low-income African American women; a greater awareness of the values, beliefs, and health care practices of the population; and a greater understanding of the impact of poverty on the families within the targeted community. To assist the staff in gaining a better understanding of the influence of culture and economics on infant feeding practices, a study of the infant feeding practices of a select group of low-income African American women was undertaken. The study aimed to (a) gather information that could be used to describe common infant feeding practices of low-income African American women in an inner-city community of Wisconsin and (b) determine the influence of cultural and economic variables on the decisions made by low-income African American women regarding infant feeding. This article presents an analysis and summary of the data collected during the course of the study.

Adult↗
PubMed2000

Health promotion and senior women with limited incomes.

Health promotion is increasingly being recognized as making an important contribution to the well-being of Canada's seniors. Most research relating to this topic, however, has focused on middle-income senior men and women. An exploratory study using ethnographic methods was conducted to explore and describe the health promotion experience of senior women living on limited incomes. Interviews with a total of 11 urban senior women living on limited incomes were analyzed. A major finding of this study was that the women utilized a wide variety of "ways of living" that are presented in the model, Health Promotion as Self Nurturance. Health promotion was perceived to be influenced by living on a limited income by most participants; however, 3 of the participants believed that their health status and income level were unrelated. Findings are discussed and implications for community health nurses are offered.

Aged↗
PubMed2006

Pedometer-determined physical activity among multiethnic low-income housing residents.

PURPOSE: We sought to characterize pedometer-determined physical activity among a predominantly racial and ethnic minority sample of adults residing in low-income housing. METHODS: Data were collected from 433 participants at baseline in a randomized colon cancer prevention intervention trial conducted within low-income housing communities. Using random effects models to control for clustering within housing sites, we examined variation in daily steps by several sociodemographic characteristics. RESULTS: Participants recorded a mean of 5326 (+/- 3871 SD) daily steps over a 5-d sampling period. Significantly lower levels of pedometer-determined physical activity were found among older-aged participants (P < 0.0001), women (P = 0.02), those who were overweight and obese (P = 0.03), those reporting no weekly exercise (P = 0.04), as well as among nonworking individuals (P < 0.0001). No significant differences were found by education or income. In multivariable analyses, age, gender, body mass index, and employment status remained significantly associated with steps. CONCLUSIONS: These findings suggest a high prevalence of physical inactivity among low-income housing residents. These data, derived from a well-characterized sample, provide useful estimates for the investigation of pedometers as measures of total accumulated physical activity among lower-income, racial and ethnic minority populations.

Adult↗
PubMed2001

Stress and illness in low-income women: the roles of hardiness, John Henryism, and race.

This study examines the stress-illness relationship in a biracial group (African-American and Caucasian-American) of low-income women. Two personality constructs, hardiness and John Henryism, were studied for their possible moderating influences on the stress-illness relationship. One hundred women, with family incomes below the poverty line, completed questionnaires of stress, illness, hardiness, and John Henryism. Hierarchical regression models indicated that hardiness moderated the stress-illness relationship, with high stress, low hardy women having higher levels of illness. In addition, race also moderated the effect of stress, with high stress, Caucasian women having higher levels of illness. However, John Henryism had no effect on stress-related illness in these low-income women. Analyses of additional stress measures indicated that hardy women perceive their external environments as less stressful, although high and low hardy women have similar levels of network stress. Correlational analyses indicated that life-event stress, network stress and low-income concerns were all associated with illness scores. Thus, a range of stress measures are linked to physical illness in low-income women; furthermore, hardiness and being African-American both buffered the effects of stress on illness.

Adaptation, Psychological↗
PubMed2005

Health-related quality-of-life in low-income, uninsured men with prostate cancer.

The objective was to describe health-related quality-of-life (HRQOL) in low-income men with prostate cancer. Subjects were drawn from a statewide public assistance prostate cancer program. Telephone and mail surveys included the RAND 12-item Health Survey and UCLA Prostate Cancer Index Short Form and were compared with normative age-matched men without cancer from the general population reported on in the literature. Of 286 eligible men, 233 (81%) agreed to participate and completed the necessary items. The sample consisted of 51% Hispanics, 23% non-Hispanic whites, and 17% African Americans. The low-income men had worse scores in every domain of prostate-specific and general HRQOL than had the age-matched general population controls. The degree of disparity indicated substantial clinical differences in almost every domain of physical and emotional functioning between the sample group and the control group. Linear regression modeling determined that among the low-income men, Hispanic race, and income level were predictive of worse physical functioning, whereas only comorbidities predicted mental health. Low-income patients with prostate cancer appear to have quality-of-life profiles that are meaningfully worse than age-matched men from the general population without cancer reported on in the literature.

Adaptation, Psychological↗
PubMedDate not supplied

Insuring low-income adults: does public coverage crowd out private?

During the mid-1990s Minnesota, Washington State, Oregon, and Tennessee implemented programs to provide subsidized health insurance for low-income persons who were not previously eligible for Medicaid. We estimate the effects of these programs on the health insurance status of low-income adults in these states. We find that among persons with family incomes below 100 percent of the federal poverty level, subsidized public coverage reduced the number of uninsured persons with very little effect on private coverage rates. Among persons with income between 100 percent and 200 percent of FPL, public coverage reduced the number of uninsured persons and crowded out some private insurance. The partial successes achieved by these programs should be kept in perspective: Even after program implementation, approximately 30 percent of low-income adults in the four states were uninsured.

Adult↗
PubMed2004

Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996.

BACKGROUND: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical cancer mortality diminished from 1971 to 1996. METHODS: Death registration data for Canada's census metropolitan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff values. We compared age-standardized death rates (using the 1966 world population standard) in the female population (excluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and interquintile rate differences (poorest minus richest). RESULTS: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5-5.6) to 1.9 (1.7-2.1), the interquintile rate ratio diminished from 2.7 (1.8-4.2) to 1.7 (1.1- 2.6), and the interquintile rate difference decreased from 4.6 (2.8- 6.4) to 1.1 (0.2-1.9). INTERPRETATION: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementation of effective screening programs.

Adult↗
PubMed2001

Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics.

OBJECTIVE: Anxiety disorders appear to influence morbidity and medical utilization. However, little is known about the relationship between Generalized Anxiety Disorder, quality of life, and medical utilization, especially among low-income patients. The goals of this investigation were to 1) determine if low-income patients with GAD utilize medical services more than patients with other Axis I diagnoses, or no psychopathology, and 2) compare the health-related quality of life of these three groups. METHOD: Participants were randomly recruited from public primary care clinics and administered intake assessments of demographics, stress, and health-related self-report questionnaires. At the end of the first year a structured psychiatric interview was administered (N = 431). Over the second year, patients (n = 360) were administered a health-related quality of life measure every three months for four assessments. Medical charts were abstracted to collect information about chronic illnesses and visits to outpatient clinics and the emergency department during the two years. RESULTS: Patients were predominantly middle-aged, low-income, uninsured African-American females. In this low-income sample, patients with GAD utilized the emergency department more and reported poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. CONCLUSION: Low-income patients with GAD utilize the emergency department more and report poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Programs to identify and treat patients with GAD may yield improvements in quality of life, as well as reduce emergency department utilization.

Black or African American↗
PubMed1997

The relationship between low family income and psychological disturbance in young children: an Australian longitudinal study.

OBJECTIVE: This study examines the relationship between low family income (LFI) experienced at different points in time, chronic low income status and its impact on child behaviour measured at 5 years of age. METHOD: Longitudinal data from the Mater University Study of Pregnancy were used to measure LFI in families at three points in time (the antenatal period, 6 months post birth and at 5 years cf age). Outcome variables were three independent groups of behaviour problems labelled as externalising, social, attentional and thought (SAT) problems, and internalising problems. These groups were developed from the Child Behaviour Checklist. An analysis based on logistic regression modelling was carried out examining the relationship between LFI and a range of intermediate variables known to be associated with child behaviour problems. RESULTS: The more often families experienced low income, the higher the rate of child behaviour problems at age 5. Low family income was still independently associated with SAT behaviour problems after controlling for smoking in the first trimester, parenting styles, maternal depression and marital dysharmony at age 5. The association between LFI and internalising and externalising behaviour problems was largely mediated by maternal depression. CONCLUSION: Low family income is a significant factor in the aetiology of a variety of child behaviour problems. The mechanisms involved in the link between LFI and childhood internalising and externalising behaviours involve the exposure of the children to maternal depression. However, the relationship between LFI and SAT behaviour problems remains to be elucidated.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Acceptability of computer assessments among ethnically diverse, low-income smokers.

PURPOSE: To examine the acceptability of computer-based assessments among an ethnically diverse, low-income population of primary care patients. Although computers have been used to provide assessments and interventions in health care settings, members of ethnic minority and low-income households have less access to computers than other groups, and therefore the acceptability of computers as a health care assessment and delivery tool needs to be examined. DESIGN: We examined the acceptability of computers for providing assessments of smoking history, nicotine dependence, and other related variables among an ethnically diverse, low-income primary care population. No intervention was used in this study. SETTING: Three inner-city primary care clinics located in hospitals were used as sites for this study. These hospitals were located in areas of the city where low-income and ethnic minority households are overrepresented relative to the total population. SUBJECTS: Adult male and female smokers (n = 522) were recruited while awaiting appointments in each primary care clinic. MEASURES: A questionnaire assessing smoking rate, patterns, history, motivation to quit smoking, and other smoking-related variables was administered using either a paper-and-pencil format or a laptop computer. RESULTS: Frequency counts, analysis of variance, and chi 2 tests were used where appropriate. Most subjects (78.5%) used the computer to complete the baseline survey. Almost all subjects (92%) rated the computer "very easy" or "easy" to use. Subjects who were Spanish-speaking, were born outside the United States, or were Hispanic tended to rate the program as slightly less easy to use than other subjects. CONCLUSIONS: Computer-based assessments appear highly acceptable to individuals in low-income populations.

Adult↗
PubMedDate not supplied

Assuring access to dental care for low-income families in North Carolina. The NC Institute of Medicine Task Force Study.

Following publication of the Task Force's recommendations for improving dental care access among low-income populations, North Carolina has taken several steps forward. The Division of Medical Assistance and the NC Dental Society are forming an advisory committee (comprising Medicaid patients, providers, and representatives from all elements of organized dentistry in the state) to review dental coverage and reimbursement rates. Using existing state funds, the NC Office of Research, Demonstrations and Rural Health Development has recruited 15 additional dentists and 1 dental hygienist to practice in community facilities serving low-income and uninsured patients. In 1999, the NC General Assembly revised the NC Dental Practice Act. Now, under the general direction of a licensed public health dentist, specially trained public health dental hygienists can perform oral health screenings and preventive and educational services outside the public school setting. The NC Institute of Medicine has begun exploring how to use dental hygienists to expand preventive dental services to underserved populations in federally-funded community or migrant health centers, state-funded health clinics, and the not-for-profit clinics that serve predominantly Medicaid, low-income or uninsured populations. A report is to be sent to the Governor and the Joint Legislative Commission on Governmental Operations no later than May 1, 2000. In 1999, the General Assembly directed the NC State Board of Dental Examiners to establish a procedure for streamlined licensing of dentists and dental hygienists who have been practicing in other states. This should increase the number of qualified dental practitioners in the state. The proposed rules governing the new licensing pathway are to be prepared by May 15, 2000. The Board of Dental Examiners will determine which new procedures will be needed to allow less burdensome and more timely entry of qualified out-of-state licensed applicants, while still affording the public the same protection as under current law and procedures. The NC Institute of Medicine is organizing a work group to study the feasibility of new residency programs in pediatric dentistry in addition to the current program located in Chapel Hill. The Institute will present a report to the General Assembly, no later than May 1, 2000. On April 1, 1999, the state Medicaid program authorized use of ADA Procedure Code 1203, which allows reimbursement for the application of dental fluoride varnishes without a full prophylaxis. It also authorized pediatricians, nurse practitioners, or physician's assistants to apply these varnishes to the teeth of young children, allowing more rapid dissemination of this proven preventive procedure among the state's low-income children. Implementation began in Carolina Access II and III project sites in the fall, 1999, and should spread statewide in 2000. Furthermore, the General Assembly's 1999 session expanded NC Health Choice to cover dental sealants, fluoride treatment, simple extractions, stainless steel crowns, and pulpotomies. Since publication of the Task Force Report in May 1999, considerable forward movement has taken place. It was apparent that the problems associated with poor dental care were severe, of immediate concern, and needed a broad, nonpolitical analysis followed by action from public and private-sector policy makers and shapers. The key recommendation of the Task Force (to increase the level of payment to dentists for services provided to Medicaid beneficiaries) was not acted on in the 1999 session of the General Assembly, but it was seriously discussed in legislative hearings and will be considered further in the year 2000 legislative session. Given the number of problems surrounding adequate health care for North Carolina's low-income populations, inquiries such as that described here can point the way to the concrete and feasible steps that need to be taken. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1999

HIV-risk practices among homeless and low-income housed mothers.

BACKGROUND: Knowledge of human immunodeficiency virus (HIV) and its risk behaviors have not been systematically studied in homeless mothers. The identification of the factors associated with HIV-risk practices will guide interventions for low-income housed and homeless women. METHODS: We interviewed 220 homeless and 216 low-income housed mothers living in Worcester, Massachusetts, to gather information on demographic, psychosocial , and HIV-risk practice characteristics. We used standardized instruments and questions drawn from national surveys. The primary study outcome was high HIV-risk behavior. RESULTS: Although homeless mothers were more likely than low-income housed mothers to report first sexual contact at an early age, multiple partners during the last 6 months, and a history of intravenous drug use, homelessness was not associated with high HIV-risk practices. Both homeless and low-income housed mothers demonstrated misconceptions about HIV transmission through casual contact. Among high-risk women, approximately 75% perceived themselves as having low or no risk for contracting HIV. A history of childhood victimization, adult partner violence, or both placed women at a significantly increased likelihood of high HIV-risk practices. African American race, knowledge about HIV, and self-perception of risk were also significantly associated with high-risk practices. CONCLUSIONS: Homeless mothers are a subgroup of poor women at high risk for HIV and should be targeted for preventive interventions. In addition, there are potentially modifiable factors associated with HIV-risk practices in both low-income housed and homeless mothers that should be directly addressed.

Adult↗
PubMed2001

Enhancing smoking cessation of low-income smokers in managed care.

BACKGROUND: Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems, it is not clear whether such services are effective for very low-income smokers. We evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care. METHODS: A randomized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers. All clinicians and center staff received standard training in usual care. Selected nurses and telephone counselors received special training in a computer-assisted counseling program focusing on relapse prevention. RESULTS: The majority of the study population (233 adult smokers with telephones) were white (64%) women (70%) with annual incomes of less than $10,000 (79%) and with prescriptions of nicotine replacement therapy (>90%). At 3 months, quit rates (smoke-free status verified by carbon monoxide monitors) were 8.1% in the usual-care group and 21% in the telephonic-counseling group (P=.009) by intention-to-treat analysis. Special tracking methods were successful in maintaining participants in treatment. CONCLUSIONS: Smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephonic-counseling is provided. State and Medicaid managed care plans should consider investing in both office-based nurse and centralized telephonic-counseling services for low-income smokers.

Adult↗