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PubMed1994

Alcoholism and income: the role of indirect effects.

The potential pathways by which alcoholism might affect income are examined using data on males from the New Haven site of the Epidemiologic Catchment Area (ECA) data set to illustrate important indirect, and direct, effects of alcoholism on income. The detrimental indirect effects occur through reduction of educational attainment and increased probability of divorce. Because both educational attainment and marriage positively influence income, the adverse impact of alcoholism on both of these variables translates into lower income for alcoholics. The implications should lead researchers to distinguish more carefully between the direct and indirect costs of this condition. Policy analysts also should explore the financial impact of early onset when they look at overall costs. Because this has often been underestimated, fewer resources are devoted to prevention and treatment of alcoholism than a considered awareness of the problem would indicate is warranted.

Adult↗
PubMed1993

Income, race, and mortality.

This study was undertaken to clarify the complex relationship between poverty and race with disease-specific mortality. Data from the 1987 National Health Interview Survey and the 1986 National Mortality Followback Survey were used to estimate standardized mortality ratios (SMRs) for various categories (all causes, all cancers, noncancerous medical causes, lung and breast cancers, ischemic heart disease, and cerebrovascular disease) associated with income below the poverty line and were compared with those with adequate or better than adequate income. All SMRs were substantially elevated. The SMRs were not appreciably affected by adjustments for confounding by alcohol consumption, occupation, or smoking. Sex-specific SMRs of blacks relative to whites with the exception of ischemic heart disease were significantly elevated for males but not for females with the exception of the SMR for all causes. However, when adjusted for per capita income within the family, black mortality never significantly exceeded that of whites. These results strongly support the conclusion that mortality differences between blacks and whites are due to differences in income and related factors. However, it is unclear why poverty should be associated with elevation in cancer relative risk.

Adult↗
PubMed1993

Use of coronary artery bypass surgery in the United States and Canada. Influence of age and income.

OBJECTIVE: To compare overall rates of coronary artery bypass surgery (CABS) in several Canadian and US jurisdictions and to compare use by age and income groups in the two countries. DESIGN: Survey, using computerized hospital discharge abstracts. SETTING: All nonfederal hospitals in New York, California, Ontario, Manitoba, and British Columbia between 1983 and 1989. PATIENTS: All adult residents of the five jurisdictions who underwent CABS in a hospital in their jurisdiction. RESULTS: Between 1983 and 1989, the CABS rates were consistently highest in California and lowest in the Canadian jurisdictions. In 1989, the age-adjusted rate of CABS in California (112.5/100,000 adults) was 27% higher than in New York (88.4/100,000) and 80% higher than in the three Canadian provinces combined (62.4/100,000). The CABS rates increased for those aged 65 years and older and decreased for those aged 20 to 54 years in all five jurisdictions. In 1989, CABS rates were three times higher in California than in Canada for those aged 75 years and older, and the higher rates for those aged 65 years and older accounted for 75% of the overall difference in rates between California and Canada. In Canada, CABS rates for the nonelderly varied little by income of area of residence, but in New York and California, rates increased steadily with the income of area of residence. CONCLUSION: Control over the supply of resources in Canada is associated with markedly lower CABS rates for the elderly than found in the United States. While overall rates are lower in Canada, the Canadian universal health insurance system reduces the influence of income on access to CABS found in the United States. However, even without universal health insurance, CABS rates for the nonelderly living in the poorest areas in California are similar to the rates for those living in the poorest parts of Canada.

Adult↗
PubMed1977

Aged women OASDI beneficiaries: income and characteristics, 1971.

This article examines selected benefit characteristics--primary insurance amount, entitlement status, and actuarial reduction--of women aged 62 and over and the relationship between these characteristics and the receipt of income from other sources and the size of total income in 1971. Special attention is given to age variations in beneficiary and income factors and to the comparatively disadvantageous economic situation of the oldest cohorts of aged beneficiary women. A major conclusion is that the lower incomes of the oldest cohorts were largely due to the fact that OASDI cash benefits are not adjusted to reflect rising wage levels after retirement or to steady increases in the taxable maximum.

Age Factors↗
PubMed1996

The characteristics and needs of sheltered homeless and low-income housed mothers.

OBJECTIVE: To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains. DESIGN: Case-control study. SETTING: Community of Worcester, Mass. PARTICIPANTS: A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare. MAIN OUTCOME MEASURES: Income, housing, life events, social support, history of abuse and assault, and mental and physical health. RESULTS: Comparison of homeless and housed mothers revealed some important similarities and differences. The proportion of homeless mothers with annual incomes of less than $7000 was 46% vs 17% for housed mothers (P<.O1). Homeless mothers experienced more residential instability than the housed mothers (3.8 moves vs 1.8 moves; P<.001) and had smaller support networks (P<.001). More homeless mothers reported severe physical and sexual assault over the lifespan than housed mothers (91.6% vs 81.1 %; P<.003). No significant differences were found between the groups in mental and physical health. However, the lifetime prevalence of major depressive disorder, posttraumatic stress disorder, and substance use disorders was overrepresented compared to the general female population. Both groups had lower physical functioning compared to the general population and a higher prevalence of chronic health conditions. CONCLUSIONS: Sheltered homeless mothers had fewer economic resources and social supports and higher cumulative rates of violent abuse and assault over their lifespans than their housed counterparts. However, both groups faced extreme adversity that compromised family well-being. Practitioners and social policymakers need to be cognizant of the multiple economic, psychosocial, and physical health needs of these mothers in providing treatment and developing program interventions.

Adolescent↗
PubMed1997

An income-based approach for evaluating the financial components of capitated managed care contracts.

In this fictitious example the contractual reimbursement level being reviewed would produce an annual income level of $246,564, if we could replace 100% of our practice with patients at this reimbursement level. This resulted in a 64% increase over the income level shown in the example. In this example we have learned that this is a very favorable contract and we should identify and employ techniques to increase the volume from this payer. If, on the other hand, this analysis had shown that the capitation rates reduced the current income level we should implement measures to limit the extent of volume that this contract represents in the practice. If you desire the actual increase or decrease in income expected from the volume associated with this contractual arrangement can be calculated. To do this one needs to estimate the number of members in the plan that will choose to be in your panel and then calculate the volume and reimbursement level associated with this patient population. Rarely, does this next level of calculation need to be performed. It is usually quite clear, from a decision-making and negotiating perspective prior to going to this level of detail, if the contract in question is attractive or not attractive.

Capitation Fee↗
PubMed1998

The relation between income and mortality in U.S. blacks and whites.

Differential mortality exists in the United States both between racial/ethnic groups and along gradients of socioeconomic status. The specification of statistical models for processes underlying these observed disparities has been hindered by the fact that social and economic quantities are distributed in a highly nonrandom manner throughout the population. We sought to provide a substantive foundation for model development by representing the shape of the income-mortality relation by racial/ethnic group. We used data on black and white men and women from the longitudinal component of the National Health Interview Survey (NHIS), 1986-1990, which provided 1,191,824 person-years of follow-up and 12,165 mortal events. To account for family size when considering income, we used the ratio of annual family income to the federal poverty line for a family of similar composition. To avoid unnecessary categorizations and prior assumptions about model form, we employed kernel smoothing techniques and calculated the continuous mortality surface across dimensions of adjusted income and age for each of the gender and racial/ethnic groups. Representing regions of equal mortality density with contour plots, we observed interactions that need to be accommodated by any subsequent statistical models. We propose two general theories that provide a foundation for more elaborate and testable hypotheses in the future.

Adolescent↗
PubMed1998

Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice.

We analyze the effects of relative income expectations, expected malpractice premium cost, and other economic and noneconomic factors on physician specialty choice. The data for this paper are taken from responses of medical students who completed the Association of American Medical Colleges' Medical School Questionnaire and graduated from medical school in 1995. A random utility model is used to guide our thinking; the econometric technique is multinomial logit regression. Selection of a surgical or support specialty is found to be positively income motivated, while the influence of expected relative income is negatively related to the choice of primary-care and medical practices. Concern over malpractice premium cost is negatively related to surgical and positively related to primary-care selection. Other important determinants of choice are planned location of practice, length of residency, type of medical school attended, score on the science problems section of the Medical College Admission Test, predictable working hours and perceived prestige of the specialty. Policies that alter expected relative income, length of residency, desired location of practice, medical school attended, predictable working hours, and prestige of practice, rather than financial aid, may be appropriate for correcting a perceived maldistribution of physicians among specialties.

Adult↗
PubMed1976

Factors affecting the incomes of men and women physicians: an exploratory analysis.

Income differences between men and women physicians are analyzed using data from the Americal Medical Association's 1973 Eighth Periodic Survey of Physicians. While women tend to possess less favorable professional characteristics in terms of income-earning potential, the returns to many characteristics associated with higher incomes are greater for women than for men. Additional evidence on differences in weekly hours worked is presented in an effort to explain the lower incomes of women doctors.

Female↗
PubMed1998

[Food habits, consumption, and knowledge of a low-income French population].

Behaviors related to nutrition as well as the eating habits of low-income French people are analyzed from data collected by the Nutrition and Health Barometer of the CFES in 1996. French people with monthly incomes of less than 4000 francs appear to go to fast-food restaurants more often than to other types of restaurant (for leisure or work). They appear to eat their three main meals alone more often, to spend less time over the evening meal, to watch television during their noon and evening meals, to have cheese or another dairy product rather than a main dish, and to limit their evening meal to a single dish. They are less numerous than higher-income people to have the "ideal" breakfast. These economically disavantaged French people do their shopping more often in large of medium-sized supermarkets and more often plan their meals according to the family budget. In terms of food they are more numerous to eat neither fruit nor vegetables; they consume less pork, fish and shellfish, dairy products, alcoholic beverages and especially before-dinner drinks. This study shows that the eating behavior of low-income French people is less in conformity with commonly accepted nutritional recommendations. Likewise, the rate of obesity observed among the women from this households appears high.

Adolescent↗
PubMed2005

Prevention of the epidemic increase in child risk of overweight in low-income schools: the El Paso coordinated approach to child health.

OBJECTIVE: To assess the impact on children's health of translating an evidence-based national intervention trial (Child and Adolescent Trial for Cardiovascular Health [CATCH]) to low-income elementary schools with primarily Hispanic students. DESIGN: An untreated, matched control group design with repeated dependent pretest and posttest samples was used. SETTING: Four El Paso CATCH and 4 control elementary schools in El Paso, Tex, along the US-Mexico border region. All had Title I status (most were low-income students). PARTICIPANTS: Participants were 896 third-grade children (473 control schools [224 girls and 249 boys] and 423 CATCH schools [199 girls and 224 boys]); 93% were Hispanic. INTERVENTION: Community-based implementation of the national CATCH program. MAIN OUTCOME MEASURES: Risk of overweight or overweight, body mass index, waist-to-hip ratio, yards run in 9 minutes, passing rates for Fitnessgram national mile standards, moderate to vigorous physical activity and vigorous physical activity in physical education class, and percentage of fat and sodium in school lunches. RESULTS: Girls in control schools had significant increases in percentage of risk of overweight or overweight from third (26%) to fifth (39%) grades, as did girls in CATCH schools (30%-32%); however, the rate of increase for girls in the CATCH schools was significantly lower (2%) compared with the rate for control girls (13%). A similar pattern was seen for boys, with a rate of increase for boys in CATCH schools of 1% (40%-41%), which was significantly less than the 9% increase (40% to 49%) for control boys. CONCLUSIONS: The translation of the national CATCH program to low-income schools with Hispanic students successfully slowed the epidemic increase in risk of overweight or overweight seen in control school children. An emphasis should be placed on community organizing and evaluation feedback when implementing evidence-based school health programs in low-income Hispanic communities.

Anthropometry↗
PubMed1995

Breast-feeding in a low-income population. Program to increase incidence and duration.

OBJECTIVE: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population. DESIGN: A randomized, nonblinded clinical control trial. Patients were followed up through pregnancy, delivery, and the first year of the infant's life or until the time of weaning from the breast, whichever came first. SETTING: The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income, inner-city population. PATIENTS: There were a total of 108 patients: 51 were randomized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant, and 57 were randomized to the control group that received the standard of care at the institution. Patients in the control group were not seen by the lactation consultant. The two groups were similar demographically. INTERVENTION: This program consisted of individual prenatal lactation consultation, daily rounds by the lactation consultant on the postpartum unit, and outpatient follow-up at 48 hours after discharge, at the time that the infant was 1 week of age, and at all future health supervision visits for infants up to 1 year of age. MAIN OUTCOME MEASURES: The incidence and duration of breast-feeding. RESULTS: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P = .002). The duration of breast-feeding was also significantly longer in the intervention group (P = .005). CONCLUSIONS: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.

Adult↗
PubMedDate not supplied

Bucking the trend? Health care expenditures in low-income countries 1990-1995.

Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

Data Collection↗
PubMed2000

School-based identification of asthma in a low-income population.

The increase in the prevalence, morbidity, and mortality of asthma among children over the last decade has been well documented, especially among low-income minority children. Hypotheses for the increases in morbidity and mortality include limited access to primary care services and the failure to recognize the presence and severity of asthma. The University of Miami Pediatric Mobile Clinic (Mobile Clinic) Asthma Intervention Program is designed to identify underserved asthmatic children at school and offer them culturally sensitive care. Nine elementary schools with low income, predominantly Hispanic and African-American populations regularly served by the Mobile Clinic, were chosen for study participation. All 5,800 students who were enrolled in kindergarten through third grade were given letters at the time of registration by their homeroom teachers about the asthma program. Caretakers who returned the questionnaire and reported that the student had asthma symptoms were invited to have the student undergo a medical evaluation in the Mobile Clinic. Over a 2-year period, caretakers of 423 students (7.3% of all students) expressed an interest in further evaluating their child's respiratory health. Of these, we enrolled and evaluated 154 in the Mobile Clinic's Asthma Intervention Program. The Mobile Clinic physicians identified 145 of the enrollees as having asthma. These results indicate that in elementary schools serving predominantly low-income minority populations, a large fraction of the asthmatic population (estimated prevalence, 6-10%) can be identified by a school-based letter. Further, in a subset of asthmatic students (children of interested caretakers), there is good agreement between caretaker responses and physician diagnosis of asthma. Since school attendance is mandatory, school-based methods may be an effective method for identifying low-income children with asthma.

Black or African American↗
PubMed2005

Income related inequality in prescription drugs in Denmark.

PURPOSE: To examine income-related inequity in utilisation of prescription drugs in Funen County, Denmark after a new reimbursement system was implemented. METHODS: An individual level prescription database was merged with a health survey of 2927 respondents interviewed in 2000 and 2001 about their health status and socio-economic and socio-demographic characteristics. An index of horizontal inequity was used to estimate the degree of inequity in drug utilisation across income groups, using the indirect method of standardisation to control for age, gender and health status as a proxy for need. The results were compared to estimates from a traditional regression analysis. RESULTS: The least advantaged with respect to income consume a bigger share of the prescription drugs than the most advantaged. After standardisation for age, gender and health status the least advantaged have a lower share of the drug consumption than expected. However, traditional regression analysis showed no signs of an income effect on the level of consumption of prescription drugs. CONCLUSIONS: The index of horizontal inequity suggests that some horizontal inequity favouring the better off is present. However, the results deviate from what can be found by traditional regression analysis.

Adolescent↗
PubMed1997

Life satisfaction among low-income rural youth from Appalachia.

The purpose of this study was to examine the relative strength of objective, subjective, and congruency variables as predictors of life satisfaction among low-income youth from rural areas. A 10-year longitudinal survey of low-income, rural youth from Appalachia (n = 322) was conducted to explore these issues. Although support was provided for variables representing all three types of life satisfaction predictors, the strongest of these were subjective variables such as self-perceptions about goal attainment in jobs, overall goal attainment in life, and self-esteem. Another set of consistent predictors of life satisfaction, congruence variables, were concerned with the extent to which low-income you believed that they had fulfilled their own aspirations in terms of formal education, proximity to their childhood homes, and number of children, Finally, some of the objective variables consisting of family of origin's SES, community size, and marital status also were predictive of life satisfaction. In general, the life satisfaction of low-income, rural youth seemed to be influenced more extensively by personal meanings shaped within a particular cultural context rather than by traditional objective measures of life circumstances.

Adolescent↗
PubMed1994

Correlates of healthy eating habits in low-income black women and Latinas.

BACKGROUND: Few factors related to healthy or unhealthy eating habits in low-income, ethnic minority groups have been identified. In this study, factors associated with healthy and unhealthy eating habits and intent to change eating habits were examined in a sample of low-income Black and Latino women. METHODS: Survey questionnaires designed to identify correlates of healthy eating habits were administered to 243 Black and Latino women whose children were enrolled in Head Start programs in South Central Los Angeles. RESULTS: Having health insurance, lower perceived susceptibility to cancer, and higher levels of social support were significantly related to healthy eating habits. Exposure to domestic violence, lower income and knowledge of risk factors, and lower perceived efficacy in changing health outcome were associated with lower levels of intent to change eating habits. CONCLUSIONS: Economic factors such as insurance coverage and level of social support should be considered in evaluating and addressing eating habits in low-income, ethnic minority women. Exposure to domestic violence and self-efficacy may also be related to intent to change eating habits in these groups.

Adult↗
PubMed1986

Young adult mortality as an index: associations with income and social indicators.

In an effort to find an indicator for use in studies of the epidemiological impact of drug abuse in California in the late 1960s, we recognized that, for comparative analyses, cause specific mortality was less attractive than total mortality of the population group principally affected, young adults. This paper examines the all cause mortality; and its major components for young adults, age 15-24, (Young Adult Mortality, YAM) for the U.S. as it varied over time and for various countries in relation with income and social indicators. Between 1961 and 1969 in the United States a striking overall increase occurred (40.6%) with motor vehicle accidents a dominant cause which neither accounted for, all the increase, nor for the racial gradients. Male rates are higher than female rates. In the U.K. a steep and persistent social class gradient has been shown. Comparative studies done among countries whose vital statistics are reported to the World Health Organization, were analyzed in relation to international social and economic indicators. Countries with a Per Capita Income (GNP/person) below $3,000 show a striking increase in mortality from diseases with decreasing income, but above $3000 GNP/person "environmental" (non-disease) causes of death begin to increase, so that total mortality increases with increasing income. Two distinct groups of "industrialized countries" can be identified, seven with low mortality, and ten with high mortality. Per capita expenditure on education and ethnic homogeneity appear to be the social indicators which best discriminate between these two groups of countries.

Accidents, Traffic↗