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PubMed1999

Increasing response rates for mailed surveys of Medicaid clients and other low-income populations.

Mailing surveys to low-income populations is often avoided because of concern about low response rates. In this study, the authors used a mailed survey of a low-income population to test whether $1.00 or $2.00 cash-response incentives were worth the expense and whether 2-day priority mail ($2.90 postage) would yield a sufficiently higher response rate than certified mail ($1.52 postage) to justify its cost. In 1994, 2,243 randomly selected families in subsidized health care programs in Pierce County, Washington, were randomly sent no incentive, $1.00, or $2.00 in the first of three mailings. For the third mailing, nonrespondents were randomly assigned to receive either certified or 2-day priority mail. After 4 weeks, the response rates were 36.7%, 48.1%, and 50.3% for the no-incentive, $1.00, and $2.00 groups, respectively. After three mailings, the cost per response was the lowest for the group that received $1.00. The response rate for the certified mailing (28.1%) was significantly higher than the rate for the more expensive priority mailing (21.7%). No incentive-related bias was detected. The authors concluded that the most efficient protocol for this low-income population was to use a $1.00 incentive in the first mailing and a certified third mailing.

Aged↗

PubMed1995

'A medical El Dorado'? Colonial medical incomes and practice at the Cape.

This article focuses on a neglected area--the economics of colonial medicine. It examines medical incomes and practice in the Cape of Good Hope Colony before 1910 in relation to licensed practitioners in private practice. The imperial relationship shaped medical practice, notably in relation to a comparative early regulation of medicine, and an increasingly crowded medical market. The article suggests that Britain was exporting some of its problems--in the form of an oversupply of medical practitioners--to its empire. The opportunities for making a good medical income in the Cape are compared with those in Britain; and the article concludes that, although there were generally better opportunities to make high incomes in the Cape, the risks of professional failure were often greater.

Colonialism↗

PubMed2002

What social workers need to know about the earned income tax credit.

Over the past decade, the federal earned income tax credit (EITC) has become the largest antipoverty program in the United States. For the 2002 tax year, working families with children can receive as much as $4,140 in EITC benefits. Although families may arrange to receive benefits throughout the year (through their paychecks), most receive a lump sum after filing federal income taxes. Research suggests that many families use the credit to purchase big-ticket items, to move, to pay for educational expenses, or to set aside savings. Thus, the credit may promote long-term household development as well as help families with basic expenses. Research also suggests that EITC encourages work among single-parent families, an outcome that is consistent with one goal of welfare reform. Social workers can be involved in outreach efforts that help low-income workers claim EITC benefits and inform them about advance-payment options. Social workers can also support efforts to increase EITC benefits for larger families and link tax refunds to saving programs.

Consumer Advocacy↗

PubMed1979

An evaluation of income incentives and board-certification trends.

In this paper the author examines income differentials between board-certified and non-board-certified physicians to determine whether the trend toward board certification is consistent with economic incentives. Although simple income comparisons indicate substantial differentials by certification status, after adjustments are made for specialty-mix, age distribution, and hours worked, the remaining differential is small. However, results by specialty indicate that physicians are most likely to become certified in specialties with the largest income differentials.

Adult↗

PubMed2002

The more things change: revisiting a comparison of educational costs and incomes of physicians and other professionals.

The authors previously compared the 1990 educational costs and incomes of physicians and other professional groups. Since then, there have been dramatic changes in the market for the groups examined. This article reports their update of the previous analysis, using 1997 data. For this update, the authors applied standard financial techniques to expected incomes and educational costs to determine the return on educational investment over the working lifetime for five professional groups: primary care physicians, procedure-based physicians, dentists, attorneys, and graduates of the top 20 business schools. The hours-adjusted net present values of the educational investments for attorneys ($10.73) and procedure-based physicians ($10.40) are considerably higher than those for dentists ($8.90) and businessmen ($8.27); the return for primary care physicians ($5.97) remains much lower than all others. Primary care physicians have an hours-adjusted internal rate of return on their educational investment equal to 16%, compared with 18% for procedure-based medicine, 22% for dentistry, 23% for law, and 26% for business. Although it remains the lowest of all professional groups examined, primary care medicine has made the largest percentage gain in net present value of all groups. Although anticipated changes in physician incomes have occurred, the standing of physicians relative to other professional groups has not changed. Students can still anticipate relatively poorer returns on their educational investment when they choose a career in primary care medicine as compared with careers in procedure-based medicine or surgical specialties, business, law, or dentistry.

Career Choice↗

PubMedDate not supplied

Knowledge of the limitations associated with prostate cancer screening among low-income men.

This correlational pilot study measured limitations of prostate cancer screening, using a revised Knowledge of Prostate Cancer Questionnaire. Knowledge in 81 low-income men is reported. The Knowledge About Prostate Cancer Screening Questionnaire consists of 12 questions, with scores ranging from 0 to 12. Concepts measured include limitations, symptoms, risk factors, and screening age guidelines. The Total Knowledge Score had a mean of 6.60, with a standard deviation of 3.00, indicating that knowledge was low. Half of the men knew that "some treatments for prostate cancer can make it harder for men to control their urine." More than half of the men knew that, "some treatments for prostate cancer can cause problems with a man's ability to have sex." Married men, low-income men, and Caucasian men had significantly lower Total Knowledge Scores than unmarried, higher income, and African American men. Implications for practice and research are discussed.

Adult↗

PubMed1980

Childhood depression, family income, and locus of control.

Family income and the response style of internal-external locus of control were studied for their relationship to childhood depression. The subjects were 944 prepubertal school children representing three levels of socioeconomic status. Depression was measured by three methods: peer nominations, self-rating, and teacher ratings. Externality was associated with high depression and internality with low depression. The joint effects of low family income and externality produced the highest depression scores. Income and externality were inversely related.

Child↗

PubMed1976

Personality patterns of academy fellows and high-income optometrists.

Practicing optometrists who have achieved Academy membership status, and, separately, optometrists who have attained unusually high incomes in practice were studied and compared with optometrists in general. Academy fellows differed from non-fellows in their greater initiative, self-confidence, independent spirit, and a pattern of interests like persons engaged in professional social service occupations. High-income optometrists were more like Academy fellows than were optometrists in general, but showed somewhat less of the leadership potential evidenced by Academy members. High-income optometrists showed more interest than other optometrists in business occupations. The findings show that personal qualities and interest patterns associated with being financially successful and with achieving Academy membership can be assessed in a meaningful and objective manner.

Achievement↗

PubMed2006

Do gender, education, and income modify the effect of air pollution gases on cardiac disease?

OBJECTIVE: We sought to determine whether gender, education, and income influence the susceptibility to ambient air pollution. METHODS: We determined the association between daily cardiac hospitalizations and daily concentrations of gaseous air pollutants in 10 large Canadian cities using time-series analyses adjusted for day-of-the week, temperature, barometric pressure, relative humidity. RESULTS: Percentage increases in hospitalization associated with an increase in air pollution equivalent to its mean value were statistically significant for ozone, carbon monoxide and nitrogen dioxide individually (P < 0.05) and the combined pollutant effect was 8.5% (95% confidence interval: 1.8, 14.6). The air pollution-cardiac disease association was not significantly influenced by gender or community level of education or income. CONCLUSION: Short-term changes in air pollution may adversely affect cardiac disease but gender, and community education and income do not accurately identify those with increased susceptibility.

Air Pollution↗

PubMed1994

Immunization status of 2-year-olds in middle/upper- and lower-income populations: a community survey.

Immunization rates of preschool children in the United States are well below recommended levels. Whereas low-income and minority groups have been targeted as at risk for inadequate immunization, the assumption is generally made that middle/upper-income children are adequately immunized through the private sector. We conducted a community-based survey that refutes this assumption. Only 31% of the 302 parents surveyed reported full immunization of their 2-year-olds. No significant differences were found in the immunization rates for middle/upper-income (34% immunized) versus lower-income children (28% immunized). Failure to receive the 18-month doses of DTP and polio was the most frequent cause of inadequate coverage for both groups. Barriers to immunization reported by middle/upper- and lower-income parents were similar, with over one-third of the parents identifying cost and lack of insurance coverage as problems. Additional barriers related to methods of operations of providers. Findings have immediate implications for public health nurses in terms of assessing coverage of their own preschool populations and introducing corrective actions to improve levels of immunization.

Adult↗

PubMed2001

The relation of household income to mammography utilization in a prepaid health care system.

Managed care organizations should be expected to provide equivalent access to preventive and screening services to all members. We studied mammography in 1,667 women members of one HMO who had an overall utilization rate of 84.9%. Significant correlates of mammography utilization included age, estimated household income, and division of the managed care organization in which the member was enrolled. Each $10,000 increment of income increased mammography rates by 2.5 percentage points (95% confidence interval [CI], 1.4% to 3.6%), independent of age and division. Our findings suggest that coverage for mammography services is not sufficient to ensure equivalent use of screening across income groups.

Adult↗

PubMed1992

Accessibility of Norwegian dental services according to family income from 1977 to 1989.

During the last 10-20 yr there has been a marked increase in demand for dental services in most western countries. An important issue is how this increase in demand has influenced inequalities in use of services among different income groups in the population. It is of particular interest to study this in Norway, as almost all the costs for dental care among adults are borne by the patient. The aim of the present study was to examine how the effect of family income on demand for dental services has changed over time. The analyses were performed on three sets of national data from 1977, 1983, and 1989. The samples were representative of the non-institutionalized Norwegian population aged 20 yr and above. Inequalities in use of dental services among different income groups have decreased between 1977 and 1989. However, separate analyses on the data from 1989 showed that some inequalities still exist. A non-selective subsidizing policy for dental care is unlikely to have any great effect in reducing these inequalities. Subsidized dental care is likely to raise the total amount of dental care demanded. However, it is difficult to assess accurately the size of this increase as the elasticity of demand for dental care in Norway with respect to price is unknown.

Adult↗

PubMed1994

A comparative study of costs for dental services and dentists' income in the United States and Norway.

The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66,940 in the US and $27,125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.

Dental Health Services↗

PubMed1998

Combination of low parental educational attainment and high parental income related to high caries experience in pre-school children in Abu Dhabi.

Children aged 2, 4 and 5 years were examined for dental caries using WHO criteria, in the Emirate of Abu Dhabi, UAE, in 1996. The children were from the three administrative regions of Abu Dhabi, Al Ain and Western Region. Sampling of health centres and kindergartens was stratified by urban or rural location. Parents completed a questionnaire, and children were classified into high, middle or low groups on the basis of their parents' education and income. All 20 kindergartens and 22 health centres sampled agreed to participate. The participation rate of sampled children was high and complete data were available for 640 children--217 aged 2 years, 204 aged 4 years, and 219 aged 5 years. Similar numbers of boys and girls were included. The prevalence of dental caries was very high--36% to 47% at age 2 years, 71% to 86% at age 4 years and 82% to 94% at age 5 years. The mean dmft at age 5 years was 8.4 in Abu Dhabi, 8.6 in Al Ain and 5.7 in Western Region. Few teeth had been filled. Apart from age, the parents' education and income were found to be statistically significantly related to caries experience (P<0.05), while gender, ethnicity (UAE or non-UAE), region, and urban or rural living, were not related to dental caries experience (P>0.3). While high parental educational attainment was related to lower caries experience, conversely, high parental income was related to higher caries experience. Caries experience was higher than that recorded approximately 6 years previously and is a cause of concern.

Age Factors↗

PubMed1987

Changes in the distribution of American family incomes, 1947 to 1984.

The American family income distribution now lies at the center of several controversies. Some observers argue that the American middle class is vanishing, but U.S. census income statistics show income inequality has not changed appreciably since 1947. A second controversy involves whether average living standards have risen or fallen since the major oil price increase of 1973-74. These controversies can be partially resolved by understanding the sharp slowdown in the growth of workers' wages which occurred after 1973 and the demographic trends which kept per capita living standards rising despite stagnant wages, including more working women and low birthrates.

Adult↗

PubMed2003

Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial.

OBJECTIVE: To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population. DESIGN: Parallel group randomised controlled trial. SETTING: Primary health centre in a deprived, ethnically mixed inner city area. PARTICIPANTS: 271 patients aged 18-70 years without serious illness. INTERVENTION: Brief individual behavioural counselling based on the stage of change model; time matched nutrition education counselling. MAIN OUTCOME MEASURES: Self reported number of portions of fruit and vegetables eaten per day, plasma beta carotene, alpha tocopherol, and ascorbic acid concentrations, and 24 hour urinary potassium excretion. Assessment at baseline, eight weeks, and 12 months. RESULTS: Consumption of fruit and vegetables increased from baseline to 12 months by 1.5 and 0.9 portions per day in the behavioural and nutrition groups (mean difference 0.6 portions, 95% confidence interval 0.1 to 1.1). The proportion of participants eating five or more portions a day increased by 42% and 27% in the two groups (mean difference 15%, 3% to 28%). Plasma beta carotene and alpha tocopherol concentrations increased in both groups, but the rise in beta carotene was greater in the behavioural group (mean difference 0.16 micromol/l, 0.001 micromol/l to 1.34 micromol/l). There were no changes in plasma ascorbic acid concentrations or urinary potassium excretion. Differences were maintained when analysis was restricted to the 177 participants with incomes < or = pound 400 (596, $640) a week. CONCLUSIONS: Brief individual counselling in primary care can elicit sustained increases in consumption of fruit and vegetables in low income adults in the general population.

Adolescent↗

PubMed2006

Income inequality and physical and mental health: testing associations consistent with proposed causal pathways.

OBJECTIVES: To test associations between individual health outcomes and ecological variables proposed in causal models of relations between income inequality and health. DESIGN: Regression analysis of a large, nationally representative dataset, linked to US census and other county and state level sources of data on ecological covariates. The regressions control for individual economic and demographic covariates as well as relevant potential ecological confounders. SETTING: The US population in the year 2000. PARTICIPANTS: 4817 US adults about age 40, representative of the US population. MAIN OUTCOME MEASURES: Two outcomes were studied: self reported general health status, dichotomised as "fair" or "poor" compared with "excellent", "very good", or "good", and depression as measured by a score on the Center for Epidemiologic Studies depression instrument >16. RESULTS: State generosity was significantly associated with a reduced odds of reporting poor general health (OR 0.84, 95%CI: 0.71 to 0.99), and the county unemployment rate with reduced odds of reporting depression (OR 0.91, 95%CI: 0.84 to 0.97). The measure of income inequality is a significant risk factor for reporting poor general health (OR 1.98, CI: 1.08 to 3.62), controlling for all ecological and individual covariates. In stratified models, the index of social capital is associated with reduced odds of reporting poor general health among black people and Hispanics (OR 0.40, CI: 0.18 to 0.90), but not significant among white people. The inequality measure is significantly associated with reporting poor general health among white people (OR 2.60, CI: 1.22 to 5.56) but not black people and Hispanics. CONCLUSIONS: The effect of income inequality on health may work through the influence of invidious social comparisons (particularly among white subjects) and (among black subjects and Latinos) through a reduction in social capital. Researchers may find it fruitful to recognise the cultural specificity of any such effects.

Adult↗

PubMed1981

The income effect of a disabled child.

Data from the General Household Survey were employed to compare the participation rates, hours worked, earnings, and net incomes of families with and without a disabled child. In families with a disabled child it was found that the spouse was significantly more likely to work the more children there were in the family and that income, and income as a proportion of supplementary benefit entitlement, was lower.

Child↗