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At least 919 records · Page 51Linked to original sources
PubMed1999

The impact of ethnicity, family income, and parental education on children's health and use of health services.

OBJECTIVES: This study characterized ethnic disparities for children in demographics, health status, and use of services; explored whether ethnic subgroups (Puerto Rican, Cuban, and Mexican) have additional distinctive differences; and determined whether disparities are explained by differences in family income and parental education. METHODS: Bivariate and multivariate analyses of data on 99,268 children from the 1989-91 National Health Interview Surveys were conducted. RESULTS: Native American, Black, and Hispanic children are poorest (35%, 41% below poverty level vs 10% of Whites), least healthy (66%-74% in excellent or very good health vs 85% of Whites), and have the least well educated parents. Compared with Whites, non-White children average fewer doctor visits and are more likely to have excessive intervals between visits. Hispanic subgroup differences in demographics, health, and use of services equal or surpass differences among major ethnic groups. In multivariate analyses, almost all ethnic group disparities persisted after adjustment for family income, parental education, and other relevant covariates. CONCLUSIONS: Major ethnic groups and subgroups of children differ strikingly in demographics, health, and use of services; subgroup differences are easily overlooked; and most disparities persist even after adjustment for family income and parental education.

Adolescent↗
PubMed2000

The effects of race/ethnicity, income, and family structure on adolescent risk behaviors.

OBJECTIVES: The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse. METHODS: Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders. RESULTS: White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths. CONCLUSIONS: Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.

Adolescent↗
PubMed2004

Income-related inequality in the use of dental services in Finland.

The aim of this article is to measure and explain income-related inequalities in dentist utilisation. We apply concentration and horizontal inequity indices and the decomposition method to decompose observed inequalities into sources. The data are from the Finnish Health Care Survey of 1996. We examine three measures of utilisation: (a) the total number of visits; (b) the probability of visiting a dentist; and (c) the conditional number of positive visits for (i) visits to all dentists, (ii) those to public dentists and (iii) those to private dentists. The results for the whole sample show pro-poor inequities in all three measures of utilisation in public care, whereas in the first two measures there are pro-rich inequities nationwide and in private care. Among those entitled to age-based subsidised dental care, we find equality and equity in all three measures of utilisation nationwide. The two main factors related to pro-rich distributions of use are income and dentist's recall. To enhance equity in dental care across income groups, attention should be focused on supply factors and other incentives to encourage the poor to contact dentists more often.

Adolescent↗
PubMed1999

Income inequality, social cohesion, and health: clarifying the theory--a reply to Muntaner and Lynch.

Statistical evidence suggests that social cohesion provides the link between income inequality and health, but it is not clear how it might do so. The vagueness of the concept of cohesion and the difficulty of seeing how something so apparently ephemeral could exert a major influence on health has led to skepticism about its role in the relation between income distribution and mortality. The author suggests that social cohesion is indicative of underlying psychosocial risk factors that are known to be closely associated with health. Attention is drawn to the strong inverse relationships between measures of social inequality and measures of the quality of social relations in numerous different data sets. Given that social status and social affiliations, in terms of population-attributable risks, are among the most powerful influences on population health in the developed world, this is a potentially potent mixture for health. An antipathy between hierarchical relations across inequalities of power, income, and status on the one hand, and supportive social relations between equals on the other, is likely to exert a powerful influence on health.

Health Services Accessibility↗
PubMed2006

Should we worry about income inequality?

Liberals (in the European sense) argue that a liberal free-market economic policy regime-nationally and globally-is good for economic growth and poverty reduction and for keeping income inequality within tolerable limits. Second, they argue that substantial income inequality is desirable because of its good effects on other things, notably incentives, innovation, and panache; and conversely, they dismiss concerns about growing inequality as "the politics of envy." Third, they argue that the core liberal theory of capitalist political economy satisfactorily explains the central tendencies in the role of the state in advanced capitalist economies. This essay challenges all three arguments on both conceptual and empirical grounds. It then suggests why the arguments are nevertheless widely accepted, proposes criteria for deciding how much inequality is fair, and ends by suggesting ways for achieving higher salience for income redistribution (downwards) in political agendas.

Commerce↗
PubMed1999

Income inequality, social cohesion, and class relations: a critique of Wilkinson's neo-Durkheimian research program.

Wilkinson's "income inequality and social cohesion" model has emerged as a leading research program in social epidemiology. Public health scholars and activists working toward the elimination of social inequalities in health can find several appealing features in Wilkinson's research. In particular, it provides a sociological alternative to former models that emphasize poverty, health behaviors, or the cultural aspects of social relations as determinants of population health. Wilkinson's model calls for social explanations, avoids the subjectivist legacy of U.S. functionalist sociology that is evident in "status" approaches to understanding social inequalities in health, and calls for broad policies of income redistribution. Nevertheless, Wilkinson's research program has characteristics that limit its explanatory power and its ability to inform social policies directed toward reducing social inequalities in health. The model ignores class relations, an approach that might help explain how income inequalities are generated and account for both relative and absolute deprivation. Furthermore, Wilkinson's model implies that social cohesion rather than political change is the major determinant of population health. Historical evidence suggests that class formation could determine both reductions in social inequalities and increases in social cohesion. Drawing on recent examples, the authors argue that an emphasis on social cohesion can be used to render communities responsible for their mortality and morbidity rates: a community-level version of "blaming the victim." Such use of social cohesion is related to current policy initiatives in the United States and Britain under the New Democrat and New Labor governments.

Community Health Planning↗
PubMed1993

Changes in poverty, income inequality, and the standard of living in the United States during the Reagan years.

The record of economic well-being in the 1980s belied Reagan's claim that Americans would be better off if they scaled back the welfare state and cut tax rates. Though the standard of living rose, its growth was no faster than during 1950-1980. Income inequality increased. The rate of poverty at the end of Reagan's term was the same as in 1980. Cutbacks in income transfers during the Reagan years helped increase both poverty and inequality. Changes in tax policy helped increase inequality but reduced poverty. These policy shifts are not the only reasons for the lack of progress against poverty and the rise in inequality. Broad social and economic factors have been widening income differences and making it harder for families to stay out of poverty. Policy choices during the Reagan Administration reinforced those factors.

Data Collection↗
PubMed2003

A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses.

OBJECTIVE: To determine whether type 2 diabetes contributes to the presence of depressive and anxiety disorder diagnoses in low-income adults with hypertension, asthma, and/or arthritis. RESEARCH DESIGN AND METHODS: Using a cross-sectional design, this study administered a structured diagnostic interview to low-income primary care patients diagnosed with type 2 diabetes, hypertension, arthritis, and asthma, as well as to those with no chronic illness (n = 326), to determine the 12-month prevalence of depressive and anxiety disorders. A logistic regression (LR) model was used to assess whether a diagnosis of depression and/or anxiety was associated with type 2 diabetes after adjusting for known risk factors. RESULTS: A high prevalence rate of depressive and/or anxiety disorders was found in the total sample (29%) and in all three illness groups: type 2 diabetes (36%), other chronic illnesses (24%), and no chronic illness (31%). Using LR, a main effect was detected for illness group when age and education were controlled (chi(2) = 22.66, df 4, P = 0.000). Specifically, the odds of occurrence of a depressive and/or anxiety disorder in those with comorbid type 2 diabetes were twice that in the nondiabetic, chronically ill comparison group (odds ratio 2.26, 95% CI 1.28-4.01, P = 0.005). CONCLUSIONS: These results suggest a positive contribution of type 2 diabetes to increased rates of depressive and/or anxiety disorders in patients with hypertension, asthma, and/or arthritis and support prior research that type 2 diabetes may serve as an indicator of depression and anxiety in low-income adults treated in primary care clinics.

Adolescent↗
PubMed1994

Comparison of Holsteins selected for high and average milk production. 1. Net income and production response to selection for milk.

The objective of the experiment was to quantify differences between two divergent lines of Holsteins for net income per day, per lactation, and per life-time using a linear profit function. Data consisted of 2768 lactation records from 1078 Holstein cows by 140 sires. Bulls with high PD milk were mated to daughters of sires with high PD for milk, and bulls with average PD for milk were mated to cows of average genetic merit, creating two divergent genetic lines of cattle. Data on production, health, and reproduction were collected. Analyses were based on lactation and lifetime. High line cows had greater net returns than average line cows by $.30/d (16.0%) per lactation and $.33 (19%) advantage/d of life. The high line cows were $103.79 more profitable (20.4%) per lactation and $375.60 (17.4%) more profitable during their lifetime than their average line herdmates. This income superiority was because high line cows averaged 940 kg more milk per lactation (16.4%) and 3435 kg more milk per lifetime (15.7%) than the average line cows. High line cows were superior by 500 kg for PTA for milk from January 1990. Selecting sires with high PD for milk effectively improved milk production and increased net income.

Animals↗
PubMed1998

Use of alternative therapies by a low income population.

Patients in a family health center clinic were surveyed about their use of alternative/complementary medicine. These were mostly low-income individuals on Medicaid. The aim was to estimate prevalence and patterns of use of medically unconventional therapies such as chiropractic, homeopathy, and acupuncture in this population. Nearly two hundred patients (N = 199) filled out questionnaires inquiring about medical conditions and illnesses, personal health habits (physical activity, tobacco smoking, alcohol intake, etc.), and use of preventive measures or therapies that are neither taught widely in US medical schools nor generally available in US hospitals, and which we refer to as 'alternative' therapies (ATs). The term 'alternative' is not intended to imply that ATs are necessarily chosen to replace, rather than to be used in combination with standard treatments, although that may indeed be so in specific cases. Twenty-nine percent of respondents (58/199) reported using at least one type of AT, as defined for the purposes of the survey. Frequency of use varied somewhat, with greatest AT use reported by those over 29 years of age with more education and higher incomes (p < 0.10, defined as chi 2 tests at p < 0.10). While no significant differences were found between AT users and nonusers with respect to exercise participation, alcohol intake or smoking, there was a difference with respect to the reporting of at least one medical condition (p < 0.01). Among those who have used ATs, 90% reported more than one medical condition. Of those reporting no AT use, 70% indicated only a single medical condition for which they had sought treatment. In conclusion, use of alternative therapy (AT) appears to be common in all socio-economic groups, although AT use is apparently slightly less among low-income persons than in the general population. It is therefore important for physicians and other medical providers to be aware that their patients may be using ATs. Obviously, such practices should be taken into account in case management.

Adult↗
PubMedDate not supplied

Smoking attitudes and practices among low-income African-Americans: qualitative assessment of contributing factors.

PURPOSE: Studies have shown that African-American adolescents are less likely to smoke cigarettes than white youth. National data suggest that this pattern changes in late adolescence and early adulthood. Specifically, African-American adults have a relatively high smoking prevalence rate when compared with other racial/ethnic groups. The purpose of this study was to qualitatively examine the sociocultural factors associated with smoking attitudes and practices among low-income African-American young adults. DESIGN: Cross-sectional qualitative study. SETTINGS: High schools, 2-year colleges, housing developments, and trade schools in New Orleans, Louisiana, and Memphis, Tennessee. SUBJECTS: One hundred eighteen low-income African Americans between 18 and 35 years of age (65 men and 53 women). MEASURE/PROCEDURE: Fourteen focus groups were conducted with the target population. Nonmonetary incentives were provided for each participant in the 1-hour sessions. The majority of focus group moderators were African-American females trained in focus group moderation. Participants were recruited through flyers and project liaisons at each field location. RESULTS: Themes elicited from the focus groups were classified according to the PEN-3 model, and they included: lighting cigarettes for parents as a first experience with cigarettes, perceived stress relief benefits of smoking, use of cigarettes to extend the sensation of marijuana, and protective factors against smoking such as respect for parental rules. CONCLUSION: The results indicate that there are specific contextual and familial factors that can contribute to smoking initiation, maintenance, and cessation among low-income African-American young adults. Limitations of this study include the exploratory nature of focus groups and the relatively small sample size. Further studies are necessary to quantitatively examine the role of these factors on smoking patterns in this population.

Black or African American↗
PubMed1994

Implications of new accounting rules for income taxes.

The provisions of the Financial Accounting Standards Board (FASB) Statement No. 109, Accounting for Income Taxes, require all organizations that issue financial statements to shift the focus of their accounting for income taxes from the income statement to the balance sheet. This change can alter significantly a healthcare organization's financial position. The change also may affect the way in which investors, lenders, regulators, and other users of financial statements evaluate corporations in the healthcare industry. Hospitals and other healthcare organizations, particularly for-profit organizations, therefore, should review carefully their methods of accounting for such items as deferred tax assets and loss and expense reserves.

Accounting↗
PubMed1998

JEMS' 1997 Provider Income Survey.

Each year the JEMS salary survey presents the organizational perspective of salaries, benefits and working conditions in EMS. In 1997, JEMS editors wanted to know whether an individual provider's financial perspective changed meaningfully when their non-EMS income was also considered. That question led to the provider income survey, which accompanied last November's feature on salaries. For a review of the most interesting trends and tidbits on EMS provider income, read on.

Data Collection↗
PubMed1982

Medicaid program; deeming of income between spouses; categorically needy--Health Care Financing Administration. Proposed rule.

We propose to revise current Medicaid rules for determining the financial eligibility and the level of Medicaid payments for institutional care of aged, blind, and disabled categorically needy individuals when one spouse is institutionalized and the other spouse is not. We propose to reinstate the rules that were in effect prior to the court orders in the Gray Panthers litigation. The change would affect those States that, as permitted by statute, use more restrictive eligibility criteria than those applied nationally under the Supplemental Security Income (SSI) program. It would also apply in Puerto Rico, Guam, and the Virgin Islands. These amendments would revise the regulations permitting these jurisdictions, in situations where one spouse is institutionalized, to consider a portion of the income of one spouse as available to the other spouse whether or not the income is actually contributed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

Living arrangement choices of elderly singles: effects of income and disability.

Logit regression is used to explain living arrangement choice of elderly single individuals. The propensity to live independently is found to increase with income and decrease with disability; an interaction effect for females suggests that income may lessen the impact of disability on the propensity to seek shared living arrangements. Independent living is less likely for people who are not white, foreign-born males, those with at least one adult child, and those in States with higher living costs; and more likely for the ever-married and those in States with high per capita nursing home use. If home care services are preferentially allocated to disabled elderly who live alone, resources may flow to higher income individuals who have been able to maintain independent households.

Activities of Daily Living↗
PubMed1999

Have family income mobility patterns changed?

We examine the mobility of individuals in the United States based on equivalent family income--that is, total income of all family members adjusted for family size according to the equivalence scale implicit in the U.S. poverty line. Our analysis, which tracks movements across quintiles, centers on four questions: How much movement is there across the family income distribution? How has this mobility changed over time? To what extent are the movements attributable to factors related to changes in family composition versus events in the labor markets? In light of major socioeconomic changes occurring in the quarter-century under study, have the determinants of mobility changed over time? Our findings indicate that mobility rates in the 1980s differed little from those in the 1970s. However, individuals in families headed by a young person or a person without a college education were less likely to experience upward mobility in the 1980s than in the 1970s.

Adolescent↗
PubMed1998

Household income in relation to dental health and dental health behaviours: the use of Super Profiles.

OBJECTIVE: To investigate the relationship between household income defined by Super Profiles, a socio-economic indicator, and dental health and dental health behaviours. BASIC RESEARCH DESIGN: Analytical survey involving a clinical examination and a questionnaire to parents. SETTING: Primary schools in Salford, UK. PARTICIPANTS: Two thousand five hundred and seventy eight 5-year-old children were examined; 1938 (75%) returned questionnaires. MAIN OUTCOME MEASURES: Mean caries experience and ages at first visit to dentist and when toothbrushing commenced. RESULTS: Children in the highest income group had a mean dmft of 1.83 compared with 2.56 in the middle group and 3.43 in the lowest income group. The proportions who had visited a dentist by their second birthday were 71%, 64% and 62% respectively. The corresponding proportions having their teeth brushed by their first birthday were 69%, 58% and 57%. CONCLUSIONS: The study showed a relationship between Super Profiles, and the dental health and dental health behaviours of 5-year-old children.

Age Factors↗
PubMed2000

Rural Minnesota family physicians. Practice characteristics, gender, income, and job satisfaction.

This study investigated rural physicians' job satisfaction, income, and working conditions through a survey of a random sample of rural family physicians in Minnesota. Of the 300 surveys sent, 210 (70%) were returned and usable. Male physicians reported more years of experience, work hours, and call hours per week than female physicians (p < 0.0005). On a scale of 1 to 5, average overall job satisfaction among the physicians was 4.04, with men averaging 4.0 and women, 4.3. Overall job satisfaction was positively correlated with the presence of a hospital in town (p < 0.05) and negatively correlated with the number of work hours, including hours on call, per week (p < 0.05). Overall job satisfaction was lowest for those in practice 20-34 years. Average reported annual income was $127,213 (men, $131,400; women, $97,800; p < 0.0001). In a comparison of physicians working the same number of hours including call, men earned more than women. Rural Minnesota family physicians reported high job satisfaction. Income was positively correlated with size of practice, years of experience, and number of hours worked. In addition, men earned more than women, and physicians whose pay was based on production earned more than physicians on straight salary.

Adult↗