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Low-income widows and other aged singles.

Based on data collected in a nationwide survey in late 1973, this report describes the living conditions, health, social activity, and attitudes of unmarried older persons at low to middle income levels--that is, below $5,000 per year. Although most previous research has focused on the special situation of widows, the current findings indicate that lower income widowers and divorced/separated/never-married persons generally experience many of the same problems as the widows and respond to them in a remarkably similar fashion. Old age without a spouse or adequate income seems to dictate the same material and social hardship regardless of whether the spouse was lost to death, divorce, or separation, or was never acquired in the first place.

Activities of Daily Living↗

Impact of income maintenance on low birth weight: evidence from the Gary Experiment.

Birth weight is a useful index of infant health. Low birth weight (5.5 pounds or less) is associated with high rates of infant mortality and morbidity. Low birth weight is also associated with low socioeconomic status. The question arises, therefore, whether income transfers can affect the incidence of low birth weight among the poor. The impact of an expanded income support plan on low birth weight was analyzed using data on 404 infants born to participants in the Gary Income Maintenance Experiment. A significant health response was observed for children of women who face high-risk pregnancies.

Adolescent↗

Is there a trade-off between income and health? The case of hypertensive steelworkers in Canada.

It is often assumed that medical treatment creates a trade-off between good health and income; that is, an individual "pays" for good health by an income loss (at least at the early stages of treatment) compared, for example, with the no-treatment choice. We examined empirical data on hypertensive steelworkers in Canada to evaluate whether such a trade-off exists. We found none. Indeed, those who participated in a treatment program to reduce their blood pressure not only gained improved health but also made small income "gains." Our findings thus challenge the validity of the trade-off assumption and call for further studies of its generalizability.

Adult↗

Low-Income Energy Assistance Program.

In fiscal year 1981, Congress appropriated $1.85 billion for home heating assistance to help low-income households meet rapidly rising energy costs. Eligibility for payments was based on income and energy-cost criteria. This procedure represented a departure from the earlier Federal focus of assisting households facing emergency hardships. Funds for the Low-Income Energy Assistance Program were allocated to the 50 States and District of Columbia, six territories, and 55 Indian tribal organizations. This article presents program data and information on the characteristics of the more than 17 million persons who received aid under this program.

Air Conditioning↗

Income and fertility: the elusive relationship.

This paper uses longitudinal data for 1962-1977 to examine the relationship of husband's income to 1962 expected fertility to final parity, and to the discrepancy between initial expectations and final parity, separately for four groups of women who in 1962 either had just given birth to a first, second, or fourth child or had just been married. Although economic reasons frequently were cited in 1977 for downward revisions in family size goals, husband's income was not positively related to fertility in three of the four parity groups. For the merged sample, excluding women with unwanted births, husband's income showed a small positive relationship to completed fertility.

Family Characteristics↗

Low-income aged: eligibility ad participation in SSI.

This article reports on a study undertaken to evaluate the Social Security Administration's (SSA) methods for estimating the number of persons eligible for Federal Supplemental Security Income (SSI) payments. SSA estimates that 65-70 percent of the aged eligible for SSI actually participate in the program. It has been argued that the actual participation rate may be either higher or lower than SSA estimates because SSA misestimates the size of the eligible population. SSA bases its estimates of the number of persons eligible on data in the Census Bureau's Current Population Survey (CPS). In this study, a sample of 2,000 low-income aged persons was interviewed in 1979, and two sets of information were collected: One duplicated the data used by SSA to make its estimates; the other duplicated the type of information collected when a person actually applies for SSI. When the two sets were compared, it was found that the methodology that SSA uses to estimate the size of the eligible population and the information collected from SSI applicants produced estimates that were quite similar. The study also evaluated theories to explain why some persons eligible for SSI do not claim benefits. The study found that the elderly are more likely to participate in SSI if they live in States that supplement Federal SSI payments and that do not have a history of imposing liens on the property of welfare recipients. Participants also tend to have somewhat lower incomes (excluding SSI) than nonparticipants. No evidence was found that variations in practices among Social Security district offices could account for differences in SSI participation rates.

Aged↗

The Income Survey Development Program: design features and initial findings.

This article summarizes the principal design features of the Income Survey Development Program (ISDP) and presents initial findings of its 1979 Research Panel. The ISDP was designed to meet the need for improved data--particularly information on cash and in-kind income, assets and debts, tax liabilities, and participation in the major income security programs. The ISDP examined many technical and operational problems that were difficult to satisfy with existing surveys and administrative record systems. The ISDP field tests indicated that several experimental features were successful. These include use of more frequent interviews, a sample that is followed over a period of more than a year, a flexible questionnaire structure that permits insertion of questions on emerging policy issues, and procedures to maximize the linking of survey data with information in administrative records. Initial findings from the 1979 Research Panel indicate the number of persons receiving benefits from more than one major transfer program and compare the assets of food stamp recipients with those of eligible nonparticipants and ineligible persons.

Food Services↗

The income and resources of the elderly in 1978.

The Social Security Administration (SSA) recently released two publications dealing with the economic situation of persons aged 55 and older in 1978. These reports--Income & Resources of the Aged, 1978 (a chartbook containing 17 charts and brief explanatory paragraphs) and Income of the Population 55 and Over, 1978 (a staff paper containing 43 tables and supporting text)--are the most recent in a series of analyses of the aged population begun by SSA 40 years ago. By means of selected findings, tabulations, tables, and charts, this article presents a sampling of the information available in the two publications. The reports reveal that the aged as a group are no longer disproportionately poor compared with the adult population as a whole, and that the 1978 income of most elderly units had kept pace with inflation since 1976, the next most recent survey year.

Age Factors↗

Access to hypertensive care. Effects of income, insurance, and source of care.

BACKGROUND: This study examines the relationship between income, health insurance, and usual source of care characteristics and screening and management of hypertension. METHODS: This is a secondary analysis of data from the 1987 National Medical Expenditure Survey. Adult survey respondents constitute a sample representative of the total adult noninstitutionalized US population. Screening, follow-up care, and pharmacologic treatment for hypertension were examined among low income individuals, the uninsured, those without a usual source of care place, and those without a particular usual source of care physician. RESULTS: The uninsured, individuals without a usual source of care place, and those without a particular usual source of care physician received less screening, follow-up care, and pharmacologic treatment for hypertension. Income did not affect receipt of hypertensive care. CONCLUSIONS: Lack of health insurance and lack of a usual source of care are barriers to hypertensive care. Policies that increase access to health insurance or to usual source of care physicians may enable more individuals to attain control of hypertension.

Female↗

Influence of income, hours worked, and loan repayment on medical students' decision to pursue a primary care career.

OBJECTIVE: To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care. DESIGN AND PARTICIPANTS: A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools. OUTCOME MEASURES: Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers. RESULTS: Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50,000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n = 313) of the students indicated either they were planning to enter primary care (n = 188) or they would change to a primary care specialty (n = 125) with appropriate adjustments in income, hours worked, or loan repayment. CONCLUSION: Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.

Career Choice↗

Racial differences in occupational status and income in South Africa, 1980 and 1991.

Using data on employed men from the 1980 and 1991 South African Censuses, we analyze the determinants of occupational status and income. Whites are found to have much higher occupational status, and especially income, than members of other racial groups. Most of the racial differentials in occupational status con be explained by racial differences in the personal assets that determine occupational attainment (especially education), but only a much smaller fraction of the White/non-White income differential can be so explained. Despite a modest reduction between 1980 and 1991 in the role of race in socioeconomic attainment, the overall picture shows more stability than change.

Adult↗

Factors associated with screening mammography in low-income women.

Despite its effectiveness as a preventive measure, studies indicate that low-income and minority women are less likely to obtain screening mammograms than other groups. Using a logistic regression model to adjust for multiple variables, we examined factors associated with women age > or = 40 years of age who obtained a screening mammogram in a community health center setting from 1990 to 1991 (screened, n = 3,521; nonscreened, n = 7,461). Women 50-64 were more likely to be screened than women 40-49 (adjusted relative risk [RR] = 1.57; 95% confidence interval [CI] = 1.42, 1.73). Native American, Asian, and women of other races were less likely to be screened than Caucasian, African-American, or Hispanic women (adjusted RR = 0.66; CI = 0.51, 0.87). Women on Medicaid were twice as likely to be screened than women who received no subsidized care (adjusted RR = 1.99; CI = 1.68, 2.35). Women who received the majority of their care at a community-based health clinic were twice as likely to be screened than women who received care primarily at a hospital-based ambulatory care site (adjusted RR = 2.34; CI = 2.06, 2.65). The greatest difference in adjusted RR was seen for women who had > or = 4 visits per year compared to women with < 4 visits (RR = 4.6; CI = 4.18, 5.06). On average, women in the screened population had fewer emergency room visits and more primary care and specialty clinic visits compared to the nonscreened population. Reducing the cost of mammography to the patient and providing systems for physician referral from hospital-based settings (emergency rooms, specialty clinics) may help increase the number of low-income and minority women who obtain screening mammograms. Medical Subject Headings (MeSH): mammography, screening, community health center, low-income, minority.

Adult↗

[Income, percent of women living in rural areas, parity, and breast cancer mortality in Spain, 1975-1991].

BACKGROUND: The aim of the present study was to analyze breast cancer mortality by provinces in Spain during the period 1975-91, and to assess the relationship with the geographical distribution of income level, percent of women living in rural areas and average parity of women in each province. SUBJECTS AND METHODS: Data were obtained from national statistical sources. Standardized mortality ratios (SMR) for breast cancer were estimated by provinces for the periods 1975-1980, 1981-1986 and 1987-1991, and for the whole period 1975-1991. Poisson regression analysis was used to explore the association between breast cancer mortality and the above mentioned variables. Provinces were categorized according to the quintile distribution of independent variables, and ecological relative risks were estimated for each category. RESULTS: Higher SMR were observed in island provinces (Canary and Balearic island), Catalonia, Basque Country, Navarre and the provinces of Saragosa, Seville and Valencia. Lowest SMR were observed in the inner provinces of Spain and the east part of Andalusian region. This pattern has remained very similar along the study period: income level showed a positive association with mortality from breast cancer. On the contrary, percent of women living in rural areas and parity were negatively associated to breast cancer mortality. The relative risk estimated for each child of parity adjusted by the other factors was 0.92 (95% confidence interval: 0.89-0.94). CONCLUSIONS: The highest mortality from breast cancer in Spain has been observed in those provinces with the highest income level, the lowest percent of women living in rural areas and the lowest parity. These findings at the ecological (provinces) level are in concordance with results from other studies at the individual level, and further supports the hypothesis that for the etiology of breast cancer, environmental factors could play a dominant role.

Breast Neoplasms↗

Dairy income and somatic status of pre-school children.

The study was conducted on pre school children of Karnataka to assess the impact of additional income from dairy on somatic status of children. Analysis of data showed that there were no differences with respect to height and weight of children between the study groups. Hence, it was concluded that income from agriculture and income from dairy products either independently or jointly did not influence height for age, weight for age and weight for height for age of the child.

Analysis of Variance↗

The effect of women's labor force participation on the distribution of income in the United States.

The effect of women's labor force participation on income distribution in the United States is reviewed. "Because the wives of highly paid men participate less in the labor force, the earnings of working wives make the distribution of pretax, money income more equal for families than it might otherwise be. Although there is considerable speculation that future developments in women's labor force participation may foster greater inequality, the empirical results are mixed." The factors that need to be considered in future research are outlined.

Americas↗

Use of the Pediatric Symptom Checklist in a low-income, Mexican American population.

OBJECTIVE: To evaluate the usefulness of the Pediatric Symptom Checklist (PSC) in identifying behavioral problems in low-income, Mexican American children. DESIGN: A cross-sectional study design was used to examine the PSC as a screening test, with the Child Behavior Checklist (CBCL) as the criterion standard. SETTING: The study was conducted at a health center in a diverse low-income community. Patients Eligible patients were children and adolescents, 4 to 16 years of age, who were seen for nonemergent, well-child care. Of 253 eligible children during a 9-month study period, 210 agreed to participate in the study. There was a 100% completion rate of the questionnaires. The average age of the children was 7.5 years, and 45% were female. Ninety-five percent of patients were of Hispanic descent (Mexican American); 86% of families spoke only Spanish. Socioeconomic status was low (more than three fourths of families earned <$20 000 annually). RESULTS: The CBCL Total scale determined that 27 (13%) of the children had clinical levels of behavioral problems. With a cutoff score of 24, the PSC screened 2 (1%) of the 210 children as positive for behavioral problems. Using the CBCL as the criterion standard, the PSC sensitivity was 7.4%, and the specificity was 100%. Receiver operator characteristic analysis determined that a PSC cutoff score of 12 most correctly classified children with and without behavioral problems (sensitivity, 0.74; specificity, 0.94). CONCLUSIONS: When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.

Adolescent↗

Lower risk of overweight in school-aged food insecure girls who participate in food assistance: results from the panel study of income dynamics child development supplement.

BACKGROUND: A quarter of US children are at increased risk of obesity-related health problems because of excess weight. The few national studies of child overweight and inadequate household resources available to purchase healthy foods, or food insecurity, have shown inconsistent results. We hypothesized that the inconsistency in these results may be attributed to a differential effect of participation in food assistance programs in food secure and food insecure households. METHODS: Using the 1997 Panel Study of Income Dynamics Child Development Supplement, we compared the risk of a child aged 5 to 12 years being at or above the 85th percentile of body mass index for age in food insecure and food secure, low-income households when controlling for participation in the Food Stamp Program and the national school lunch and breakfast programs as well as other covariates. RESULTS: We found that food insecure girls who participated in all 3 programs had a 68% reduced odds (odds ratio, 0.32; 95% confidence interval, 0.12-0.77) of being at risk of overweight when compared with food insecure girls in nonparticipating households and controlling for other factors. Girls in food secure households generally had no greater or less risk of overweight if they participated in any or all programs. Boys in both food insecure and food secure households had no greater or less risk of overweight by if they participated in any or all of the programs. CONCLUSIONS: These results support our hypothesis that food assistance programs play a protective role for low-income children's health, particularly in girls in food insecure households.

Body Mass Index↗

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children.

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.

Adult↗