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PubMedDate not supplied

Managing the electronic NIH-guide for grants and contracts.

This article describes the implementation of a suite of computer programs to manage and provide access to a database containing the electronic documents that constitute the NIH-Guide that is distributed by the NIH on a weekly basis. The software consists of a management program that reads, processes, and stores the incoming documents and performs erratum updates on existing documents; an alerting program that sends selected information to users who have registered their information needs; a viewer that can be used on the local computer to read these documents; and a World-Wide-Web (WWW) server that can distribute the guide to computers that run WWW client software. The design of the documentation annotations, the management software, and the WWW server are expected to constitute valuable models for similar projects in the future.

Feasibility Studies↗
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↗
PubMed2006

Parents' willingness to pay for diminishing children's pain during blood sampling.

BACKGROUND: Blood sampling is a frequent medical procedure, very often considered as a stressful experience by children. Local anesthetics have been developed, but are expensive and not reimbursed by insurance companies in our country. We wanted to assess parents' willingness to pay (WTP) for this kind of drug. PATIENTS AND METHODS: Over 6 months, all parents of children presenting for general (GV) or specialized visit (SV) with blood sampling. WTP was assessed through three scenarios [avoiding blood sampling (ABS), using the drug on prescription (PD), or over the counter (OTC)], with a payment card system randomized to ascending or descending order of prices (AO or DO). RESULTS: Fifty-six responses were collected (34 GV, 22 SV, 27 AO and 29 DO), response rate 40%. Response distribution was wide, with median WTP of 40 for ABS, 25 for PD, 10 for OTC, which is close to the drug's real price. Responses were similar for GV and SV. Median WTP amounted to 0.71, 0.67, 0.20% of respondents' monthly income for the three scenarios, respectively, with a maximum at 10%. CONCLUSIONS: Assessing parents' WTP in an outpatient setting is difficult, with wide result distribution, but median WTP is close to the real drug price. This finding could be used to promote insurance coverage for this drug.

Adolescent↗
PubMed1997

Studying ulcerative colitis over the World Wide Web.

OBJECTIVES: The Internet may provide a cost-effective means to collect outcomes data needed to improve the quality and efficiency of medical care. We explored the feasibility and methodology of a longitudinal outcomes study of Internet users who have ulcerative colitis (UC). METHODS: We created an open-enrollment electronic survey of Internet users who have UC and recorded the number of respondents, their demographics, and their willingness to participate. RESULTS: In a 2-month period, 582 users browsed the survey, 172 (30%) completed the questionnaire, and 162 (95%) reported willingness to enroll this study. Eighty-three percent were willing to release their medical records to verify their diagnosis. Most (> 70%) had the same E-mail address over 2 yr, suggesting that long-term follow-up could be performed electronically. In comparison with the male predominance of Internet users, respondents had gender distribution similar to that of patients who have UC. In comparison with the general population, respondents have higher education and higher household income. CONCLUSIONS: The Internet community could serve as a resource for general population outcome studies. Selection bias due to limited availability and use of the networked computers may affect results. The Internet community, however, is expanding rapidly, so it should become more representative of the general population.

Adult↗
PubMedDate not supplied

Evaluation of two strategies for heart health promotion by direct mail in a low-income urban community.

BACKGROUND: The objective of this study was to evaluate the reach of mass mailings of heart health education print materials in a low-income, urban community. Materials included a monthly newsletter and a self-help behavior change kit, both distributed to all 12,789 households in the study community. METHODS: Recall, use, and self-reported impact of the materials were measured in a cross-sectional survey of a random sample of 345 adults conducted 2 weeks after distribution of the kit and 18 months after delivery of the first newsletter. RESULTS: Over one-third of the subjects (38.6%) recalled the newsletter and 27.9% had read one or more newsletters; 21.7% recalled the kit and 10.8% had read it. Few subjects had read both materials. Female gender and older age were independent correlates of having seen and read the newsletters. Older age, being widowed/separated/divorced, and infrequent physical activity were correlates of having seen and read the kit. CONCLUSIONS: Although the newsletter and kit formats might appeal to different segments of the population, mass mailings of heart health education print materials in a low-income urban community can reach large numbers of individuals. The cost effectiveness of repeated mailings of short, simple newsletters might be higher than a single mailing of a more complex behavior change kit.

Adolescent↗
PubMed1988

City size, quality of life, and the urbanization deflator of the GNP: 1910-1984.

The authors attempt to determine the net effect of city size on quality of life by developing a welfare measure of urbanization. "The estimation procedure suggested in the theoretical part of the paper (section II) is implemented in the empirical part (section III) using 1980 census data from the [U.S.] PUMS (Public Use Micro Data Sample). The results indicate there is no single optimal city size, but rather a worst city size, and about 90 percent of the U.S. population reside in cities smaller than worst city size. If quality of life is related to the degree of urbanization, then long-term trends in the locational distribution of the population should be accounted for in any welfare-oriented measure of national income. One application of our results is, as indicated, the derivation of a GNP welfare deflator reflecting changes in the degree of urbanization (section IV). The findings suggest an urban deflator on the order of six to seven percentage points, which is steadily increasing at a rate of about half a percentage point per decade."

Americas↗
PubMed1999

Medical students and debt: a survey of students at the School of Medicine, University of Auckland.

AIMS: To assess the extent of Auckland medical students' debt, the types of debt accrued and to establish data on part-time employment, income, parental support and living circumstances for these students. METHODS: Medical students at the University of Auckland were asked to complete a written survey questionnaire, which was distributed in lecture classes for years 1-5 and by mail for year 6. The questionnaire asked about biographical data, types and amounts of debt, the use of student loan scheme money, employment, income, student allowances, parental financial support and living situation. Students not sent the survey by mail were informed about the survey several days prior to receiving it to enable them to collate the necessary financial information. Data entry was completed via an electronic scanning system and questionnaire responses were analysed using a tabular analysis of the various classes. RESULTS: There were 522 responses received, comprising 73% of students (48% male, 52% female). The major source of debt was to the Government student loan scheme (39% of students in year 1, rising to 75% in year 6). Average (median) debt to the Government loan scheme rises from $5000 in year 1 to $26,000 in year 6. Fourteen per cent of students receive a targeted student allowance and 30% have a part-time job. Average summer vacation earnings do not exceed $4000. Thirty-four percent receive no financial support from their parents and 18% receive support with some costs only. With the exceptions of students in year 1, more than 50% of students live away from home. CONCLUSION: Medical students are predominantly in debt to the Government student loan scheme and the level rises by approximately $5000 per year from year 1 to year 6. It is expected that these levels will increase in the future.

Adult↗
PubMed1977

Marital instability and the economic status of women.

This paper uses longitudinal data from the Panel Study of Income Dynamics to examine the relationship between changes in marital status and economic status. Differences between men and women and between whites and blacks are also considered. A major finding is that, after adjusting for changes in family size, the economic status of divorced or separated men improves, while that of women declines. Components of income change are discussed, with special emphasis on changes in the labor force and welfare status of women who were divorced or separated during the analysis period. Finally, data on the magnitude and distribution of alimony/child-support payments are presented.

Child Care↗
PubMed2005

The influence of parent education and family income on child achievement: the indirect role of parental expectations and the home environment.

This study examined the process of how socioeconomic status, specifically parents' education and income, indirectly relates to children's academic achievement through parents' beliefs and behaviors. Data from a national, cross-sectional study of children were used for this study. The subjects were 868 8-12-year-olds, divided approximately equally across gender (436 females, 433 males). This sample was 49% non-Hispanic European American and 47% African American. Using structural equation modeling techniques, the author found that the socioeconomic factors were related indirectly to children's academic achievement through parents' beliefs and behaviors but that the process of these relations was different by racial group. Parents' years of schooling also was found to be an important socioeconomic factor to take into consideration in both policy and research when looking at school-age children.

Achievement↗
PubMed1993

The Behavioral Risk Factor Surveillance System questionnaire: its reliability in a statewide sample.

The reliability of the Behavioral Risk Factor Surveillance System questionnaire was assessed in a random sample of adults (n = 122) and a separate sample of Black and Hispanic adults (n = 200) in Massachusetts. The questionnaire was administered twice, 21 to 44 days apart, by telephone (210 completed reinterviews, 65% response rate for second administration). There were no statistically significant differences in the distribution of demographic or risk factor variables across administrations. Individual-level reliability (kappa for categorical variables, correlation for continuous variables) for demographic characteristics was more than 0.80 for White respondents and more than 0.60 for Black and Hispanic respondents. Employment and income were reported less consistently than other variables. Reliability coefficients for behavioral risk factors were generally above 0.70. Exceptions were variables with extreme distributions. These data support the use of the Behavioral Risk Factor Surveillance System questionnaire for surveillance and research.

Adult↗
PubMed1984

The sociodemographic characteristics of Mexican immigrant status groups: implications for studying undocumented Mexicans.

"Based on Warren and Passel's...estimate that nearly two-thirds of Mexican-born noncitizens entering the U.S. during 1975-80 and included in the 1980 Census are undocumented immigrants, this article uses the 1980 Public Use Microfiles to delineate four Mexican origin immigrant status groups--post 1975 Mexican-born noncitizens, pre-1975 Mexican-born noncitizens, self-reported naturalized citizens, and native-born Mexican-Americans." It is found that "the pattern of sociodemographic differences among these groups provides support for the idea that the first two categories contain a substantial fraction of undocumented immigrants. These two groups (especially the first) reveal characteristics that one would logically associate with undocumented immigrants--age concentration (in young adult years), high sex ratios, low education and income levels, and lack of English proficiency."

Age Distribution↗
PubMed1998

Olubunmi Fape.

Explore the source record for details and available documents.

Advertising↗
PubMedDate not supplied

Urban employee health insurance reform and the impact on out-of-pocket payment in China.

Since the middle of the 1990s, China has undertaken a significant reform in urban employee health insurance programs. Using data from the pilot experiment conducted in Zhenjiang, this study examines changes in the pre- and post-reform distributions of out-of-pocket (OOP) expenditures across four representative groups by chronic disease, income, education, and job status. Major findings suggested increased OOP expenditures for all groups after the reform. However, the redistributions in OOP appear to be in favor of the disadvantaged groups, suggesting a more equitable change led by the reform. This study concludes that the post-reform insurance model did not compromise equity in cost-sharing while containing cost inflation and increasing insurance coverage for the urban population.

China↗
PubMed2005

Examining the relationships among built environment, physical activity, and body mass index in El Paso, TX.

OBJECTIVE: The current study examined the relationships among built environment, physical activity, and body mass index (BMI) in a primarily Hispanic border community in El Paso, TX. METHODS: Data from a 2001 community-wide health survey were matched to environmental data using geocoding techniques in ARC VIEW software. A total of 996 adults were surveyed by phone and 452 were successfully geocoded. RESULTS: The sample was 71% female, 79% Hispanic, 42 +/- 17 years old, moderately acculturated, and had socioeconomic status (SES) levels of semi-skilled workers. Increasing BMI was related to less moderate intensity physical activity (P = 0.05), higher SES (P = 0.0003), worse overall health (P = 0.0004), and living in areas with greater land-use mix (less residential; P = 0.03). The relationship between overall health and BMI was in part mediated by higher numbers of barriers to physical activity in those with poor health, which lead to a decrease in moderate physical activity. These variables explained 20% of the variance in BMI. CONCLUSIONS: This is one of the first studies to find a positive relationship between land-use mix and BMI in a predominantly Hispanic, low-income community. The positive association between BMI and land-use mix may be due to the inclusion of individual SES as a controlling variable in the analyses, suggesting that SES may have a differential effect on how the built environment influences BMI in low- to moderate-income minority communities.

Age Distribution↗
PubMed2006

Food insecurity in community-dwelling older Australians.

OBJECTIVE: To identify the extent of food insecurity (defined as running out of food in the last 12 months and being unable to afford to buy more) amongst older Australians, and the characteristics of those who experience this condition. DESIGN: Cross-sectional population survey. SETTING AND SUBJECTS: Respondents (n = 8,881) were community-dwelling older people (65 years and older) living independently in New South Wales, Australia, randomly sampled to participate in a computer-assisted telephone interview conducted during 1999-2000. The response rate was 71%. Responses to a food insecurity questionnaire item were collected along with sociodemographic information, living arrangements, lifestyle and self-rated health. Univariate analyses and logistic regression modelling of factors for reporting food insecurity were conducted. RESULTS: Approximately one in 50 older people reported experiencing food insecurity in the previous 12 months attributable to inadequate finances. The analyses revealed that those at risk can be identified as more likely to report poorer health, limited financial resources, not owning their own home and living alone. Gender and age differences were also evident. CONCLUSION: While only a minority of older Australians reported experiencing food insecurity attributable to inadequate finances, such people are at higher risk of malnutrition and associated morbidity. Food insecurity is an important public health and equity issue in older people that can be addressed through implementing appropriate income and social support policies.

Age Distribution↗
PubMed1990

Motivational factors for participation in breast cancer screening.

To evaluate motivational factors for participation in a breast cancer screening program and concurrently to examine beliefs regarding carcinoma of the breast held by those participants, we interviewed 135 consecutive women who took part in an American Cancer Society-sponsored breast screening project in an affluent suburb of Philadelphia. Ages were equally distributed between 30 and 69. Interestingly, cost was the greatest priority for patients, regardless of income. Even 50% of those patients reporting incomes in excess of $100,000 were concerned about cost. Additional motivating factors included reassurance if normal, media advertising, physician referral, and family history of breast cancer. Concerns about actually having breast cancer was least important. Additional questions indicated a number of fallacies regarding breast cancer, including relationships to smoking, caffeine, and trauma. We conclude that even in affluent, upper-middle-class populations, problems with education regarding breast cancer exist, and cost remains a primary deterrent to screening. Efforts must be increased to lower the cost of mammography and, at the same time, to improve patient education, perhaps through the appropriate use of the media.

Adult↗
PubMed1980

Financial well-being among the aged: a further elaboration.

This study represents a further elaboration of the relative deprivation model proposed and tested by Liang and Fairchild (1979). A central assumption underlying this inquiry is that the link between economic status and perceived financial adequacy is mediated by subjective interpretations of the situation such as relative deprivation (Stouffer et al., 1948) and distributive justice (Homans, 1961). In addition, the effects of ascribed status variables such as age, sex, race, and religion on the social comparison process are assessed. Data for this investigation came from a survey of 252 older people in the Detroit area. Findings indicate that financial satisfaction is directly influenced by relative deprivation and distributive justice, while it is only indirectly affected by social status, labor force participation, and income. Race and age are the two ascribed statuses which have a significant impact on social comparison and perceived income adequacy. Implications of these results in terms of theory building and the design of income maintenance policies are also suggested.

Aged↗
PubMed1991

Mail versus telephone surveys on mammography utilization among women 50-75 years old.

Surveys are needed to monitor trends in mammography use and to evaluate intervention programs aimed at increasing breast cancer screening. In a community-based intervention project in Long Island (New York), estimated response rates were similar in separate random surveys of women 50-75 years old by mail and telephone. Respondents by mail (n = 2,368) and telephone (n = 1,011) were similar in distributions of age, marital status, and educational level, and mail respondents did not have higher income levels than telephone respondents. Reported utilization of breast cancer screening tests was similar by survey mode. A statistically significant positive association between mammography utilization and income level was evident in both mail and telephone surveys. These findings should promote the consideration of mail surveys in other studies of the utilization of breast cancer screening tests by various health care organizations.

Aged↗