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Locational profiles: incoming veterinary students and outgoing new veterinarians, 1971-78, New York State College of Veterinary Medicine, Cornell University.

Relationships between the demographic areas of incoming veterinary students and first placement locations were examined during 1971-1978 for the New York State College of Veterinary Medicine at Cornell University. Seventy-four percent of the incoming students were New York residents whereas only 52 percent of the graduates selected New York sites for their first placement after graduation. Part of the net loss may be the result of temporary moves into the state to gain residence status, educational preparation and possibly some hope for improving admission eligibility. After completing their veterinary education, they are more likely to return to areas closely associated with family and childhood experiences for first placement choices or for advanced educational offerings. Three demographic classifications were used to identify patterns of movement into and out of the state (Urban, Suburban and Rural). No significant differences in area distribution patterns were observed between incoming and outgoing students/graduates. However, when the data were separated by sex, the outgoing distribution patterns were significantly different for female graduates (Urban and Rural areas preferred over Suburban). Sixty-five percent of the out-of-state placements were in New England and other Northeastern states, with Rural areas showing major strengths.

New England↗

Major histologic types of cancers of the gum and mouth, esophagus, larynx, and lung by sex and by income level.

Incidence rates by income level were computed for squamous cell carcinomas of the gum and mouth, larynx, and esophagus and for squamous cell carcinoma, small cell carcinoma, and adenocarcinoma of the lung in white males and females aged 35--64 years, with the use of data for the nine geographic areas of the Third National Cancer Survey and the 1970 U.S. census. Within sex, age, and geographic area groups, patterns of cancer incidence by income level were analyzed by use of a nonparametric statistical method. Higher rates for males than for females were found for every histologic type studied, and the ratio of male-to-female rates increased with age (especially for squamous cell carcinomas of the larynx and lung). A strong inverse relation to income level was found for all of the histologic types studied in males and for squamous cell carcinomas of the gum and mouth and esophagus and small cell carcinoma of the lung in females. These findings are discussed with reference to patterns of smoking and alcohol use by sex and social class.

Adult↗

Low-income children's after-school care: are there beneficial effects of after-school programs?

4 types of after-school care (formal after-school programs, mother care, informal adult supervision, and self-care) were examined for 216 low-income children (M age = 9.1 years). After-school care was associated with maternal education, race, and family income but not with child gender, family marital status, neighborhood safety, or parenting style. When maternal education, race, and family income were controlled, attending a formal after-school program was associated with better academic achievement an social adjustment in comparison to other types of after-school care. Children's activities and experiences also varied in different after-school settings. Children in formal programs spent more time in academic activities and enrichment lessons and less time watching TV and playing outside unsupervised than other children. They also spent more time doing activities with peers and adults and less time with siblings than did other children. The time that children spent in these activities was correlated with their academic and conduct grades, peer relations, and emotional adjustment.

Child↗

The role of smoking in the lives of low-income pregnant adolescents: a field study.

This study examined the role of cigarette smoking in the lives of low-income, pregnant adolescents. Based on in-depth interviews, subjects' beliefs and attitudes toward smoking are described. The findings indicate that this population smoked to cope with increased weight gain; to deliver smaller infants which in turn would decrease the duration of labor and reduce the pain of delivery; to counteract anxiety arising from feelings of abandonment; and to establish an identity separate from their parents' and peers' drug abuse. These results suggest that low-income, pregnant adolescents perceive immediate benefits from cigarette smoking that outweigh long-term health consequences. It is argued that smoking-prevention programs based on an inaccurate understanding of the social context in which smoking occurs can reinforce the use of tobacco among high-risk, pregnant adolescents. Suggestions are offered to improve prevention programs targeted at low-income, pregnant teenagers.

Adaptation, Psychological↗

Drug use, drug trafficking, and weapon carrying among low-income, African-American, early adolescent boys.

OBJECTIVE: To examine relationships involving three extremely high-risk behaviors (drug use, drug trafficking, and weapon carrying) among low-income, urban, African-American early adolescent boys using both quantitative and qualitative methods. METHOD: The quantitative phase included 192 African-American boys from 9 through 15 years of age recruited from recreation centers located in low-income communities. Youth completed a survey addressing personal risk practices; intentions to engage in risk practices; risk taking among family, friends and community; and values toward risk practices. They also completed standardized assessments of sensation seeking, perceived peer pressure, and parent-child communication. All questionnaires were self-administered through MacIntosh computers programmed to present questions aurally and visually. The qualitative phase included 12 African-American youth from low-income, urban families. The youth participated in 60- to 90-minute interviews regarding drug activities and violence. RESULTS: Most boys (73%) were not involved in either drug activities or weapon carrying. Boys who were involved in drug activities or weapon carrying were often involved in other high-risk activities (cigarette and alcohol use, school failure and expulsion) and had low rates of adaptive communication with their parents. The boys reported high rates of drug involvement by their family, friends, and community. However, psychological and interpersonal factors were better predictors of individual risk activities than community or family variables. Personal values regarding economics predicted drug trafficking. More than 56% of the boys who reported past involvement in drug activities did not anticipate future involvement. CONCLUSIONS: Multilevel strategies are necessary to prevent involvement in drug activities and weapon carrying. Intervention programs should begin early and should promote communication between parents and children, adaptive behavior in school, and avoidance of cigarette and alcohol use. Community-level interventions are needed to alter the myth that drug involvement and weapon carrying are normative and to promote images that are less materialistic and more supportive of education and future-oriented activities.

Adolescent↗

Is cost a barrier to screening mammography for low-income women receiving Medicare benefits? A randomized trial.

BACKGROUND: In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women. METHODS: In an inner-city public hospital's General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10,000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure. RESULTS: Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P < .001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation. CONCLUSION: In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.

Aged↗

Cholesterol-related knowledge, attitudes, and behaviors in a low-income, urban patient population.

To determine knowledge, attitudes, behaviors, and self-reported cholesterol measurement in a low-income, urban patient population, we conducted an interview survey of users and potential users of primary care services in a public health care system for low-income Harris County, Texas, residents. The response rate was 93%, with a final sample of 547 randomly selected subjects 18 years of age and older, who were Hispanic (54%), black (28%), non-Hispanic white (14%), and Asian, Native American, or other (4%). Results indicated that 76% had heard of serum or blood cholesterol, and 30% reported past cholesterol measurement. Knowledge that dietary saturated fat can raise blood cholesterol ranged from 11% in Hispanic men to 51% in non-Hispanic white men and women. A lower percentage of Hispanics correctly answered all knowledge questions, and Hispanics reported higher-fat food choices than blacks and non-Hispanic whites. More than 90% of the respondents expressed interest in more information on diet, 60% reported that they read nutrition labels, and 15% said they have been trying to reduce blood cholesterol levels. A lower percentage of Hispanics reported previous cholesterol measurement than blacks or non-Hispanic whites, a difference that persisted after adjusting for multiple factors associated with cholesterol measurement. Older age (older than 50) and more physician visits in the past year also were associated with past cholesterol measurement. Comparisons with national surveys show that cholesterol knowledge and actual measurement in this low-income sample lag behind those of the national population. Yet, despite gaps in knowledge and cholesterol measurement, respondents showed positive attitudes about and interest in cholesterol-lowering interventions.

Adolescent↗

The effect of expansions in Medicaid income eligibility on abortion.

In this paper we examine the effect of expansions in Medicaid income eligibility on abortion, using individual-level data from South Carolina, Tennessee, and Virginia. The results suggest that for unmarried nonblack women with less than a high school degree, expansions of income eligibility lowered the probability of abortion by two to five percentage points. Most of the impact of the Medicaid expansions on abortion occurred in the first round of expansions from approximately 45% of the federal poverty level to 100%. For black unmarried women with less than a high school degree, we generally find no effect of expansions in Medicaid income eligibility on abortion.

Abortion, Induced↗

Income protection for the aged in the 21st century: a framework to help inform the debate.

It is becoming increasingly difficult worldwide for the aged to sustain a minimum level of income protection into retirement. Rapidly aging populations and lower fertility rates are creating serious fiscal strains on current social insurance systems. A report issued by the World Bank maintains that countries whose primary mechanism for providing old-age income protection is a publicly managed social insurance system will experience significant difficulties unless they make structural changes in their programs. Actuarial estimates indicate that benefit payments in the United States could in fact exceed income to the Old-Age and Survivors Insurance (OASI) Trust Fund by 2029 and a variety of proposals to address this problem are being advanced. We suggest a framework to evaluate such proposals based on a set of core values (fairness, adequacy, and efficiency) and analyze some of the proposed changes both in relation to how they have been employed in other countries and within the context of the framework. The purpose of this article is to inform and help structure a most important debate.

Actuarial Analysis↗

Inequities in access to and utilisation of primary medical care services for Maori and low income New Zealanders.

AIM: To determine the rates of utilisation and expenditure on primary medical care and related services for Maori and low income New Zealanders and to compare these rates with the average for New Zealand. METHODS: Data for the 1994/95 financial year were obtained from Health Benefits Ltd (HBL) for GMS payments in community service card (CSC) categories, laboratory and pharmaceutical expenditure and utilisation of general practitioner related ACC services from ACC. Data were also obtained from various sources to fill gaps including actual general practitioner related expenditure. Eight health centres serving predominately Maori but also low income groups totalling nearly 50,000 people provided data on their practice registers, GMS type utilisation and expenditure on laboratory and pharmaceutical services. These data were age and CSC adjusted by GMS category to permit valid comparisons with the national data. RESULTS: There were an estimated 15.77 million general practitioner consultations in 1994/5, a rate of 4.46 consultations per capita. Expenditure per capita on GMS, ACC, laboratory and pharmaceutical services was estimated to be $63.07 per consultation and $281.27 per capita. By comparison the rates of utilisation in all the centres studied were substantially lower than these national figures both overall and in all CSC groups. Adjusting for age and CSC status total expenditure on primary medical care and related services for these centres was only about 40% of the national average. Total average income per consultation, including GMS, ACC and patient fees, ranged from $16.52 to $21.71 a level which, especially for patients with often complicated health problems needing prolonged consultations, was unsustainably low. CONCLUSION: This study confirms gross underutilisation of and expenditure on primary medical care and related services to Maori and other New Zealanders in poor circumstances. It also confirms what has been known by general practitioners for a long time, that they are required to subsidise many Maori and poorer patients who face financial and other barriers in accessing their services. Practices servicing poorer populations cannot subsidise these patients from their fewer better off patients. The small advantage of the CSC is largely offset by the reduced subsidy from ACC. Poor access to and utilisation of primary care services is likely to be a significant factor in the high use of hospital inpatients services by the groups studied. A radical review is required of the current problems of financial access if health services are to have a better chance of improving the health status of disadvantaged New Zealanders.

Fees, Medical↗

Determinants of functional health of low-income black women with osteoarthritis.

This study examines 10 culturally relevant indices of physical, psychological, and social function in order to specify and quantify their influence on the multidimensional functional health of low-income Black older women who have a medical diagnosis of osteoarthritis and no known history of coexisting medical conditions that would cause severe debilitation. Using a non-experimental, correlational design, cross-sectional data were obtained in individual face-to-face interviews. A nonprobability sample of 100 low-income, community-living Black older female participants of two local senior centers were interviewed for analysis. Functional health was measured with the Arthritis Impact Measurement Scales 2; physical function by body mass index, number of arthritic joints, and a timed 8-foot walk score; psychological function with scores for the Short Portable Mental Status Questionnaire, Geriatric Depression Scale, and Spiritual Perspective Scale; and social function by the sociodemographics of age, income, years of education, and household size. Multiple regression analysis data indicated that functional health was best explained by three interrelated variables: depression, timed 8-foot walk score, and number of arthritic joints. This combination of variables explained 45% of the variance in functional health. Depression was highly correlated with other predictors and explained the largest amount of variance. Findings emphasize the need for enhanced education of providers to stimulate development of health promotion/disease prevention programs that will decrease the occurrence and effects of depression, joint pathology, and physical immobility, thereby improving health-related outcomes for Black older women who have osteoarthritis.

Activities of Daily Living↗

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women.

PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.

Adolescent↗

Alcohol and drug CAGE screeners for pregnant, low-income women: the California Perinatal Needs Assessment.

The purpose of this study is to evaluate a revised CAGE and a new drug version of the CAGE as screeners for risk of heavier or problem alcohol and/or drug use among a population of low-income, pregnant women and adolescents (n = 1147) recruited from 19 agencies in two California counties. Two versions of the CAGE were used in this analysis: (1) the 4-item Alcohol CAGE, using the year before knowing about pregnancy as the timeframe (as opposed to lifetime prevalence), and (2) a newly developed 4-item Drug CAGE using the same timeframe. The two instruments were assessed on sensitivity, specificity, and area under the receiver operating characteristic curve by using self-reported periconceptional heavier or problem alcohol and drug use as the criteria for the 12 months before knowing about the pregnancy. The results indicate that, for the Alcohol CAGE, the cut-point of 1 yielded the highest sensitivity, while maximizing sensitivity and specificity (receiver operating characteristic analysis) for this sample. For heavier drug use, the Drug CAGE had a high sensitivity rate with a cut-point of 3. The Drug CAGE was not a useful screener for periconceptional lighter drug and marijuana use. These results demonstrate the utility of a revised version of the Alcohol CAGE that incorporates a more specific timeframe (the year before pregnancy) to screen pregnant, low-income women for at-risk heavier or problem alcohol use. The Drug CAGE, which uses the same timeframe, seems to be an effective tool for identifying pregnant, low-income women at risk for heavier drug use only. More psychometric works needs to be done to refine the Drug CAGE for detecting at-risk use of lighter drugs and marijuana.

Adolescent↗

Options for aiding low-income Medicare beneficiaries.

This paper examines the effectiveness of the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) programs that seek to ease the financial burdens of health costs on low-income Medicare beneficiaries. While participation in these programs has been increasing steadily over time, much remains to be done to extend benefits to all those currently eligible. This paper estimates levels of participation in the existing programs and considers several scenarios under which participation could be increased further, including federalizing the existing programs, raising or eliminating asset limits, and raising income ceilings.

Eligibility Determination↗

Age structure and income distribution policy.

The dependence of earnings on age is a firmly established empirical fact. A simple microeconomic model of educational choice, being consistent with this observation, is designed. The model lends itself readily to aggregation over individuals and age groups. Thus, relations can be set up between economic variables influencing the aggregate distribution of labor incomes and demographic variables determining the age structure of the population. The main results of the present study are: 1) overall earnings inequality is shown to be an increasing function of life expectancy and a decreasing function of fertility. 2) The effectiveness of redistributive policies is sensitive to the age composition. In particular, the inequality-reducing effect of a 1% income tax rise is shown to be smaller the older the population.

Age Distribution↗

Evaluating the pin money hypothesis: the relationship between women's labour market activity, family income and poverty in Britain.

"In this paper we evaluate the hypothesis that the over-representation of women amongst the low paid is of little importance because women's earnings account for only a small proportion of total family income. Data from the [United Kingdom] General Household Survey (GHS), together with attitudinal evidence from three cross-sectional data sources, indicate that women's earnings are in fact an important and growing component of family income. The majority of the growth in the share of women's earnings occurs as a result of changing family labour structures; women's earnings are playing an increasingly important role in keeping their families out of poverty."

Developed Countries↗

Training, migration, and regional income disparities.

"It is assumed that there are two regions, that production requires both skilled and unskilled labour, and that one region is innately more productive than the other. Workers, who differ in their migration or training costs, make individually rational decisions. In equilibrium the ratio of skilled workers to unskilled workers is always higher in the more productive region. Average incomes differ between regions because regional differences in wage rates are reinforced by regional differences in the structure of employment. The model is also used to analyse the effects of policies intended to equalize the distribution of income."

Demography↗

Economic policy and income distribution in China.

"Using the Kakwani interpolation method to reconstruct rural and urban size distributions, the authors present Lorenz curve estimates for Chinese income distribution by period, 1952-1986. The level of inequality is one of the lowest in the world. The change in inequality over time conforms to the experience of other less-developed countries. Although rural inequality increased after 1978, national inequality fell, due to a reduction in the rural-urban income gap."

Asia↗