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The effect of income and race on quality of psychiatric care in community mental health centers.

This study examined the relationship between quality of mental health care provided by community mental health centers (CMHCs) and the poverty and racial mix of neighborhoods. Indicators of quality of care were constructed by examining service mix and prescription patterns for adult patients with schizophrenia during fiscal year 1996. CMHCs in high income, Caucasian areas were found to have higher quality of care indicators than those in low income, African American areas; i.e., higher percentage of patients on atypical antpsychotic prescriptions (47% vs. 33%) and higher percentage using intensive case management (ICM) services (67% vs. 29%). Questions arise regarding the factors underlying this phenomena and the extent to which they are provider-driven or due to patient preferences.

Antipsychotic Agents↗

Acculturation, income, education, safety belt use, and fatal motor vehicle crashes in California.

This paper investigates the role that acculturation, income, and education play in safety belt nonuse among Californian drivers involved in fatal Motor Vehicle Crashes (MVCs). To achieve this goal, measures of acculturation, income, and education were stochastically incorporated into the Fatality Analysis Reporting System (FARS). Using the 1990 California Tobacco Survey and U.S. Census data, we estimated the combination of zip-code-based measures that most accurately predicts an individual, language-based acculturation index for Hispanics and Asians. Logistic regression was used to investigate the role of these variables in safety belt nonuse in fatal MVCs. We found that acculturation has a positive direct effect on safety belt use among Hispanics. We hypothesize that this positive direct effect is caused by Hispanic immigrants learning the benefits of wearing safety belts. However, our study also suggests an indirect negative effect of acculturation on safety belt use through drinking and driving. Prevention programs aimed at increasing the safety of Hispanic drivers not only need to take acculturation differences into account, but also need to be comprehensive in their message, simultaneously targeting both seat belt nonuse and drinking-and-driving problems.

Accidents, Traffic↗

The planning of pregnancy among low-income women in central Harlem.

A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, we have compared the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal mental health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The two groups did not differ in any other risk factor or in outcome in terms of birth weight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly based interventions that are not confined to the periconceptional period.

Educational Status↗

Inner-city hospital closures/relocations: race, income status, and legal issues.

Hospital closures/relocations are occurring with increasing frequency in the United States and these actions are alleged to have adverse consequences for racial-minorities and low-income individuals. This paper through an examination and review of the literature discusses the reasons why hospitals close/relocate, examines the legal issues and questions that have arisen over decisions leading to hospital closures/relocations and discusses the implications of hospital closures/relocations on the health care of inner-city minorities and low-income individuals. The conclusion suggests that for inner-city indigents hospital closure/relocations means only one thing--a decline in hospital care. If the present trend in hospital closures/relocations continues, a few for-profit hospital chains may have the responsibility for determining community health needs based on what services are most profitable and who will be the recipient of these services.

Economics, Hospital↗

User fees, demand for children's health care and access across income groups: the Philippine case.

This paper examines the potential effects of user fees on the demand for child health care across income groups. A mixed/conditional logit model of provider choice is estimated using national data from the Philippines. The model explicitly allows for price elasticity to be dependent upon income. The results indicate that price plays a significant role in the demand for child health care and that medical care demand for poorer children is substantially more price sensitive than it is for richer children. The notion that user fees are regressive is therefore supported.

Adolescent↗

Crime as a source of income for narcotic addicts.

Although it has been well documented that narcotic addicts derive the bulk of their income from criminal activities and that there are major differences between black and white addicts, interview data presented in this paper show little difference between the two races with respect to the degree of dependence on criminal income. However, the results also highlight the diversity among narcotic addicts in that there are some individuals who derive none of their funds from illegal sources, thus suggesting that not all addicts should be treated in the same manner.

Black or African American↗

Patterns and perceptions of ecstasy use among young, low-income women.

A significant number of young, low-income women experiment with ecstasy outside of club or rave settings. The current study examined patterns and risk factors of ecstasy use among this group of women. A cross-sectional survey was conducted among 696 women aged 18 to 31 who sought gynecological care from two university clinics in southeast Texas between December 1, 2001, and May 30, 2003. Fifteen percent of participants reported ever using ecstasy. Of those, over 90% used it at a friend's home. Compared with women who used only marijuana or other illicit drugs, ecstasy users were more likely to be white, use a larger number of other drugs, be willing to use drugs in the future, and have more friends who used drugs. Fewer ecstasy users strongly disapproved of adult drug use than users of other illicit drugs. Future interventional efforts should target young, low-income women to prevent future experimentation with illicit drugs.

Adolescent↗

Brief report: Disposable income, and spending on fast food, alcohol, cigarettes, and gambling by New Zealand secondary school students.

We describe self-reported sources of income and expenditure, and the association between part-time employment and spending on fast food, alcohol, cigarettes, and gambling for a sample of 3434 New Zealand (NZ) secondary school students (mean age 15.0 years). Disposable income was usually received from parents and guardians, but nearly 40% of students also reported receiving money from part-time employment. The proportion of students employed increased as socioeconomic rating increased, and was associated with increased purchasing of fast food and alcohol, and increased spending on cigarettes and gambling. Spending by youth has obvious public health implications, particularly when it is concentrated on products that have a negative health impact.

Adolescent↗

The prevention of depressive symptoms in low-income, minority children: two-year follow-up.

We present 2-year follow-up data on the efficacy of the Penn Resiliency Program (PRP), a school-based depression prevention program, with low-income, racial/ethnic minority children. This program taught cognitive and social problem-solving skills to 168 Latino and African American middle school children who were at-risk for developing depressive symptoms by virtue of their low-income status. We had previously reported beneficial effects of the PRP up to 6 months after the conclusion of the program for the Latino children, but no clear effect for the African American children. In this paper, we extend the analyses to 24 months after the conclusion of the PRP. We continue to find some beneficial effects for the Latino children and no differentially beneficial effect for the African American children. Implications of findings and future research directions are discussed.

Adaptation, Psychological↗

Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention.

Burn prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs), such as the United States, due to sustained research on the descriptive epidemiology and risk factors, the same cannot be said of developing or low- and middle-income countries (LMICs). To move from data to action and assist preventive efforts in LMICs, a review of the available literature was conducted to assess the current status of burn preventive efforts. A MEDLINE search (1974-2003) was conducted on empirical studies published in English on the descriptive epidemiology, risk factors, treatment, and prevention of burns in LMICs. Review of the 117 identified studies revealed basically the same descriptive epidemiological characteristics but slightly different risk factors of burns including the presence of pre-existing impairments in children, lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding as well as several treatment modalities and preventive efforts including immediate application of cool water to a burned area. Continuous evaluation of promising interventions and those with unknown efficacy that have been attempted in LMICs, along with testing interventions that have proven effective in HICs in these LIMC settings, is needed to spearhead the move from data to action in preventing burns in LMICs.

Adult↗

Impact of race, age, income, and residence on prostate cancer knowledge, screening behavior, and health maintenance in siblings of patients with prostate cancer.

OBJECTIVE: This study evaluates self-reported changes in knowledge of prostate cancer (CaP), CaP screening behavior and other health-related activities in men whose brothers have been diagnosed with prostate cancer and to characterize those demographic subgroups of siblings at particular risk of failure to change their behavior. METHODS: 112 men were surveyed to self-assess their knowledge of CaP both before and after their brother's diagnosis. In addition, siblings were questioned with regard to other health-related behaviors before and after their brother's diagnosis. Demographic characteristics including age, race, income, and area of residence were also reported. Results were analyzed to determine how a brother's diagnosis with CaP affects changes in prostate cancer knowledge, screening behavior and other health related activities in these high-risk patients. RESULTS: The impact of a brother's diagnosis of CaP affects only 40% of siblings with regard to CaP knowledge. This knowledge appears to translate into increased screening behavior and other-health-related activity in these men. Unfortunately, more than half of men have no change in CaP knowledge and correspondingly no change in screening behavior. Siblings who are older, earn less, and live in rural areas have a lower baseline knowledge of CaP and are less likely to improve their self-assessed knowledge. On regression analysis, correlates of improvement in CaP knowledge included (1) those discussing with their primary physician (OR=6.6), (2) Caucasians (OR=2.7) and (3) non-smokers (OR=3.1). Improvements in prostate cancer knowledge were found to be predictive of subsequent participation in CaP screening and annual physical exams. CONCLUSIONS: Increased attention should be paid to siblings of CaP patients in efforts to improve their knowledge and thereby participation in screening as these patients are at an increased risk of development of this disease. Efforts should be made to educate siblings who are older, of lower income, African American, and rural residents with regard to CaP, as these subgroups appear less likely to change their knowledge and screening behavior despite their sibling's diagnosis.

Age Factors↗

Obesity rates, income, and suburban sprawl: an analysis of US states.

In a decade of economic growth and rising income, obesity has risen dramatically. This is puzzling when researchers have found that there is an inverse relation between income and obesity. This paper argues that new location patterns produced by suburban sprawl are an important cause of rising obesity rates. New location patterns are such that work, school and social activities are not as easily accessible by foot. Changes in sprawl then drive changes in the causes of obesity identified by medical researchers (e.g., low activity levels). We define sprawl as increases in the amount of developed land, holding population constant. Determinants and outcomes are analyzed on a population basis. We use state-level data from the 1990s on obesity to show that states that increased the amount of developed land (holding population constant) showed larger increases in obesity. As a result, town planning efforts to reduce sprawl may be justified not only on aesthetic grounds but also based on efforts to reduce the costs associated with treating medical conditions related to obesity.

Aged↗

Income and health inequality across Canadian provinces.

This paper uses the aggregate data from the Public Use Microdata Files (PUMF) of Canadian National Population Health Survey to estimate income related health inequalities across the ten Canadian provinces. The unique features of the PUMF allow for a meaningful cross-provincial comparison of health indices and their measured inequalities. It concludes that health inequalities favouring the higher income people do exist in all provinces when health status is either self assessed or measured by the health utility index. Moreover, it finds considerable variations in measured health inequalities across the provinces with consistent rankings for certain provinces.

Canada↗

The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time.

This paper examines the determinants of real per capita health expenditures in order to assess the impact of age distribution, income and time using American state-level data for the period 1980-1998 and Canadian province-level data for the period 1975-2000. Ageing population distributions and income explain a relatively small portion of health expenditures when the impact of time effects, which is a partial proxy for technological change, is controlled for. However, the impact of age is of more concern given that cost increases are concentrated in the last few years of life and there may be cohort effects as the "Baby-Boom" generation ages. There is an urgent need to better understand the exact mechanisms driving health expenditure increases given that time accounts for approximately two-thirds of health expenditure increases and that its effect is non-linear.

Age Distribution↗

The effects of a patient shortage on general practitioners' future income and list of patients.

The literature on physician-induced demand (PID) suffers from an inability to distinguish between the effect of better access and the effect of patient shortage. Data from the Norwegian capitation trial in general practice give us an opportunity to make this distinction and hence, study whether service provision by physicians is partly income-motivated. In the capitation trial, each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and a fee for service. The data set has information on patient shortage, i.e. a positive difference between a GP's preferred and actual list size, at the individual practice level. From a model of a GP's optimal choice we derive the GP's optimal practice profile contingent on whether the GP experiences a shortage of patients or not. To what extent GPs, who experience a shortage, will undertake measures to attract patients or embark on a service-intensive practice style depends on the costs of the various measures relative to their expected benefit. The model classifies GPs into five types. In the empirical analysis a panel of GPs is followed for 5 years. Hence, transitory effects should have been exhausted. We show that GPs who experience a shortage of patients have a higher income per listed person than their unrationed colleagues.

Family Practice↗