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PubMed2000

Attitudes toward nurse practitioners: influence of gender, age, ethnicity, education and income.

Survey research was undertaken to measure relationships between gender, age, ethnicity, education, income level, and an individual's attitude toward using a nurse practitioner (NP) for health care. Pender's Health Promotion Model provided the theoretical basis for the research initiative and instrument design. Following initial pilot work, 238 individuals were surveyed. While no significant differences on the basis of gender and race were found, high school graduates demonstrated significantly more positive attitudes toward NPs than non-high school graduates, and older subjects and those with lower incomes were less positively inclined to use NP services. These findings have implications for the marketing of NP services, NP education, and public education, and should be used as a basis for additional research in this area.

Adolescent↗
PubMed2000

A minimum income for healthy living.

BACKGROUND: Half a century of research has provided consensual evidence of major personal requisites of adult health in nutrition, physical activity and psychosocial relations. Their minimal money costs, together with those of a home and other basic necessities, indicate disposable income that is now essential for health. METHODS: In a first application we identified such representative minimal costs for healthy, single, working men aged 18-30, in the UK. Costs were derived from ad hoc survey, relevant figures in the national Family Expenditure Survey, and by pragmatic decision for the few minor items where survey data were not available. RESULTS: Minimum costs were assessed at 131.86 pound sterling per week (UK April 1999 prices). Component costs, especially those of housing (which represents around 40% of this total), depend on region and on several assumptions. By varying these a range of totals from 106.47 pound sterling to 163.86 pound sterling per week was detailed. These figures compare, 1999, with the new UK national minimum wage, after statutory deductions, of pound 105.84 at 18-21 years and 121.12 pound sterling at 22+ years for a 38 hour working week. Corresponding basic social security rates are 40.70 pound sterling to 51.40 pound sterling per week. INTERPRETATION: Accumulating science means that absolute standards of living, "poverty", minimal official incomes and the like, can now be assessed by objective measurement of the personal capacity to meet the costs of major requisites of healthy living. A realistic assessment of these costs is presented as an impetus to public discussion. It is a historical role of public health as social medicine to lead in public advocacy of such a national agenda.

Adolescent↗
PubMed2000

Validity of rapid estimates of household wealth and income for health surveys in rural Africa.

STUDY OBJECTIVE: To test the validity of proxy measures of household wealth and income that can be readily implemented in health surveys in rural Africa. DESIGN: Data are drawn from four different integrated household surveys. The assumptions underlying the choice of wealth proxy are described, and correlations with the true value are assessed in two different settings. The expenditure proxy is developed and then tested for replicability in two independent datasets representing the same population. SETTING: Rural areas of Mali, Malawi, and Côte d'Ivoire (two national surveys). PARTICIPANTS: Random sample of rural households in each setting (n=275, 707, 910, and 856, respectively). MAIN RESULTS: In both Mali and Malawi, the wealth proxy correlated highly (r>/=0.74) with the more complex monetary value method. For rural areas of Côte d'Ivoire, it was possible to generate a list of just 10 expenditure items, the values of which when summed correlated highly with expenditures on all items combined (r=0.74, development dataset, r=0. 72, validation dataset). Total household expenditure is an accepted alternative to household income in developing country settings. CONCLUSIONS: It is feasible to approximate both household wealth and expenditures in rural African settings without dramatically lengthening questionnaires that have a primary focus on health outcomes.

Africa↗
PubMed2005

Health indicators among low income women who report a history of sex work: the population based Northern California Young Women's Survey.

OBJECTIVES: We examined differences in demographic characteristics, HIV related risk behaviour, prevalence of sexually transmitted infections (STI), and HIV and other health concerns among women with and without a history of sex work. METHODS: A secondary analysis of a population based, cross sectional survey of young, low income women in northern California. RESULTS: Of the 2543 women interviewed, 8.9% reported a history of sex work. These women reported more lifetime male sexual partners, were more likely to use drugs before sex, and were more likely to have a history of having sex with partners at high risk for HIV (that is, men who have sex with men, inject drugs, or were known to be HIV positive). They were significantly more likely to have positive serology for syphilis, herpes simplex virus type 2 (HSV-2), and hepatitis C regardless of their personal injecting drug use history; however, they were no more likely to have HIV, chlamydia, gonorrhoea, hepatitis A or hepatitis B infection compared to women without a history of sex work. Women with a history of sex work were significantly more likely to have a history of sexual coercion and tobacco use. CONCLUSIONS: These data measure the population prevalence of sex work among low income women and associated STI. Women with a history of sex work have health concerns beyond STI and HIV treatment and prevention.

Adolescent↗
PubMed2002

Predictors of infection with Trichomonas vaginalis: a prospective study of low income African-American adolescent females.

OBJECTIVES: To identify psychosocial predictors of Trichomonas vaginalis infection among low income African-American adolescent females living in a high risk urban area of the United States. METHODS: Baseline plus 6 and 12 month follow up data collected as part of an HIV prevention intervention trial were utilised. The baseline sample consisted of 522 African-American females, 14-18 years of age. Recruitment sites were located in low income neighbourhoods of Birmingham, Alabama, characterised by high rates of unemployment, substance abuse, violence, teenage pregnancy, and sexually transmitted infections. Self administered vaginal swab specimens were cultured for T vaginalis. Baseline measures collected as part of a self administered survey and face to face interviews were used to predict subsequent infection with T vaginalis at any of the three assessment periods conducted over the span of 1 year. RESULTS: At baseline, 12.9% were diagnosed with T vaginalis. At the 6 and 12 month follow ups, T vaginalis was diagnosed in 8.9% and 10.2%, respectively. The strongest multivariate predictor of T vaginalis infection was biologically confirmed marijuana use; those using marijuana were more than six times as likely to test positive for T vaginalis (adjusted odds ratio (AOR) = 6.2, p = 0.0003). Other multivariate predictors were reporting that typical sex partners were at least 5 years older (AOR = 2.6; p = 0.005), reporting sex with non-steady partners (AOR = 1.9; p = 0.02), and history of delinquency (AOR = 1.3; p = 0.02). The odds of testing positive increased by 31% for every one unit increase on a six item scale measure of delinquency. CONCLUSIONS: Infection with T vaginalis was common and significant multivariate predictors comprised a constellation of problem behaviours, each of which are potentially amenable to behavioural intervention.

Adolescent↗
PubMed2000

Early growth, adult income, and risk of stroke.

BACKGROUND AND PURPOSE: A number of studies have shown that reduced intrauterine growth and low birth weight are associated with raised rates of fatal and nonfatal stroke in adult life. Whether this increased risk of stroke is modified by growth in childhood or by socioeconomic status in adult life is not known. METHODS: We studied hospital admissions and deaths from stroke among 3639 men who were born in Helsinki University Central Hospital during 1924 to 1933. They had detailed records of their body size at birth, their growth through childhood, and their social circumstances as adults. Three hundred thirty-one of the men had had a stroke. RESULTS: Hazard ratios for stroke were related to low birth weight in relation to head circumference (P=0.005) and to short length in relation to head circumference (P=0.02). These associations were stronger for hemorrhagic than for thrombotic stroke. Men who developed stroke still had below-average stature at 7 years (P=0.05), but after 7 years their height "caught up" through accelerated growth. As adults they had low incomes and low social class (P<0.0001). CONCLUSIONS: Stroke may originate through reduced fetal growth, with low body weight and short body length at birth but "sparing" of head growth. Other studies suggest that this pattern of growth is associated with persisting elevation of blood pressure and raised plasma fibrinogen concentrations, 2 known risk factors for stroke. The risk of stroke is increased by accelerated growth in height during childhood. Accelerated growth has previously been linked to the development of hypertension in adult life. Stroke risk is further increased by adverse influences linked to low income.

Aged↗
PubMed2003

Intrinsic and extrinsic work orientations as moderators of the effect of annual income on subjective well-being: a longitudinal study.

Income is only weakly associated with both subjective well-being (SWB) and job satisfaction in the United States, a surprising finding in light of the importance placed on financial status in capitalistic societies. To explore this further, the authors examined intrinsic and extrinsic work orientations as potential moderators of the effects of financial compensation on SWB and job satisfaction. Master's of business administration students (N = 124) completed measures of work orientation and, 4 to 9 years later, reported their current salary, SWB, and job satisfaction. As predicted, individuals high in extrinsic orientation experienced higher SWB and job satisfaction to the degree that they earned more money, whereas those high in intrinsic orientation were lower on SWB at higher income levels. These findings are discussed in terms of the Values as Moderators Perspective of SWB and Cognitive Evaluation Theory.

Adaptation, Psychological↗
PubMed2005

Labor force activities and income among young Guatemalan adults.

This paper considers labor force activities among adults (26 to 41 years of age in 2003) who participated as children in a nutrition supplementation trial in Guatemala. The vast majority of men are engaged in some type of income-generating activity in 2002-04. However, unlike their fathers, these men are much more likely to be engaged in wage labor, even if they remain in the original study villages. Those engaged in wage employment appear to do so steadily. Women are much more likely to be engaged in some type of income-generating activity than their mothers. For both men and women, there appears to be considerable movement in and out of own business activities. In Guatemala City, wage work is the predominant economic activity with more than half of the women interviewed working for wages; elsewhere operating non-farm businesses is the most often cited activity. For both men and women, agriculture now appears to be very much a secondary activity.

Adult↗
PubMed2006

Decomposition of sources of income-related health inequality applied on SF-36 summary scores: a Danish health survey.

BACKGROUND: If the SF-36 summary scores are used as health status measures for the purpose of measuring health inequality it is relevant to be informed about the sources of the inequality in order to be able to target the specific aspects of health with the largest impact. METHODS: Data were from a Danish health survey on health status, health behaviour and socio-economic background. Decompositions of concentration indices were carried out to examine the sources of income-related inequality in physical and mental health, using the physical and mental health summary scores from SF-36. RESULTS: The analyses show how the different subscales from SF-36 and various explanatory variables contribute to overall inequality in physical and mental health. The decompositions contribute with information about the importance of the different aspects of health and off-setting effects that would otherwise be missed in the aggregate summary scores. However, the complicated scoring mechanism of the summary scores with negative coefficients makes it difficult to interpret the contributions and to draw policy implications. CONCLUSION: Decomposition techniques provide insights to how subscales contribute to income-related inequality when SF-36 summary scores are used.

Adolescent↗
PubMed1999

A national profile of primary and secondary household caregivers: estimates from the 1992 and 1993 surveys on income and program participation.

According to the 1992 and 1993 Surveys of Income and Program Participation (SIPP), an estimated 4,538,000 adults in the U.S. serve as primary assistants for one or more household members with disabilities. Another 530,000 serve as secondary assistants. Spouses are the main source of primary ADL and IADL assistance, while adult children and other family members are the main source of secondary assistance. Primary household assistants tend to be older and female, while secondary assistants tend to be younger and male. Primary assistants are more likely than the general adult population to rate their health as fair or poor, describe themselves as work disabled, and be limited in or need assistance with ADLs. Secondary assistants report slightly higher rates of work disability than the general population, but similar rates of ADL limitation and health status. Both assistance groups are more likely than the general adult population to have annual family incomes which fall below the federal poverty line, and working-age (aged 18-64) assistants are much less likely to work full time.

Activities of Daily Living↗
PubMed2006

Increased wealth and income as correlates of self-assessed retirement.

This study examined whether retirement implies complete withdrawal from the labor force and the role that increased wealth and income play in regard to the nature of retirement. Data came from the Health & Retirement Study, Waves 1-5. Findings indicated that most study sample pre-retirees remained in the labor force as they moved into what are considered the normal retirement years. As they moved on average from 50+ years of age to 60+ years of age, increasing percentages of study sample pre-retirees reported themselves as completely retired. Those who viewed themselves as completely retired were far less likely to work than those who did not view themselves as completely retired. Of particular importance was the finding that increased income in 2000 decreased the likelihood of self-reported complete retirement. Equally important was the finding that increased assets had no effect on retirement status with the exception of survey year 1998 when increased assets decreased the likelihood of viewing oneself as completely retired. Findings suggested that pro-work retirement policies aimed at increasing labor force participation among pre-retirees and increasing the normal retirement age can be effective. Five pro-work policies were discussed.

Aged↗
PubMed2003

Federal income payments and mental retardation: the political and economic context.

Federal income maintenance programs for people with mental retardation in the United States were described. Combined SSI and DI spending in fiscal year 2000 totaled an estimated $20.6 billion for people with mental retardation. This population is particularly vulnerable to the vagaries of changing public policy and are particularly reliant upon public support. The relative importance of income programs in the lives of people with mental retardation is discussed and the changing role of federal social welfare policy with regard to these programs analyzed.

Aid to Families with Dependent Children↗
PubMed2003

Why poverty remains high: the role of income growth, economic inequality, and changes in family structure, 1949-1999.

After dramatic declines in poverty from 1950 to the early 1970s in the United States, progress stalled. This article examines the association between trends in poverty and income growth, economic inequality, and changes in family structure using three measures of poverty: an absolute measure, a relative measure, and a quasi-relative one. I found that income growth explains most of the trend in absolute poverty, while inequality generally plays the most significant role in explaining trends in relative poverty. Rising inequality in the 1970s and 1980s was especially important in explaining increases in poverty among Hispanics, whereas changes in family structure played a significant role for children and African Americans through 1990. Notably, changes in family structure no longer had a significant association with trends in poverty for any group in the 1990s.

Adult↗
PubMedDate not supplied

Racial and income disparities in childhood asthma in the United States.

OBJECTIVE: To examine racial and income disparities in asthma prevalence in US children, and disparities in morbidity and ambulatory health care use among children with asthma. METHODS: Using 1993-1996 National Health Interview Survey data, we measured asthma prevalence and morbidity in children aged 3 to 17 years (N = 14 211) stratifying by race and poverty status. Measures of morbidity included asthma-related activity limitation and number of bed days. We used the ratio of asthma-related doctor contacts to number of bed days in the past 2 weeks to measure health care use adjusted for severity of illness. RESULTS: An annual average of 7.4% of children aged 3 to 17 years had asthma. There were no significant differences in asthma prevalence between race and poverty groups. In contrast, asthma-related morbidity was higher among black and poor children. Black poor children were most likely to have activity limitations due to asthma: 49% were limited compared with about 20% of black nonpoor, white poor, and white nonpoor children. Among children with activity limitations, black children and white poor children were more likely to have severe limitations, and white nonpoor children were least likely. Finally, white nonpoor children had the highest level of ambulatory care use for asthma after accounting for disease severity, and black poor children had the lowest level. CONCLUSIONS: We found no significant racial or income disparities in asthma prevalence among children in the United States. However, black children and poor children are at higher risk for activity limitation, more severe activity limitation, and relative underuse of ambulatory health care. Black children living in poverty are at highest risk. Targeted interventions to reduce the burden of asthma morbidity in this population are likely to reduce disparities in asthma morbidity as well as reduce overall childhood asthma morbidity.

Adolescent↗
PubMedDate not supplied

Income levels of bad-debt and free-care patients in Massachusetts hospitals.

This study disputes the common notion that many hospitalized patients whose expenses are written off to bad debt are able to pay their bills. By matching 1996 state tax returns to more than 350,000 bad-debt and free-care claims at seven Massachusetts hospitals, we found that most patients involved had incomes below the federal poverty level and thus were presumably eligible for either public programs or hospital-based free care. This suggests that hospitals and public officials need to investigate further why low-income, uninsured patients are not receiving benefits for which they are eligible. Our results also suggest that measurements of indigent care levels in hospitals for purposes of research or regulation should include some portion of bad debt.

Boston↗
PubMedDate not supplied

Use of subsidies to low-income people for coverage through small employers.

If tax credits or other public subsidies are made available only for health insurance that is not employment-based, serious erosion of employer coverage could result. To prevent this, public subsidies targeted to low-income workers and families could be applied in ways that broaden employer coverage for low-income workers and their families by encouraging small employers with largely low-wage workforces to offer and partially fund health coverage for their workers. To accomplish this, such employers--very few of which now provide health coverage--must be allowed to contribute much less than normally required in the commercial market.

Health Benefit Plans, Employee↗
PubMed1998

Trends in per-patient gross income to dental practices from insured patients, 1980-1995.

The authors discuss changes that occurred in per-patient gross income to dental practices from insured patients between 1980 and 1995. The current young-adult cohort appears to provide lower per-patient practice incomes compared with earlier young-adult cohorts. These changes may be the result of differences in the need for restorative care among young adults who benefited from the childhood caries decline of the 1970s and 1980s. If this reduced use of restorative services pattern persists as this young-adult cohort and succeeding cohorts age, the effect on dental practices could be substantial.

Adolescent↗
PubMed2001

A randomized trial to reduce passive smoke exposure in low-income households with young children.

OBJECTIVE: Passive smoke exposure among children is widespread in the United States; estimates suggest that almost 40% of children who are younger than 5 years live with a smoker. Few randomized studies of passive smoke exposure reduction among children have been conducted, and the impact of interventions that have been evaluated has been limited. The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure. METHODS: Project KISS (Keeping Infants Safe From Smoke), a theory-driven exposure reduction intervention targeting low-income families with young children, was a randomized controlled study in which participants-smoking parents/caregivers (N = 291) who had children who were younger than 3 years and who were recruited through primary care settings-were randomly assigned to either the motivational intervention (MI) or a self-help (SH) comparison condition was used. Follow-up assessments were conducted at 3 and 6 months. The MI condition consisted of a 30- to 45-minute motivational interviewing session at the participant's home with a trained health educator and 4 follow-up telephone counseling calls. Feedback from baseline household air nicotine assessments and assessment of the participant's carbon monoxide level was provided as part of the intervention. Participants in the SH group received a copy of the smoking cessation manual, the passive smoke reduction tip sheet, and the resource guide in the mail. Household nicotine levels were measured by a passive diffusion monitor. RESULTS: The 6-month nicotine levels were significantly lower in MI households. Repeated measures analysis of variance across baseline, 3-month, and 6-month time points showed a significant time-by-treatment interaction, whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline. CONCLUSIONS: This study targeted a large sample of racially and ethnically diverse low-income families, in whom both exposure and disease burden is likely to be significant. This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children. These findings have important implications for pediatric health care providers, who play an important role in working with parents to protect children's health. Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit.

Adult↗