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PubMed2003

Parent-child concordance on reported barriers to helmet use by children.

BACKGROUND: We determined the agreement between parents and their school-age children on reported barriers to bicycle helmet use. MATERIAL/METHODS: We conducted a cross-sectional survey in a 2-county Central Texas region with no helmet use legislation. Parent-child pairs, selected through a randomized, multi-stage sampling procedure and pre-matched by unique identifiers, were surveyed independently with self-administered questionnaires. Parent-child concordance was assessed using Kappa statistic. RESULTS: Of 1,987 surveys distributed, children returned 1,203 (61%) while parents returned 636 (53% of child respondents). Parents included 31% college graduates and 33% reported annual income of >55,000 dollars. Children included 60% whites, 16% blacks, and 16% Hispanics. The most popular reasons cited by children as barriers to helmet use were not having one (34%), being a safe rider (31%), and helmets messing up hair (18%). Good concordance was found on reported child bicycle riding (parent=88.0% vs. child=88.0%; K=0.64) and child helmet use the last time child rode a bicycle (parent=25.1% vs. child=28.0%; K=0.54). While good concordance was also found for reported helmet ownership (parent=31.9% vs. child=29.9%; K= 0.50), poor concordance was found for other barriers to helmet use including helmets looking ugly (parent=6.5% vs. child=13.4%; K=0.38) and messing up hair (parent=5.6% vs. child=15.2%; K=0.36). CONCLUSIONS: Although parents may be generally aware of their children's bicycle riding and helmet use habits, they may not be fully aware of the reasons why their children may not use a helmet. Public education and interventions on helmet promotion need to focus on parents.

Adolescent↗
PubMed1988

Private social welfare expenditures, 1972-85.

This article updates the private social welfare expenditures series with complete data for 1985 and information for most categories through 1986. In the United States, private sector expenditures play a substantial role in the provision of social welfare services. This article presents private social welfare expenditures in terms of the four major categories--health, education, welfare and related services, and income maintenance that includes private pensions, sickness and disability benefits, and group insurance. The private expenditures, which totaled $429.3 billion in 1985, are distributed by major category beginning in 1972 and are also related to public social welfare expenditures and gross national product.

Education↗
PubMed2004

Quantifying income-related inequality in healthcare delivery in the United States.

BACKGROUND: Numerous studies have found that high-income Americans use more medical care than their low-income counterparts, irrespective of medical "need." The methods employed in these studies, however, make it difficult to evaluate differences in the degree of income-related inequality in utilization across population subgroups. In this study, we derive a summary index to quantify income-related inequality in need-adjusted medical care expenditures and report values of the index for adults and children in the United States. METHODS: We used the summary index of income-related inequality in expenditures developed by Wagstaff et al. 1 The source of data for the study was the Household Component of the 1996-1998 Medical Expenditure Panel Survey, which contains person-level data on medical care expenditures, demographic characteristics, household income, and a wide array of health status measures. We used multivariate regression analysis to predict need-adjusted annual medical care expenditures per person by income level and used the predictions to calculate the indices of inequality. Separate indices were calculated for all adults, working-age adults, seniors, and children ages 5 to 17. RESULTS: For all age groups, predicted expenditures per person, adjusted for medical need, generally increased as income rose. The index of inequality for all adults was +0.087 (95% confidence interval, +0.035, +0.139); for working-age adults, +0.099 (+0.046, +0.152); for seniors, +0.147 (+0.059, +0.235); and for children, +0.067 (+0.006, +0.128). CONCLUSIONS: There exists income-related inequality in medical care expenditures in the United States, and it favors the wealthy. The inequality is highest among seniors despite Medicare, intermediate among working-age adults, and lowest among children.

Adolescent↗
PubMed1991

Risk profiles of women with cervical neoplasia.

Risk-factor profiles were compared in M.D. Anderson Cancer Center patients with various uterine cervix histologic diagnoses. Intraepithelial neoplasia (n = 171) and condyloma (n = 82) were associated with significantly lower patient age (mean 23.6 and 25.8 years, respectively). In addition, these two groups were lowest in annual income, age at beginning intercourse and at first pregnancy, and highest in percentages of black and Hispanic patients, number of sexual partners, and history of gonorrhea. Women with squamous carcinoma in situ (n = 47), who were about a decade older, exhibited a similar socioeconomic distribution and sexual history. All three groups also reported high prevalences of current smokers, were most likely to use oral contraceptives, and were least likely to use diaphragms or condoms. Patients with invasive squamous cell carcinoma (n = 77) had a mean age of 46.3 years, a large lowest-income constituency, and the highest mean number of pregnancies; they were least likely to have used oral contraceptives. Adenocarcinoma (n = 21) was epidemiologically distinct: a predominance of white woman characterized by high socioeconomic status, elevated body mass index, and non of the liberal sexual practices of the other groups. Primary and secondary prevention strategies must be tailored to the unique needs and socioeconomic status of the young at-risk populations.

Adult↗
PubMedDate not supplied

The availability of reproductive health services from U.S. private physicians.

Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed2005

How many deaf people are there in the United States? Estimates from the Survey of Income and Program Participation.

The Survey of Income and Program Participation (SIPP) is one of a few national surveys that regularly collects data identifying the American population of persons with hearing loss or deafness. Estimates from the SIPP indicate that fewer than 1 in 20 Americans are currently deaf or hard of hearing. In round numbers, nearly 10,000,000 persons are hard of hearing and close to 1,000,000 are functionally deaf. More than half of all persons with hearing loss or deafness are 65 years or older and less than 4% are under 18 years of age. However, these findings are limited to those who report difficulty hearing "normal conversation" and do not include the larger population of persons with hearing loss for which only hearing outside the range and circumstances of normal conversation is affected. Policy makers, communications technology manufacturers, health and education service providers, researchers, and advocacy organizations have an interest in these results.

Adolescent↗
PubMed2000

Quality of life in survivors of colorectal carcinoma.

BACKGROUND: Colon carcinoma is a common malignancy that accounts for a substantial share of all cancer-related morbidity and mortality. However, little is known with regard to general and disease specific quality of life in survivors of colorectal carcinoma, particularly from community-based samples of cases across stage and survival times from diagnosis. METHODS: Subjects with colorectal carcinoma were recruited from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry. Subjects completed two self-administered surveys: the Functional Assessment of Cancer Therapy Scales for Colorectal Cancer (FACT-C) and the Health Utilities Index (HUI) Mark III. RESULTS: One hundred seventy-three respondents (average age: 70.4 years, 71.4% female) completed the survey. In the first 3 years after diagnosis, quality of life was lower and varied substantially among respondents. After 3 years, respondents in all TNM stages of disease except Stage IV reported a relatively uniform and high quality of life. Pain, functional well-being, and social well-being were affected most substantially across all stages and times from diagnosis. Low income status was associated with worse outcomes for pain, ambulation, and social and emotional well-being. Only emotional well-being scores improved significantly over time in both surveys. CONCLUSIONS: Those individuals who achieve a long term remission from colorectal carcinoma may experience a relatively high quality of life, although deficits remain for several areas, particularly in those of low socioeconomic status. Sampling design may have excluded the most severely ill patients.

Activities of Daily Living↗
PubMed2003

[Frequency of seropositivity to Toxocara canis in children of different socioeconomic strata].

Frequency of seropositivity for Toxocara in children from different socioeconomic strata in the city of Brasilia (Brazil) was measured. Six hundred and two children of both sexes, aged one to 12 years were distributed in two socioeconomically distinct groups. The samples of sera of the first group were obtained from blood drawn for routine tests in the laboratory of a public hospital attending children from low-income families. Samples from the second group were obtained from private laboratories attending children from middle-class families. Anti-toxocara antibodies were detected by ELISA, using Toxocara canis excretory-secretory antigens previously absorbed with Ascaris suum extract. The prevalence of seropositivity was 21.8% (66/302) in the first group and 3% (9/300) in the second (p< 0.0001). No differences in frequency according to age or sex could be detected. Our results suggest a high prevalence of childhood toxocariasis in Brasilia, with children from lower income brackets being the most affected.

Animals↗
PubMed1988

A life-cycle model of repeat migration.

"This paper develops a theoretical model which analyzes the impact of the spatial distribution of a family's stock of human capital on its migration decision. This stock of human capital is composed of location-specific and non-specific human capital. The distribution of location-specific capital is a function of the residential and employment history of the family, while non-specific capital is distributed evenly over space. An empirical specification of the model is derived and estimated with a [U.S.] data set consisting of a number of cases from the Michigan Panel Study of Income Dynamics."

Americas↗
PubMed2006

Socio-economic distribution of environmental risk factors for childhood injury.

OBJECTIVE: Childhood injury remains the single most important cause of mortality in children aged between 1-14 years in many countries. It has been proposed that lower socio-economic status (SES) and poorer housing contribute to potential hazards in the home environment. This study sought to establish whether the prevalence of observed hazards in and around the home was differentially distributed by SES, in order to identify opportunities for injury prevention. METHODS: This study was a cross-sectional, random sample survey of primary school children from 32 schools in Brisbane. Interviews and house audits were conducted between July 2000 and April 2003 to collect information on SES (income, employment and education) and previously identified household hazards. RESULTS: There was evidence of a relationship between prevalence of household environmental hazards and household SES; however, the magnitude and direction of this relationship appeared to be hazard-specific. Household income was related to play equipment characteristics, with higher SES groups being more likely to be exposed to risk. All three SES indicators were associated with differences in the home safety characteristics, with the lower SES groups more likely to be exposed to risk. CONCLUSION: The differential distribution of environmental risk factors by SES of household may help explain the SES differential in the burden of injury and provides opportunities for focusing efforts to address the problem.

Adolescent↗
PubMedDate not supplied

The 'graying' of group health insurance.

We examine differential declines in private insurance by income and age. We show that older, higher-income people in working families are more likely to retain private coverage as premiums rise, and we project these effects on future coverage rates. The analysis suggests that trends are leading to the "graying" of the employment-based health insurance system, where older, higher-income people get private health insurance, and others increasingly have public coverage or go without. These changes raise questions about the private health care system's ability to pool health risks. Population aging could interact with rising premiums and place additional pressure on an already strained employment-based health insurance system.

Adolescent↗
PubMed1996

Parenting style and adolescent depressive symptoms, smoking, and academic achievement: ethnic, gender, and SES differences.

This paper examines whether the relationship between parenting style and adolescent depressive symptoms, smoking, and academic grades varies according to ethnicity, gender, and socioeconomic status. Four parenting styles are distinguished, based on patterns of parent-adolescent decision making: autocratic (parents decide), authoritative (joint process but parents decide), permissive (joint process but adolescent decides), and unengaged (adolescent decides). The sample included 3993 15-year-old White, Hispanic, African-American, and Asian adolescents. Results are generally consistent with previous findings: adolescents with authoritative parents had the best outcomes and those with unengaged parents were least well adjusted, while the permissive and the autocratic styles produced intermediate results. For the most part, this pattern held across ethnic and sociodemographic subgroups. There was one exception, suggesting that the relationship between parenting styles, especially the unengaged style, and depressive symptoms may vary according to gender and ethnicity. More research is needed to replicate and explain this pattern in terms of ecological factors, cultural norms, and socialization goals and practices.

Achievement↗
PubMed1996

Mediators of the long-term impact of child sexual abuse: perceived stigma, betrayal, powerlessness, and self-blame.

Using a community sample of 192 adult women who had been sexually abused during childhood, the present study tested the hypothesis that perceived stigma, betrayal, powerlessness, and self-blame mediate the long-term effects of child sexual abuse. A path analysis indicated that the level of psychological distress currently experienced by adult women who had been sexually abused in childhood was mediated by feelings of stigma and self-blame. This result provides partial support for Finkelhor and Browne's (1985) traumagenic dynamics model of child sexual abuse. The limitations of the study are discussed.

Adult↗
PubMed1984

On-line data acquisition system using an Apple computer: ISI and PST histograms.

A combined hardware/software system for the study of the temporal distributions of spike data is described. Through extensive use of assembly language subroutines the program is able to simultaneously acquire, analyze and display the incoming data. Production of a "Temporal Memory Map" makes possible the examination of acquired data at a wide variety of different bin widths. Interaction with the user is made extremely simple. Provisions are included for the labelling and printing of the output histograms and for the compact storage of data onto floppy disks. Maximum temporal resolution is 0.1 millisecond and maximum total acquisition width is 12.8 minutes. Hardware requirements beyond the basic computer consist of an external signal conditioning circuit and a slot-independent peripheral card containing two integrated circuits. The system has been successfully used in the analysis of neural and EMG evoked responses and should be widely useable in other applications.

Computers↗
PubMed2006

Socioeconomic and racial disparities among infertility patients seeking care.

OBJECTIVE: To examine sociodemographic differences based on patient race/ethnicity among infertility patients seeking care in a state with mandated coverage of infertility treatment. DESIGN: Cross-sectional survey. SETTING: University-hospital-based fertility center. PATIENT(S): A total of 1,500 consecutive women who presented for infertility care. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Self-report questionnaire assessing patient race/ethnicity, diagnosis, income, education level, and duration of infertility before seeking care. RESULT(S): African American women experienced a significantly longer duration of infertility before seeking care compared with Caucasian women (4.3 vs. 3.3 years, respectively; P=.03). With regard to infertility diagnosis, a significantly greater proportion of African American and Hispanic women had tubal factor infertility compared with Caucasian women (24.0% and 27.3% vs. 5.3%, respectively; P=.001). Looking at the highest level of education attained by patients, a significantly greater proportion of African American and Hispanic women had less than a 4-year college degree compared with Caucasian women (48% and 40.9% vs. 13.2%, respectively; P<.001). Examining the gross annual household income of patients, a significantly greater proportion of African American and Hispanic women had household incomes below $100,000 compared with Caucasian women (72% and 68.2% vs. 37.3%, respectively; P<.01). CONCLUSION(S): African American women are more likely to seek infertility treatment after a longer duration of failed conception compared with Caucasian women. Furthermore, African American, and Hispanic women are more likely to have tubal factor infertility, a lower education level, and a lower household income compared with Caucasian women.

Adult↗
PubMed1995

High-risk nutrient intakes among low-income Mexican women in Chicago, Illinois.

OBJECTIVES: The Cross-sectional Cooking, Eating, Nutrition, and Shopping (CENAS) Survey was used to obtain data on food consumption patterns of low-income Mexicans living in Chicago, Ill. DESIGN: As part of the CENAS Survey, 186 Mexican women provided 24-hour dietary recall data. OUTCOME MEASURES: Distributions of macronutrient and micronutrient intakes were determined. The proportions of CENAS Survey participants achieving the National Heart Association and National Cancer Institute dietary guidelines were calculated. Intakes of Mexican women in Chicago were compared with intakes of Mexican women of similar socioeconomic status in Texas, Mexican-American women participating in phase 1 of the third National Health and Nutrition Examination Survey (1988-1991), and Mexican-American women participating in the Hispanic Health and Nutrition Examination Survey (1982-1984). STATISTICAL ANALYSIS: Tests were used to compare the nutrient intakes of CENAS Survey respondents with published results from other studies. RESULTS: The proportion of respondents reporting intakes less than two thirds of Recommended Dietary Allowances for nine micronutrients ranged from 11% (thiamin and riboflavin) to 82% (folacin). Respondents also reported median fat (34% of energy) and fiber (16.9 g/day) intakes that departed from recommendations to reduce the risk of heart disease and cancer. APPLICATIONS AND CONCLUSIONS: Half or more of the Mexican women interviewed in Chicago reported inadequate consumption of calcium, folate, zinc, and iron; higher than recommended intakes of fats; and lower than recommended intakes of fiber, indicating the need for nutrition education and intervention. Their nutrient consumptions differed significantly from those of Mexican-American women in the United States, suggesting possible regional or temporal variation in dietary patterns and underscoring the need for population-specific interventions.

Adult↗