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PubMed2002

Oral health and use of dental services among Hispanics.

OBJECTIVES: This study examined factors related to oral health and dental service use among Mexican-Americans, Cuban-Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-84 (HHANES). METHODS: Categorical measures of oral health were created: (1) perceived oral health status, (2) evaluated oral health status, (3) decayed permanent teeth, (4) teeth missing due to caries, (5) total permanent teeth present, and (6) periodontal classification. The effects of acculturation, education, dental insurance, and perceived condition of teeth and gums on dental service use in the past two and five years were examined using logistic regression. All analyses were performed separately for each of the three samples using SAS-callable SUDDAN. RESULTS: Dental insurance and education were the most important factors in determining use of dental cleanings and use of dental care. For Mexican-Americans, Cuban-Americans, and Puerto Ricans, acculturation was a factor in determining use of dental care in the past five years. CONCLUSIONS: While dental insurance and education appear to be the most important factors for determining both use of dental cleaning services and use of dental care in all three samples, acculturation also had some impact for determining use of dental care.

Acculturation↗
PubMedDate not supplied

Disparities in diabetes management practice between racial and ethnic groups in the United States.

PURPOSE: The purpose of this study was to evaluate the association between race/ethnicity and self-management practices of people with diabetes. METHODS: Analyses were based on data from the 2001 Behavioral Risk Factor Surveillance System. Contingency tables and multiple logistic regression were used to assess the data. RESULTS: Frequency distributions of selected diabetes management variables significantly varied across levels of race/ethnicity. These differences persisted after adjusting for current age, age at diagnosis, gender, marital status, income, and education. Analyses revealed that Hispanics, compared with whites, were more likely to take oral agents to control their blood glucose, less likely to monitor their blood glucose daily, and less likely to check their feet for sores or irritation. There was no difference among the racial/ethnic groups use having participated in a diabetes education class. CONCLUSIONS: Health literacy and cultural factors, including the influence of family, beliefs about diabetes, and access and utilization of health care, may influence Hispanic diabetes management behaviors. Understanding these influences is essential to the development of programs, policies, and other strategies that are culturally appropriate and relevant.

Blood Glucose↗
PubMed2004

The importance of employer sponsorship in the long-term care insurance market.

Medicare and Medicaid are major sources of long-term care payments and thus will bear much of the burden from the growth in long-term care service use. The large future demand for long-term care services is of great concern among policymakers due to its expense and the use of public program dollars. It is argued that the individual purchase of long-term care insurance can help alleviate the increasing financial pressure on public programs responsible for the majority of longterm care financing. However, consumers have shown little interest in insuring against the high costs of long-term care. This analysis examines the effect of several factors on the decision to purchase a long-term care insurance policy: knowledge and attitudes of long-term care insurance and the long-term care financing system, the perceived risk for longterm care, financial planning behavior, and the availability of long-term care insurance. The interim results indicate the factor most likely to affect the decision to purchase long-term care insurance is access to employer-sponsored long-term care insurance. This suggests tht the availability of affordable and high quality coverage is more important than demand-side factors such as awareness of long-term care insurance and a perceived greater risk for long-term care.

Adult↗
PubMed2004

Housing and wealth inequality: racial-ethnic differences in home equity in the United States.

In our study, we took a first step toward broadening our understanding of the sources of both housing and wealth inequality by studying differences in housing equity among blacks, Hispanics, Asians, and non-Hispanic whites in the United States. Using data from the American Housing Survey, we found substantial and significant gaps in housing equity for blacks and Hispanics (but not for Asians) compared with whites, even after we controlled for a wide range of locational, life-cycle, socioeconomic, family, immigrant, and mortgage characteristics. Furthermore, the payoffs to many factors are notably weaker for minority than for white households. This finding is especially consistent across groups for the effects of age, socioeconomic status, and housing-market value. Blacks and Hispanics also uniformly receive less benefit from mortgage and housing characteristics than do whites. These findings lend credence to the burgeoning stratification perspective on wealth and housing inequality that acknowledges the importance of broader social and institutional processes of racial-ethnic stratification that advantage some groups, whites in this case, over others.

Adult↗
PubMed1999

Explaining educational differences in mortality: the role of behavioral and material factors.

OBJECTIVES: This study examined the role of behavioral and material factors in explaining educational differences in all-cause mortality, taking into account the overlap between both types of factors. METHODS: Prospective data were used on 15,451 participants in a Dutch longitudinal study. Relative hazards of all-cause mortality by educational level were calculated before and after adjustment for behavioral factors (alcohol intake, smoking, body mass index, physical activity, dietary habits) and material factors (financial problems, neighborhood conditions, housing conditions, crowding, employment status, a proxy of income). RESULTS: Mortality was higher in lower educational groups. Four behavioral factors (alcohol, smoking, body mass index, physical activity) and 3 material factors (financial problems, employment status, income proxy) explained part of the educational differences in mortality. With the overlap between both types of factors accounted for, material factors were more important than behavioral factors in explaining mortality differences by educational level. CONCLUSIONS: The association between educational level and mortality can be largely explained by material factors. Thus, improving the material situation of people might substantially reduce educational differences in mortality.

Adolescent↗
PubMedDate not supplied

How managed care organizations develop selective contracting networks for psychiatric inpatient care: a Massachusetts case study.

Medicaid agencies recently have adopted selective contracting to control use and costs of publicly financed behavioral health care. This case study describes formation of an inpatient network for serving psychiatrically disabled Medicaid beneficiaries in Massachusetts. Network formation is seen as a two-stage process: hospitals first decide to bid for a contract, and form a pool from which the managed care organization chooses hospitals. We used logit models to predict how hospital experience with Medicaid patients, competition, prior reimbursement rates, and geographic distribution affected these two stages. Hospitals are more likely to bid if they have treated more psychiatric inpatients and more disabled Medicaid inpatients receiving Supplemental Security Income. Managed care organizations take into account hospitals' experience with Medicaid patients and geographic dispersion, but not prior reimbursement rates.

Competitive Bidding↗
PubMed1992

Knowledge of colorectal cancer among older persons.

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

Aged↗
PubMed1992

Effect of family size and income on the biochemical indices of urban school children of Bangladesh.

The relationship between family size and income and the biochemical indices of 242 children (aged from 5 to 12 years) from five schools in Dhaka City, Bangladesh, was investigated. Socio-economic data were collected by questionnaire and blood samples were drawn by visiting each school on a prefixed date. Mean levels of all measures, except for serum zinc, fell within the normal range. Older boys, but not girls (10-12 years of age) had statistically significantly higher haemoglobin, serum protein and serum vitamin A levels compared with those of the younger boys (5-9 years of age). The children were divided into three family size groups (small, up to 4 members; medium, 5-7 members; and large, 8 or more) to investigate the effect of family size on the biochemical data. The children from smaller families showed significantly higher levels of haemoglobin and serum vitamin A compared with the children from large families. For serum protein, copper and zinc, there was no statistically significant difference between the children of different family size groups. To analyse the effect of family income, children were divided into three income groups (low, up to taka 2000; medium, taka 2001-4500; and high, 4501 or more). The children from the low family income group had significantly lower serum protein (7.5 g/100 ml) and haemoglobin (13.4 g/100 ml) levels compared with those of the children from the high family income group (for protein, 7.7 g/100 ml and haemoglobin, 14.1 g/100 ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1979

Estimates of preventive versus nonpreventive medical care demand in an HMO.

Multiple regression analysis is used to investigate whether medical services in a large HMO are distributed primarily on the basis of need and predisposing factors (such as health status, age and sex) or according to enabling characteristics (such as coinsurance and income) of the population. Equations are formulated to estimate the likelihood and volume of preventive visit demand, nonpreventive visit demand and hospital admissions for a sample of 3,892 individuals enrolled in the Kaiser Foundation Health Plan of Portland, Oregon. The results indicate that predisposing and need factors are the main determinants of nonpreventive visits and hospital utilization, while enabling characteristics are important determinants (along with age and education) of preventive utilization. There are marked differences in the impact of explanatory factors on utilization by dependents (children) versus nondependents (adults).

Adult↗
PubMed1995

[Bar attendants as health educators. Prevention of sexually transmitted diseases in high-risk areas].

In Tanzania, a nation-wide programme against the spread of HIV is targeting villages along the main highways, mining and construction centres, and border towns. These places contain a high number of bars and guest houses, where female bar attendants offer sexual favours to obtain a minimum income for survival. The strategy is to elect and educate bar workers as "peer health educators", motivate them to reduce the number of sexual partners, to distribute and promote use of condoms, and to establish easier access to treatment for sexually transmitted diseases. The activities are monitored and supervised through regular visits by trained health behaviour officers. The Tanzanian-Norwegian AIDS project has implemented the programme in Arusha and Kilimanjaro regions.

Adult↗
PubMed1995

[Comparison between nutritional status of school children of low socioeconomic level from Santiago, Chile and Sao Paulo, Brazil].

The objectives of this study were to determine and compare the anthropometric profiles of schoolchildren from low income household from Santiago, Chile and Sao Paulo, Brasil. A total of 1779 children from Santiago and 2210 from Sao Paulo were evaluated. Z-score distribution of the height/age (H/A), weight/age (W/A) and weight/height (W/H) indicators were utilized to assess the children. As a reference, the pattern recommended by WHO was used. The distribution of the H/A curves from both cities were deviated to the left. This deviation was more evident in Santiago. This situation points out the existence of a greater prevalence of growth retardation of the children from this city. In relation to the W/A indicator, both groups showed a similar distribution curves, Sao Paulo group however, had an increment of cases in the left extreme of the curve, under -2 < >. According to the W/H indicator the profile of both groups are different; one-Santiago-is deviated to the excess and Sao Paulo to the deficit. The differences observed in both groups of children studied indicated higher deficit of height, but lower current undernutrition in Santiago and increased wasting with conservated height in Sao Paulo. The observed situation suggests that the distinct patterns are consequences of socioeconomic factors at different stages of the growing process of the children and/or etnic differences of the population.

Anthropometry↗
PubMed2004

Socioeconomic inequities in invasive cardiac procedures after first myocardial infarction in Finland in 1995.

OBJECTIVE: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients. STUDY DESIGN AND SETTING: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers. RESULTS: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district. CONCLUSION: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.

Adult↗