bluuebunny/crossref_metadata_2025 huggingface dataset:
An Analysis of Unmet Need for HIV Services: The Houston Study
Authors: Montoya Isaac D. , Richard Alan J. , Bell David C. , Atkinson John S.
Published: July 2012

HIV/AIDS is indicative of general institutional neglect that disproportionately affects minorities, poor, and underserved populations. Among women and minorities, HIV infection is associated with preexisting economic distress. Moreover, socioeconomic resources, gender, and race/ethnicity may determine access to medical and nonmedical services that affect disease progression. An analysis of data collected for the Ryan White Care Act needs assessment in Houston, Texas, was performed to assess the effects of socioeconomic and demographic factors on unmet needs for existing medical, social, and counseling services, adjusting for the effects of illness and substance abuse. Results indicated that lower income and Hispanic ethnicity were associated with the unmet need for medical services. Higher income was positively associated and African American ethnicity was negatively associated with the unmet need for social services. Also, higher income and private insurance were negatively associated with counseling services. The authors suggest that these latter findings may result from program eligibility requirements and respondents' hierarchy of needs, respectively.
Medicaid Patients' Access to Office-Based Obstetricians
Authors: Fossett James W. , Perloff Janet D. , Kletke Phillip R. , Peterson John A.
Published: July 2012

Recent expansion of the eligibility of low-income pregnant women for Medicaid-funded prenatal care may be jeopardized by undersupplies of obstetricians and gynecologists (OB/GYNs) in rural and urban low-income areas and by widely reported declines in the number of OB/GYNs willing to accept Medicaid patients. This paper examines the availability of office-based obstetric care to Medicaid patients in Illinois. We present and test a model of the determinants of Medicaid participation by private, office-based OB/GYNs that highlights the role of residential segregation and practice economics. We find that a large growth in demand for obstetrical care or the enhancement of Medicaid fees is unlikely to have a major effect on OB/GYN participation in Medicaid. We conclude that improving access will require expanding the supply of providers in underserved areas.
Poverty, Residential Segregation, and Black/White Mortality Ratios in Urban Areas
Authors: Polednak Anthony P.
Published: July 2012

Researchers speculate that in addition to poverty, residential patterns may contribute to black/white differences in mortality rates. But few have assessed the relationship. This study reports considerable variation in the black/white ratio of age-specific all-cause mortality rates (ages 15-24 to 65-74 years) from 1982 to 1986 among the 38 U.S. Standard Metropolitan Statistical Areas (SMSAs) with populations greater than one million in 1980. The black/white poverty-rate ratio for each SMSA was a stronger predictor of variation in the black/white mortality ratio for men than for women. For both men and women age 15-44, the level of black/white residential segregation was a significant (positive) predictor of the black/white ratio of the age-standardized death rate. This analysis also identifies SMSAs containing geographic areas with unusually high or low black/white mortality ratios, and indicates the need for more-detailed studies of explanations for such variation.
Increasing Obstetrical Care Access to the Rural Poor
Authors: Taylor Donald H. , Ricketts Thomas C.
Published: July 2012

Rising malpractice insurance rates have led to a decrease in the number of physicians who provide rural obstetrical care. North Carolina has responded with the Rural Obstetrical Care Incentive (ROCI) Program, which provides up to $6,500 per year to physicians who provide obstetrical care to the rural poor in conjunction with a local health department. This study finds some evidence that the program has led to an increase in the satisfaction that physician participants feel toward the prenatal care available at the local health department; that participants are increasing their provision of obstetrical care to Medicaid patients compared to other physicians in the state; and that the percentage of women delivering after receiving inadequate prenatal care is decreasing in the original ROCI counties, at a time when other rural counties are experiencing an increase in this measure. Other states should consider the ROCI program as one aspect of a rural health strategy.
Saving Rural Health Care: Strategies and Solutions
Authors: Johnson Lane W.
Published: July 2012

Health care for rural populations has been threatened in recent years by a significant number of hospital closures and a scarcity of primary care providers. While some factors that influence hospital closures lie beyond the reach of individual facilities, others, such as low occupancy rates and poor management, can and should be addressed through hospital networking, strategic planning, and well-focused marketing. To recruit and retain physicians, communities should develop financial-incentive packages and such alternatives to the traditional fee-for-service medical practice as recruiting older providers, establishing a community-based health maintenance organization, or founding a community-owned and -operated medical clinic staffed by primary care providers. Improving rural health care requires community involvement and commitment, and good planning.
Preventive Health Counseling Reported by Uninsured Women With Limited Access to Care
Authors: Nickel Jennie T. , Salsberry Pamela J. , Polivka Barbara J. , Kuthy Raymond A. , Loebs Stephen F. , Slack Carolyn , Shapiro Nancy
Published: July 2012

Low-income women in the childbearing years are at an increasing risk of becoming uninsured as welfare reforms are enacted and women enter minimum-wage jobs without insurance benefits. This study contrasts preventive counseling reported by low-income uninsured mothers and mothers insured through Medicaid. Low-income women attending Women, Infant, and Children (WIC) clinics and human services offices who had received health care during the previous 12 months (N = 406) were asked if they had received counseling from a health provider regarding any of seven types of preventive health behaviors. Uninsured women were less than half as likely to receive counseling on three or more preventive topics (OR = 0.42) as were mothers on Medicaid. Risk estimates were stable on bivariate analyses and logistic regression models. Findings indicate that opportunities for preventive health counseling need to be maximized for this group already experiencing compromised access to care.
Factors Related to the Keeping of Appointments by Indigent Clients
Authors: Ide Bette A. , Curry Margaret A. , Drobnies Barbara
Published: July 2012

Few recent studies address how situational variables and the characteristics of clients and organizations predict whether indigent clients will keep medical appointments. In this study at a southern urban charity hospital, lack of transportation was a main reason given for not keeping the last appointment at an internal medicine clinic. In contrast, clients who kept their last appointment had higher incomes; had visited the facility for pain, infection, or follow-up after hospitalization; and had been referred to the clinic less than two weeks before their appointment. Overall, whether appointments were kept or broken seemed to depend on the recency of medical attention and the perceived severity of a problem. Implementation of a system-wide discharge-planning system resulted in fewer broken appointments. Perceived communication difficulties with clinic personnel and long waits were important predictors of overall utilization. Decentralizing care through community health clinics and adopting a more holistic approach to care may improve utilization of health care facilities.
A Public-Sector HMO in a Competitive Market: Ensuring Equity for the Poor
Authors: Bluford John W.
Published: July 2012

While managed care is still a new concept in much of the country, it has been a reality in the Minneapolis-St. Paul area for more than three decades. Metropolitan Health Plan (MHP), a public-sector, county-owned health maintenance organization (HMO), was developed 10 years ago as a mechanism to ensure retention of the county hospital's historical patient base if the state of Minnesota were to mandate managed care for public-assistance patients (which occurred in 1985). Because MHP's chief provider organization was Hennepin County Medical Center, which has a long history of serving the poor, it had an advantage over its more established competitors. MHP's greater knowledge of the population and sensitivity to ethnic and cultural diversity has enabled it to develop programs and systems to streamline access to services, many of which are unique to MHP.
Health Promotion Priorities of Economically Stressed Cities
Authors: Greenberg Michael , Schneider Dona , Martell Jennifer
Published: July 2012

The authors surveyed the local health officers (LHOs) of 436 northeastern and midwestern cities about their priorities for promoting health through prevention. LHOs of the most economically stressed cities identified the following as the five most important public health prevention goals that are amenable to intervention: reducing the incidence of HIV infection and AIDS, improving maternal and infant health, controlling sexually transmitted diseases, reducing violent and abusive behavior, and immunizing against infectious diseases. Their judgments were almost identical to those of LHOs of the least economically stressed cities and of a sample of African American political and public health leaders. LHOs of the most stressed cities were more pessimistic than their counterparts about achieving the objectives. The results of this survey can be used by federal, state, and local governments as well as private organizations as a guide for allocating scarce resources.
Predictors of Cervical Cancer Screening in Mexican American Women of Reproductive Age
Authors: Buller David , Modiano Manuel R. , de Zapien Jill Guernsey , Meister Joel , Saltzman Sallie , Hunsaker Frank
Published: July 2012

Several barriers impede cancer prevention in the Mexican American population. This study identified sociocultural factors that could be used to increase screening rates for cervical cancer in women of reproductive age. A survey was conducted in 1991 of 366 Mexican American women ages 18 to 40 in Tucson, Arizona, to assess current compliance with cervical cancer screening guidelines and several psychological, social, and cultural variables. Women who had never been screened (13 percent of the sample) had a knowledge deficit, no gynecological care, and no sexual activity. Women not screened annually (16 percent) lacked preventive care, imperfectly understood the Pap test, had lower selfefficacy expectations for understanding physicians, experienced higher emotional stress about the test, and were older and less acculturated. Women who have never been screened require basic education on cancer and cancer screening and policy changes increasing access to care. For women with less routine screening, preventive care, supportive attitudes, and health care skills must be encouraged.
No More "Let Them Eat Admonitions": The Clinton Administration's Emerging Approach to Minority Health
Authors: Mondragón Delfi
Published: July 2012

The startling health disparities between whites and racial and ethnic minorities in the United States are partly the result of six major assumptions about health promotion that permeated the Reagan and Bush Administrations. These assumptions, which placed the responsibility for maintaining health on individual Americans, are consistent with policymakers' reliance on market forces to address social issues. While this model may serve persons with a continuum of options and resources to elicit change, it does not benefit the underserved. In contrast, the Clinton Administration's approach, rooted in broad-based participation and multisector planning, is consistent with international models and promises long-overdue recognition that health problems in underserved communities stem from poverty—not the poor.
Managed Care and Community-Oriented Care: Conflict or Complement?
Authors: Lairson David R. , Schulmeier Gregory , Begley Charles E. , Aday Lu Ann , Coyle Yvonne , Slater Carl H.
Published: July 2012

Motivated by the need for fundamental change, reform of the health care delivery system is continuing despite the recent failure of national initiatives. One aspect of this reform is the restructuring of managed care systems to include low-income, at-risk populations in their health delivery programs. It is a move that threatens current "safety-net" providers, which already serve these populations with programs that combine public health and traditional primary care. This paper explores this potential conflict by providing a brief history and comparison of the main features of the community-oriented primary care (COPC) and health maintenance organization (HMO) models. The authors provide a framework that contrasts the structure, process, and outcome characteristics of these two models, delineating key similarities and differences. The framework is used in profiling a service delivery system model that integrates the two systems and in discussing issues related to operationalizing the proposed integration.
Personal Costs Associated With High-Risk Prenatal Care Attendance
Authors: Stringer Marilyn
Published: July 2012

Personal costs associated with attending prenatal care may influence women's care-seeking behavior, particularly poor, pregnant women and those with complicated pregnancies who receive more visits. This study described personal costs incurred by poor, high-risk pregnant women while attending care. Personal costs included direct out-of-pocket and time costs. Also, the relationship between personal costs and attendance was examined. Mean direct costs throughout pregnancy were $101.96 per patient. Women waited a mean of 3.22 hours per visit for care and received direct physician care for a mean of 5 minutes. As child care costs increased, attendance decreased significantly (r = 0.60, p ≤ 0.05). As transportation costs, meal costs, wages lost, and time spent awaiting care increased, attendance decreased. Prenatal care has associated dollar and time costs for patients. Problem solving these issues with patients is critical. System changes to decrease waiting times and to address child care issues are needed.
Neurological Impairment Among Elderly African-American Nursing Home Residents
Authors: Wallace Gloriajean L.
Published: July 2012

In this pilot study, 288 elderly African-American and 482 white residents of 10 nursing homes in Wayne County, Michigan, were compared for neurological impairment. The frequency of diagnosis of neurological impairment was equivalent for African-American and white males, but greater for African-American females than for white females. Cerebral vascular accident (CVA, or stroke) and nonspecific dementia were the most common neurological diagnoses for all groups. For males but not females, there was a statistically significant difference in the causes of neurological impairment, with more African-Americans diagnosed as having CVA, and more whites diagnosed as having nonspecific dementia. While the incidence of neurological impairment in African-Americans exceeded that of whites, predominantly white nursing homes offered more sophisticated care. This suggests the need to review the means by which comprehensive nursing home care may be expanded in the African-American community.
Improved Maternal and Child Health Care Access in a Rural Community
Authors: Carcillo Joseph A. , Diegel Joan E. , Bartman Barbara A. , Guyer Freddie R. , Kramer Sylvie H.
Published: July 2012

Few studies have measured the extent to which expansion of health services for pregnant women and children in poor rural communities improves access to care and health status. This paper describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a three-year period, use of preventive services increased, whereas emergency room visits and hospitalizations at the community hospital decreased. Low birthweight, risk of congenital syphilis and childhood tuberculosis, and child mortality all decreased. Provision of comprehensive services was met with increased use of preventive health care and improved health outcomes in this rural community.
Illiteracy among Medicaid Recipients and its Relationship to Health Care Costs
Authors: Weiss Barry D. , Blanchard Jay S. , McGee Daniel L. , Hart Gregory , Warren Barbara , Burgoon Michael , Smith Kenneth J.
Published: July 2012

Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/ Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.
Developing a Medical Achievement Reading Test to Evaluate Patient Literacy Skills: A Preliminary Study
Authors: Hanson-Divers E. Christine
Published: July 2012

A medical terminology achievement reading test (MART) administered to patients was developed for health care practitioners and researchers. In this study, 405 respondents from five populations (nursing home patients, college students, high school students, adult basic education students, and shopping mall customers) took both the MART and the Wide Range Achievement Test (WRAT). Cronbach's reliability test alpha indicated a high level (alpha = 0.98) of likelihood that the MART score is a good estimate of the true score (WRAT), and, therefore, reading ability. MART is designed to resemble a prescription label with its use of small print size, glossy cover, and medical terminology. This design allows practitioners and researchers to assess patients' inability to read the test. It is thought that its design and use of medical terminology makes the MART less threatening to patients than other literacy tests. Further studies of the MART in low-literate populations could determine whether this is true.
Changes in Usual Sources of Medical Care Between 1987 and 1992
Authors: Moy Ernest , Bartman Barbara A. , Clancy Carolyn M. , Cornelius Llewellyn J.
Published: July 2012

This study is a secondary analysis of data from the 1987 and 1992 National Health Interview Surveys. Analyses compared adults who do not have a usual source of care and those who identified usual sources of care in 1987 and 1992. Between these years, the estimated number of adult Americans without a usual source of care rose from 29.7 to 39.4 million. Adults were 0.75 times less likely to identify a physician's office and 1.8 times more likely to identify an outpatient clinic as that source of care in 1992 than they were in 1987. These changes were observed among Americans of all demographic and socioeconomic backgrounds. Increasing numbers of adult Americans without a usual source of care and shifts in care from physicians' offices to outpatient clinics may reflect deteriorating access to care. This may affect quality and costs of medical care, demanding continued surveillance of sources and access to care.
Prenatal Ultrasound: Are Socially Disadvantaged Groups Afforded Equal Access?
Authors: Moore Roscoe M. , Kaczmarek Ronald G. , Hamburger Stanford
Published: July 2012

A retrospective cohort study was conducted of the patterns of ultrasound use during pregnancy for all single live births (n=2542) delivered at a major teaching hospital in one calendar year. Extent of maternal education was inversely correlated with the probability of receiving a prenatal ultrasound examination (p<0.001). Clinic patients were more likely to receive prenatal ultrasound examinations than were private patients (p<0.001). Blacks were more likely than whites to receive prenatal ultrasound examinations (p<0.001). Short duration of prenatal care, inadequate weight gain during pregnancy, and history of previous pre-term delivery were all associated with an increased probability of receiving a prenatal ultrasound examination (p<0.001).
Improving Public Health Care: Lessons on Governance from Five Cities
Authors: Salmon J. Warren , Whiteis David G.
Published: July 2012

Policy-oriented investigations into public health care delivery have been limited, especially during the Reagan era of competition and profit-based health care, when the inner city was essentially forgotten. In this study, policymakers toured five urban public health care systems in different parts of the country to promote consideration of a new governance for Chicago and Cook County's complicated and uncoordinated care for the medically indigent. A comparison of patterns of governance revealed strengths and weaknesses of each model. Local leadership and the political will to evolve a system of care, with clear connections between the public and private sectors, account for each city's relative success in addressing mounting needs of inner-city populations.
Attitudes and Beliefs Toward Mammography Among Women Using an Urban Public Hospital
Authors: Thompson Beti , Montaño Daniel E. , Mahloch Jan , Mullen Mary , Taylor Victoria
Published: July 2012

Although overall use of mammography is steadily increasing, low-income and minority women consistently have relatively lower screening rates than white, middle-class women. To assess the mammography-seeking behavior of low-income women using an urban public hospital, this study sought to understand why women in this population decide whether or not to obtain a screening mammogram. Two qualitative techniques, elicitation interviews and focus groups, were used to develop an understanding of attitudes, concerns, and barriers of this group relative to mammography. Fear, embarrassment, susceptibility to breast cancer, inconvenience, cost, concerns about efficacy of mammography, fear of acquiring cancer, and scheduling difficulties were identified as important concerns. "People in the news" were the most influential social referents for mammography decision making, followed by physicians, family members, and friends. The insights gained from these women will assist in developing interventions that encourage mammography-seeking behavior by low-income women.
African American Women and Diabetes: A Sociocultural Context
Authors: Rajaram Shireen S. , Vinson Valerie
Published: July 2012

Diabetes is the fourth leading cause of death among African American women. One in four black women (23.4 percent) older than age 55 has diabetes. In evaluating the experience of black women with diabetes, an understanding of their social context is essential. Resulting from historical and sociocultural factors, black women have relatively lower income and education levels and consequently, poorer health and restricted access to quality health care. In a sense, being black, female, elderly, and chronically ill places this group in quadruple jeopardy. Tackling the problem of diabetes among African American women is a public health priority and requires a multilevel approach.
Preventing Violence in At-Risk African-American Youth
Authors: Hammond W. Rodney , Yung Betty R.
Published: July 2012

Homicide and nonfatal injuries resulting from interpersonal violence are significant contributors to the excess early mortality and morbidity of African-American youth. Although there is growing recognition of the need for prevention programs specifically directed to these youth, culturally relevant programs to reduce aggression and victimization in high-risk racial and ethnic groups are virtually nonexistent. This article reports preliminary findings of a program to train African-American adolescents in social skills, an approach which shows promise as a means of preventing violence. The pilot study suggests a need for continued research on this and other prevention approaches to reduce the disproportionate-and preventable-risk of injury or death for this vulnerable population.
The African-American Cancer Crisis, Part II: A Prescription
Authors: Byrd W. Michael , Clayton Linda A.
Published: July 2012

To appreciate the causes of the African-American cancer crisis, contemporary myths and perceptual gaps regarding cancer in blacks must be analyzed and placed in historical context. Since ancient times, racism has permeated western scientific, medical, and social cultures. Yet contemporary analysts typically frame a 370-year-old African-American health deficit in nonracial terms, and ignore both the metamorphosis of racism and the impact of racism on the prevention, diagnosis, and treatment of cancer; exposure to cancer-causing industrial pollutants; educational opportunities for black health professionals and policymakers, and other factors. If the African-American cancer crisis is to be halted, the growing divergence between urgent needs and meager resources devoted to preventing, detecting, and treating cancer in blacks must be sharply reversed.
Health Status of and Access to Health Services by Residents of Urban Encampments in Los Angeles
Authors: Cousineau Michael R.
Published: July 2012

This paper reports findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles. These data, of concern to public health officials, include the physical conditions in the camps, the health status of residents, their use of drugs and alcohol, and their access to and use of health care services such as substance abuse treatment. Many encampment residents report poor health status; over 30 percent report chronic illnesses, and 40 percent report a substance abuse problem. Although outreach efforts have had success in bringing HIV and tuberculosis screening services to encampments, residents report significant barriers to using primary health care and drug and alcohol treatment services. Public hospitals and clinics remain the major source of primary medical care for homeless people living in encampments. Outreach and case management continue to be critical components of improved access to health care for homeless people.
Health Status, Needs, and Health Care Barriers Among the Homeless
Authors: Wojtusik Laurie , White Mary Castle
Published: July 2012

Perceived health status, health conditions, and access and barriers to care are important predictors of mortality and the use of services among the homeless. This study assesses these issues by structured interview of 128 homeless adults from San Francisco. Of these adults, 21.1 percent were women (mean age 37 compared to 42 for men). In terms of ethnicity, 38 percent were white; 30 percent were African American; 17 percent were Latino; and 15 percent were Asian/Pacific Islander, Native American/Alaskan, or of mixed ethnicity. Of these adults, 49 percent rated health as poor or fair. Men were four times as likely as women to report their health status as excellent or good. Persons of color were more likely to report unmet needs for shelter, regular meals, employment, and job skills/training. These findings add information on those homeless not often included in research and indicate that these marginalized individuals may be in the poorest health.
Managed Care and the Poor
Authors: Smith Mark D.
Published: July 2012

While the momentum for health care reform stems from the concerns of the middle class rather than the poor, we should recognize that managed care—at least as an ideal—can still represent an improvement over the fee-for-service system. For the reality of managed care to approach its promise for underserved communities, issues surrounding cost-sharing, preventive health, traditional providers for the poor, and premium adjustment must be resolved.
African American and White Differences in Nutritional Status Among Low-Income Women Attending Public Health Clinics
Authors: Liu Tiepu , Soong Seng-Jaw , Wang Xingqiu , Wilson Nedra P. , Craig Carol B.
Published: July 2012

Information concerning nutritional status and factors influencing dietary intakes among underserved populations is scarce. To obtain this information, data on nutritional status in a group of 726 white and African American women of low education and low income who were inner-city dwellers were analyzed. Dietary habits in all subjects were characterized by high intakes of fat, saturated fat, cholesterol, and salt and low intakes of fiber and folate. A comparison of dietary intake patterns of low-income white and African American women showed a trend toward poorer dietary habits among the white women. It is suggested that differences between African Americans and whites in most nutrient intakes were due to factors such as low levels of education and income rather than racial background alone. Results imply that disease prevention and health promotion programs should include efforts to increase awareness and practice of healthy diet habits among all low-income women.
Health Habits of School-Age Children
Authors: Cornelius Llewellyn J.
Published: July 2012

While health habits such as eating breakfast, maintaining desirable weight, sleeping regularly, and wearing seat belts are related to the longevity of adults, very little is known about the health habits of disadvantaged school-age children. Using data from the 1987 National Medical Expenditure Survey (NMES), this paper examines selected health habits of children between the ages of five and 17 (n=6,722) by sociodemographic characteristics. Descriptive analyses indicate that while the majority of these school children had good health habits, many did not. Over 17 million school-age children did not regularly wear a seat belt. More than eight million of these children did not regularly eat breakfast, while close to three million were overweight. Multivariate analyses revealed that after controlling for gender, age, race, income, residence, and the education level of the highest wage earner in the family, only income and education were significantly related to the number of good health habits.
Does Subsidizing Rural Community Health Centers Hurt Private Practice Physicians?
Authors: Kolimaga Jane T. , Konrad Thomas R. , Ricketts Thomas C.
Published: July 2012

One reason for the shortage of primary care physicians in rural areas may be these physicians' reluctance to compete for patients with federally subsidized Community Health Centers (CHCs). Yet little is known about the relationship between private practice physicians and physicians in federally subsidized practices who share service areas. We used surveys from a two-state subset of a nationally representative sample to compare practice characteristics of three types of physicians: those who work in CHCs; those in private practice within CHC service areas; and private practice physicians in other rural areas. We found that rural physicians who compete with CHCs earn incomes comparable to physicians in rural areas who do not compete with CHCs, and that the percentage of Medicaid and uninsured patients seen in private physician practices does not increase when a CHC is not in the county. We conclude that CHCs do not provide competitive barriers to physicians in private practice, although we do not know if the presence of a CHC inhibits new private physicians from entering practices in these communities.
The Effectiveness of Florida's "Improved Pregnancy Outcome" Program
Authors: Clarke Leslie L. , Miller Michael K. , Vogel W. Bruce , Davis Karen E. , Mahan Charles S.
Published: July 2012

The development of a national program to assure access to prenatal care for all women, regardless of income, is believed to be an effective means of reducing low birthweight and neonatal mortality in the U.S. Yet scarce empirical evidence concerning the effectiveness of large-scale prenatal care programs is available. This paper summarizes an evaluation of a statewide public prenatal care program which grew out of the federal Improved Pregnancy Outcome (IPO) project. Using linked birth and infant death-certificate data, and IPO program records from a four-year period (1985-1988), this study compares the neonatal mortality rates of participants of Florida's IPO program with those of a matched comparison group. The results indicate an inverse relationship between IPO participation and the risk of neonatal mortality in a low-income population. These findings suggest that large-scale prenatal care programs can be effective in improving birth outcomes.
Impact of Access and Social Context on Breast Cancer Stage at Diagnosis
Authors: Mandelblatt Jeanne , Andrews Howard , Kao Richard , Wallace Roderick , Kerner Jon
Published: July 2012

This study examined the impact of individual demographic characteristics (age, race/ethnicity, and type of reporting hospital), together with measures of social context, including area of residence socioeconomic status (SES), change in SES, and access to screening (area mammography capacity), on breast cancer stage at diagnosis among New York City residents diagnosed between 1980 and 1985. Three logistic regression models evaluated the impact of individual variables, social context variables, and both classes of variables combined on the outcome of having late-stage (regional or distant) compared to early-stage (local) cancer. The logistic regression models indicated that women aged 50 to 64 years were independently more likely to have late-stage cancer than those younger or older. Controlling for individual and social context variables, African American women were 25 percent more likely than White women to have late-stage breast cancer (p < 0.0001); higher odds seen in the individual model for Hispanic women disappeared after controlling for area SES. In the combined model, women diagnosed from public hospitals were 44 percent more likely to have late-stage disease than those diagnosed in nonpublic settings (p < 0.0001). In both the social context and combined models, area mammography capacity was a significant independent predictor of stage (p = 0.016); area-level SES, but not change in SES, was independently related to late-stage disease (p = 0.002). These data suggest that breast cancer control activities should more actively ensure adequate access to screening, particularly for minorities, populations living in socioeconomically disadvantaged areas, and those cared for in the public sector.
Cancer-Screening Determinants Among Hispanic Women Using Migrant Health Clinics
Authors: Skaer Tracy L. , Robison Linda M. , Sclar David A. , Harding Gary H.
Published: July 2012

This study was designed to identify determinants of breast and cervical cancer screening among rural, low-income Hispanic women using migrant health clinics in eastern Washington state. Five hundred and twelve foreign-born Hispanic women were interviewed. Odds ratios and 95 percent confidence intervals generated via logistic regression analysis were used to discern the influence of independent factors on use or nonuse of Papanicolaou (Pap) smear, breast self-examination (BSE), and mammography. Being married, having a higher income, more years of education, and longer U.S. residency predicted receipt of Pap smear. Women who performed BSE had higher incomes and were more likely to have been taught how to perform the procedure. Low concern for direct expenditure and increasing years of U.S. residency predicted receipt of mammogram. On the basis of these findings, implications for developing cancer-screening interventions using inreach and outreach strategies to target this high-risk subgroup are discussed.
Access to Ambulatory Care for Adolescents: The Role of a Usual Source of Care
Authors: Bartman Barbara A. , Moy Ernest , D'Angelo Lawrence J.
Published: July 2012

Using data from the 1987 National Medical Expenditure Survey, characteristics of ambulatory service utilization for adolescents aged 11 through 17 were examined. Access to health care was further explored by identifying adolescents at risk of not receiving an ambulatory service in the event of symptomatology. Approximately two-thirds of an estimated 25 million adolescents experienced an outpatient visit. African American race, Hispanic ethnicity, middle income, and lack of insurance and a usual source of care placed adolescents at risk for not receiving an ambulatory service. Sixteen million adolescents experienced symptomatology, but only one-third saw a physician. Those lacking a usual source of care were at greater odds of not receiving care. For symptom-based care, inequities were related more to lack of usual source of care rather than socioeconomic characteristics. Health care reform efforts may benefit from ensuring that adolescents have an identified usual source of care to ensure equity of access to care.
Health Risk Behaviors and Attempted Suicide in Adolescents Who Report Prior Maltreatment
Authors: Alario A , Riggs S , McHorney C
Published: July 2012

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of an urban public high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9-12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. The mean age of the students was 15.8 years; 52 percent were girls; 23 percent were from families on welfare; and 56 percent from single-parent families or other living arrangements (e.g., with grandparents). Thirteen percent of the adolescents had been maltreated: 5.2 percent reported prior physical abuse, 5.4 percent sexual abuse, and 2.7 both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were 3.3 times more likely (CI 95% : 1.2-9.6; p≤0.01) than nonabused peers to drink alcohol and smoke cigarettes, almost twice as likely (CI 95% : 1.0-5.1; p=0.05) to use illicit drugs, 5.8 times more likely (CI 95% : 1.3-26.1; p<0.01) to self-induce vomiting, and 5.2 times more likely (CI 95% : 1.8-15.4; p≤0.01) to attempt suicide. A student with a history of prior sexual abuse had a 3.5 times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicated that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.
Community Health Organizing: Whom Are We Empowering?
Authors: Kelly Elizabeth , McFarlane Judith , Rodriguez Rachel , Fehir John
Published: July 2012

Current strategies for initiating and operating community health programs rely on one of two approaches. One is a predetermined, operational process. The other comes from the grassroots, beginning with involvement of the recipients of the program. This editorial chronicles how one grassroots program, begun by volunteer mothers and one community health nurse, developed into a partnership for primary health care that advocates and empowers the entire community. In the end, the editorial challenges community health organizers to ask whom their programs are empowering-the community or the organizers themselves?
Exploratory Analysis of Factors Associated with Teens' Repeated Childbearing
Authors: Bull Sheana , Hogue Carol J. R.
Published: July 2012

This study was designed to explore the factors regarding unique determinants of repeat childbearing among teens. The influence that key people have on subsequent teen childbearing is examined. Data for this research were gathered in focus groups with teen mothers and parents of teen mothers who access the Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Georgia. Based on the results, repeated childbearing appears to occur within the context of poor parent-child relations, conflicting support for the roles teen mothers are expected to assume, limited social pressures for effective fathering, and limited access to social services for all family members. Pregnancy prevention efforts by agencies for teen mothers should coordinate services for the teen mother, her parent, and her partner.
Cardiovascular Implications of Smoking: The Surgeon General's Point of View
Authors: Manley Audrey F.
Published: July 2012

One-fifth of all heart disease-related deaths are due to cigarette smoking. Smoking alone doubles the risk of heart failure. African Americans suffer the highest death rates from smoking among all U.S. population groups. Excess risk of heart disease caused by smoking can be reduced by half after just one year of quitting smoking. Therefore, the Agency for Health Care Policy and Research recommends that all patients who smoke be offered smoking cessation treatments such as nicotine replacement therapy, social supports, and skills training to achieve smoking abstinence. Such treatments should also include nutritional counseling and programs of appropriate physical activity. Other strategies to reduce the prevalence of smoking among youth include curtailing marketing efforts that glamorize smoking and strict enforcement of the minimum-age-of-sale laws. With proper nutrition, moderate physical activity, and the cessation of smoking, the risk factors associated with heart disease could be greatly reduced.
The Political Agenda of Health Care for African Americans
Authors: Brooks Thomas J.
Published: July 2012

Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations; to assure that all licensed black physicians have continued access to patients; and to develop black-owned health-related businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform.
The Health Status of Veterans Using Mobile Clinics in Rural Areas
Authors: Wray Nelda P. , Weiss Thomas W. , Christian Carol E. , Menke Terri , Ashton Carol M. , Hollingsworth John C.
Published: July 2012

Between 1992 and 1994, the Department of Veterans Affairs (VA) experimented with mobile clinics to provide health care for rural veterans. The objective was to assess the health status of rural mobile clinics' patients and compare this with patients receiving care in VA hospital-based clinics. This study hypothesized that hospital-based clinic patients would be more ill (i.e., have a greater reduction in health status). The Medical Outcomes Study (MOS) Short Form was used to evaluate patients' health status. Most patients sought care for the management of chronic disease. Patients in both groups had similar types of diseases. Mobile clinic patients were as ill as hospital-based patients (i.e., similar health status scores). This study shows that rural veterans have a case mix and a reduction in health status similar to that of VA hospital-based patients. Planners should account for this health reduction when planning the kinds of facilities and services needed in rural areas.
Variation in Preventive Service Use Among the Insured and Uninsured: Does Length of Time Without Coverage Matter?
Authors: Bednarek Heather L. , Schone Barbara Steinberg
Published: July 2012

Lacking health insurance has consequences for the ways in which individuals seek care. In this research, the authors use data from the first panel (1996) of the Medical Expenditure Panel Survey to assess the relationship between preventive services and the length of time with insurance during a 12-month period. Regression analyses show that individuals with continuous coverage during the entire period have dramatically higher rates of preventive service use than individuals who lack coverage for all 22 months. For most services, the authors also find modest differences in preventive service use between the continually insured and those individuals with coverage for 1 to 6 months. Rates of preventive service use for individuals with 7 to 11 months of coverage are statistically indistinguishable from the continually insured. The authors' findings highlight the importance of considering the length of time without coverage when evaluating preventive service use of the uninsured population.
Correlates of Violent Assault Among Young Male Primary Care Patients
Authors: Rich John A. , Sullivan Lisa M.
Published: July 2012

Correlates of violent assault (defined here as having been shot, stabbed, shot at, or beaten) were identified among young male primary care patients. Data were analyzed from a cohort of young men ages 17 to 29 during their initial visits to an urban primary care facility. Each underwent a clinical assessment, including a self-report health inventory and provider history. In multivariable analysis, history of incarceration (odds ratio [OR] = 6.29, 95 percent confidence interval [CI], 2.34-16.89), having children (OR = 3.06, 95 percent CI, 1.30-7.17), and a high school education or less (OR = 0.69, 95 percent CI, 0.50-0.96) were significantly associated with increased likelihood of violent assault. Patients reporting more serious traumatic experiences, such as incarceration, witnessing violence, or carrying a weapon, had the highest risk (OR = 9.91, 95 percent CI, 4.0-24.57). These findings may help primary care physicians identify young men at risk for violence and foster better interventions.
Nutrition in Minority Elders: Current Problems and Future Directions
Authors: Buchowski Maciej S. , Sun Ming
Published: July 2012

Nutrition and aging are inseparably connected as eating patterns affect the progress of many degenerative diseases associated with aging. In turn, the nutritional status of the elderly, particularly minority elders (the most rapidly growing segment of the population in the United States), may be adversely affected by a number of factors associated either directly or indirectly with aging. Because reducing morbidity through health promotion and disease prevention could both improve the quality of elderly life and lessen the burden on the health care system, it would seem reasonable that such efforts, including nutrition education, in minority elderly would be of benefit. The extent of the potential value of such preventive programs, however, remains uncertain, and the task of determining nutrient needs of the elderly difficult. Special studies are required to describe the association of nutrition-related factors with chronic diseases, particularly those prevalent in minority elders.