bluuebunny/crossref_metadata_2025 huggingface dataset:
Agency without Avoidability: Defusing a New Threat to Frankfurt's Counterexample Strategy
Authors: Shabo Seth
Published: April 2012

Many believe that we are not morally responsible for what we cannot help doing. Call this ‘the Traditional View of Responsible Agency.’ Some forty years ago, Harry Frankfurt (1969) challenged this view, thereby initiating a new stage of the free-will debate. In contrast to the previous stage, in which debate centered on how best to accommodate the Traditional View, contemporary theorists have focused on whether this view should be accepted at all. If the link between moral responsibility and avoidability is severed, an important threat to compatibilism is neutralized.

In the wake of Frankfurt's challenge, a tremendous literature has sprung up, with many ingenious responses matched by equally thoughtful extensions of Frankfurt's original argument. Quite recently, an altogether new line of response has been proposed. This new approach, versions of which have been advanced by Maria Alvarez (2009) and Helen Steward (2009), attempts to support the Traditional View indirectly, by appealing to the conditions for action, rather than to the conditions for moral responsibilityper se.
Causal and Logical Necessity in Malebranche's Occasionalism
Authors: Fisher A.R.J.
Published: April 2012

The famous Cartesian Nicolas Malebranche (1638-1715) espoused the occasionalist doctrine that ‘there is only one true cause because there is only one true God; that the nature or power of each thing is nothing but the will of God; that all natural causes are nottruecauses but onlyoccasionalcauses’ (LO, 448, original italics). One of Malebranche's well-known arguments for occasionalism, known as, the ‘no necessary connection’ argument (or, NNC) stems from the principle that ‘a true cause… is one such that the mind perceives a necessary connection between it and its effect’ (LO, 450).
The Labor Market in the Great Recession—An Update to September 2011
Authors: Elsby Michael W. L. , Hobijn Bart , Şahin Ayşegül , Valletta Robert G.
Published: April 2012

Since the end of the Great Recession in mid-2009, the unemployment rate has recovered slowly, falling by only 1 percentage point from its peak by September 2011. We find that the lackluster labor market recovery can be traced in large part to weakness in aggregate demand; only a small part seems attributable to increases in labor market frictions. This continued labor market weakness has led to the highest level of long-term unemployment in the postwar period and a blurring of the distinction between unemployment and nonparticipation in the labor force. We show that flows from nonparticipation to unemployment are important for understanding recent changes in the duration distribution of unemployment. Simulations that account for these flows suggest that the labor market is unlikely to be subject to high levels of structural long-term unemployment after aggregate demand recovers.
The Income- and Expenditure-Side Estimates of U.S. Output Growth—: An Update to 2011Q2
Authors: Nalewaik Jeremy J.
Published: April 2012

In light of recent large revisions to the official measures of U.S. output, this update reviews the evidence in my 2010 Brookings Paper showing that the income-side estimate of output (currently called gross domestic income, or GDI) likely captures business cycle fluctuations in true output better than its better-known expenditure-side counterpart (called gross domestic product, or GDP). Most notably, over the 2007-09 downturn, the revisions moved the expenditure-side estimates closer to the income-side estimates, which showed that the downturn was considerably worse than reported initially by the expenditure-side estimates. The tendency for the expenditure-side estimates to be revised toward the income-side estimates is clearer now, as is a tendency for the smoothed income-side estimates to be revised away from the smoothed expenditure-side estimates.
Recessions and the Costs of Job Loss
Authors: Davis Steven J. , von Wachter Till
Published: April 2012

We develop new evidence on the cumulative earnings losses associated with job displacement, drawing on longitudinal Social Security records from 1974 to 2008. In present-value terms, men lose an average of 1.4 years of predisplacement earnings if displaced in mass-layoff events that occur when the national unemployment rate is below 6 percent. They lose a staggering 2.8 years of predisplacement earnings if displaced when the unemployment rate exceeds 8 percent. These results reflect discounting at a 5 percent annual rate over 20 years after displacement. We also document large cyclical movements in the incidence of job loss and job displacement and present evidence on how worker anxieties about job loss, wage cuts, and job opportunities respond to contemporaneous economic conditions. Finally, we confront leading models of unemployment fluctuations with evidence on the present-value earnings losses associated with job displacement. The 1994 model of Dale Mortensen and Christopher Pissarides, extended to include search on the job, generates present-value losses that are only one-fourth as large as observed losses. Moreover, present-value losses in the model vary little with aggregate conditions at the time of displacement, unlike the pattern in the data.
What Do Small Businesses Do?
Authors: Hurst Erik , Pugsley Benjamin Wild
Published: April 2012

We show that most small business owners are very different from the entrepreneurs that economic models and policymakers often have in mind. Using new data that sample entrepreneurs just before they start their businesses, we show that few small businesses intend to bring a new idea to market or to enter an unserved market. Instead, most intend to provide an existing service to an existing market. Further, we find that most small businesses have little desire to grow big or to innovate in any observable way. We show that such behavior is consistent with the industry characteristics of the majority of small businesses, which are concentrated among skilled craftspeople, lawyers, real estate agents, health care providers, small shopkeepers, and restaurateurs. Lastly, we show that nonpecuniary benefits (being one's own boss, having flexibility of hours, and the like) play a first-order role in the business formation decision. Our findings suggest that the importance of entrepreneurial talent, entrepreneurial luck, and financial frictions in explaining the firm size distribution may be overstated. We conclude by discussing the potential policy implications of our findings.
Unemployment Insurance and Job Search in the Great Recession
Authors: Rothstein Jesse
Published: April 2012

More than 2 years after the official end of the Great Recession, the labor market remains historically weak. One candidate explanation is supply-side effects driven by dramatic expansions of unemployment insurance (UI) benefit durations, to as long as 99 weeks. This paper investigates the effect of these extensions on job search and reemployment. I use the longitudinal structure of the Current Population Survey to construct unemployment exit hazards that vary across states, over time, and between individuals with differing unemployment durations. I then use these hazards to explore a variety of comparisons intended to distinguish the effects of UI extensions from other determinants of employment outcomes. The various specifications yield quite similar results. UI extensions had significant but small negative effects on the probability that the eligible unemployed would exit unemployment. These effects are concentrated among the long-term unemployed. The estimates imply that UI extensions raised the unemployment rate in early 2011 by only about 0.1 to 0.5 percentage point, much less than implied by previous analyses, with at least half of this effect attributable to reduced labor force exit among the unemployed rather than to the changes in reemployment rates that are of greater policy concern.
The Effects of Quantitative Easing on Interest Rates: Channels and Implications for Policy
Authors: Krishnamurthy Arvind , Vissing-Jorgensen Annette
Published: April 2012

We evaluate the effect of the Federal Reserve's purchase of long-term Treasuries and other long-term bonds (QE1 in 2008-09 and QE2 in 2010-11) on interest rates. Using an event-study methodology, we reach two main conclusions. First, it is inappropriate to focus only on Treasury rates as a policy target, because quantitative easing works through several channels that affect particular assets differently. We find evidence for a signaling channel, a unique demand for long-term safe assets, and an inflation channel for both QE1 and QE2, and a mortgage-backed securities (MBS) prepayment channel and a corporate bond default risk channel for QE1 only. Second, effects on particular assets depend critically on which assets are purchased. The event study suggests that MBS purchases in QE1 were crucial for lowering MBS yields as well as corporate credit risk and thus corporate yields for QE1, and Treasuries-only purchases in QE2 had a disproportionate effect on Treasuries and agency bonds relative to MBSs and corporate bonds, with yields on the latter falling primarily through the market's anticipation of lower future federal funds rates.
Practical Monetary Policy: Examples from Sweden and the United States
Authors: Svensson Lars E. O.
Published: April 2012

In the summer of 2010, the Federal Reserve's and the Swedish Riksbank's inflation forecasts were below the former's mandate-consistent rate and the latter's target, respectively, and their unemployment forecasts were above sustainable rates. Conditions in both countries clearly called for policy easing. The Federal Reserve maintained a minimum policy rate, soon started to communicate possible future easing, and in the fall launched QE2. In contrast, the Riksbank started a period of rapid tightening. I find the arguments against the Federal Reserve's easing and the arguments for the Riksbank's tightening unconvincing. Although the Swedish economy subsequently performed better than expected, probably an important reason was that the market implemented much easier financial conditions than were consistent with the Riksbank's policy rate path. Without the policy tightening, performance would have been even better. The U.S. economy meanwhile performed worse than expected because of factors other than monetary policy. Without the policy easing, performance would have been even worse. In short, the Riksbank did the wrong thing but was lucky, whereas the Federal Reserve did the right thing but was unlucky.
Postpartum Depression: A Review
Authors: Patel Milapkumar , Bailey Rahn K. , Jabeen Shagufta , Ali Shahid , Barker Narviar C. , Osiezagha Kenneth
Published: April 2012

Postpartum depression is a disorder that is often unrecognized and undertreated. Many psychosocial stressors may have an impact on the development of postpartum depression. The greater risk of postpartum depression is a history of major depression and those who have experienced depression during past pregnancies. Untreated maternal depression can have a negative effect on child development, mother-infant bonding, and risk of anxiety or depressive symptoms in infants later in life. Management of postpartum depression is a vital part of adequate medical care. The obstetrician and pediatrician can serve important roles in screening for and treating postpartum depression. To prevent adverse outcomes associated with depression and its impact on the child, it is important that all health care professionals and nurse practitioners are aware of specific signs and symptoms, appropriate screening methods, and proper treatment. This review article covers major traits of postpartum depression.
Rural Medical-Legal Partnership and Advocacy: A Three-Year Follow-up Study
Authors: Teufel James A. , Werner Danilea , Goffinet Diane , Thorne Woody , Brown Stephen L. , Gettinger Lori
Published: April 2012

Introduction . Medical-legal partnerships perform advocacy services for vulnerable and underserved populations, who are burdened disproportionately by legal and medical problems. This study aimed to examine the effectiveness and projected sustainability of a rural medical-legal partnership (MLP). Methods . Five years of baseline data and three years of follow-up data were analyzed using descriptive and inferential statistics as well as logic modeling. Results . The benefit relative to cost of the MLP increased between the years of 2002-2006 and 2007-2009. The number of people served increased across the two time periods, and the proportion of cases won remained the same. Overall, the population served remained similar across time. The MLP continued to show social and financial impacts, such as health care recovery dollars (319% return on investment between 2007 and 2009), Social Security benefits, family law services, and end-of-life guidance. Conclusion . A rural MLP can maintain its impact and efficiency across time and have opportunities for expansion.
Implementation of Massachusetts Health Insurance Reform with Vulnerable Populations in a Safety-Net Setting
Authors: Mulvaney-Day Norah , Alegría Margarita , Nillni Anna , Gonzalez Sabrina
Published: April 2012

This qualitative study examines the experience of racial and ethnic minorities receiving behavioral health care in a safety net setting during the early process of health insurance reform in Massachusetts. Three rounds of interviews were conducted between August 2007 and May 2009, collecting information from patients (n=65) on the experience of health reform and delivery of mental health care. Four categories of enrollees transitioning into health reform emerged over the course of the study that grouped into a typology of experiences with reform: early enrollees, middle enrollees, late enrollees, and multiple switchers. With support, a majority of the sample transitioned smoothly to the new health insurance mechanisms. However, some experienced administrative confusion and disruption in mental health care during the transition. Administrative policies providing special accommodations for individuals with mental health disorders and other vulnerable populations may be important to consider during the transition to health insurance reform.
Low Knowledge of the Three-Dose HPV Vaccine Series among Mothers of Rural Hispanic Adolescents
Authors: Kepka Deanna L. , Ulrich Angela K. , Coronado Gloria D.
Published: April 2012

Background . Few previous investigations on correlates of HPV vaccine uptake have included Hispanics, a group known to have a disproportionately high risk of cervical cancer. Methods . Rural Hispanic mothers of daughters aged 9-17 (n=78) were recruited at local community events to participate in a standardized Spanish-language survey that examined factors related to vaccine uptake. Results . Approximately 35% of the mothers reported that their daughter had received at least one dose of the vaccine. Mothers who had heard of the HPV vaccine were more likely to have a vaccinated daughter (p<.01). Mothers who thought their daughter's father would approve were more likely to have a vaccinated daughter (p=.004). Contrary to expectation, parents who believed that only one injection is necessary were more likely to have a vaccinated daughter (p=.009). Conclusions . HPV vaccine education programs that target both parents are needed to ensure that Hispanic parents receive the complete HPV vaccine regimen.
Sociodemographic Characteristics, Health, and Success at Obtaining Work among Latino Urban Day Laborers
Authors: Nelson Ronald W. , Schmotzer Geri , Burgel Barbara J. , Crothers Rachel , White Mary C.
Published: April 2012

Background . The purpose of this study was to examine the health and social circumstances, knowledge of and access to health and social services, and success at getting work among urban day laborers. Methods . We conducted an interview survey of 217 men waiting for work at several sites in San Francisco. Results . Day laborers were generally unsuccessful at obtaining work and had less than optimal housing, but supported a number of family members. Over half reported fair or poor health, associated with longer time as a day laborer, poor English proficiency, and financially supporting three or more other people. Awareness of health and social services available to them was low. Discussion . The stress of seeking work daily, separation from family, inadequate housing and lack of health care puts this population at increased risk for disease conditions associated with poor physical and mental health.
Pain Characteristics and Pain Catastrophizing in Incarcerated Women with Chronic Pain
Authors: Darnall Beth D. , Sazie Elizabeth
Published: April 2012

Chronic pain in incarcerated women is understudied and poorly described. Study objectives were to describe pain characteristics, correlates, and predictors in a convenience sample of incarcerated women with chronic pain. A survey packet that included the Brief Pain Inventory Short Form (BPI-SF) and the Pain Catastrophizing Scale (PCS) was distributed to all inmates at a state prison for women. Those who self-identified as having chronic pain ≥4 on a 0-10 numeric rating scale were invited to complete the survey. Demographics and medical and psychiatric diagnoses were abstracted by chart review. Participants (N=159) rated their current and average pain intensity as severe. Pain catastrophizing was found to predict average pain intensity and level of pain-related interference in functioning. Pain catastrophizing is treatable with behavioral intervention in the general population. Findings suggest that pain catastrophizing may be an important target for research and treatment in incarcerated women with chronic pain.
Breast Cancer Mortality in Appalachia: Reversing Patterns of Disparity over Time
Authors: Yao Nengliang , Lengerich Eugene J. , Hillemeier Marianne M.
Published: April 2012

Breast cancer death rates in the U.S. have decreased in recent decades, however areas such as Appalachia with fewer cancer care resources may not have experienced comparable mortality declines. This study examines trends in breast cancer mortality rate disparities in Appalachian states and the continental U.S. using data from SEER mortality files 1969-2007 and the Area Resource File. Overall breast cancer mortality rates decreased significantly, with a smaller decline in Appalachian counties (17.5%) compared with non-Appalachian counties in Appalachian states (30.5%), and compared with non-Appalachia U.S. counties (28.3%). After accounting for poverty, rural/urban status, education, health care resources, and proportion White in the population, residence in Appalachian counties except for those in the Northern subregion was significantly associated with smaller reduction in breast cancer mortality rates. Lower levels of education, physician density, and percent White in the population were also associated with smaller reductions in breast cancer mortality.
Awareness, Treatment and Control of Hypertension, Diabetes and Hyperlipidemia and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Shuaib Faisal M. , Durant Raegan W. , Parmar Gaurav , Brown Todd M. , Roth David L. , Hovater Martha , Halanych Jewell H. , Shikany James M. , Howard George , Safford Monika M.
Published: April 2012

Background . Health Professional Shortage Areas (HPSA) receive extra federal resources, but recent reports suggest that HPSA may not consistently identify areas of need. Purpose . To assess areas of need based on county-level ischemic heart disease (IHD) and stroke mortality regions. Methods . Need was defined by lack of awareness, treatment, or control of hypertension, diabetes, or hyperlipidemia. Counties were categorized into race-specific tertiles of IHD and stroke mortality using 1999-2006 CDC data. Multivariable logistic regression was used to model the relationships between IHD and stroke mortality region and each element of need. Results . Awareness and treatment of cardiovascular (CVD) risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties with the highest mortality. Conclusions . High stroke and IHD mortality identify distinct regions from current HPSA designations, and may be an additional criterion for designating areas of need.
Anticipated Tuberculosis Stigma among Health Professionals and Haitian Patients in South Florida
Authors: Coreil Jeannine , Lauzardo Michael , Heurtelou Maude
Published: April 2012

This paper compares tuberculosis-related stigma perceptions of health professionals with that of local patient populations, and examines these in relation to other measures of anticipated distress. Comparison groups were service providers and Haitian American patients diagnosed with latent TB (LTBI). Providers consistently rated LTBI higher on anticipated stigma than patients both overall and for internal perceptions and emotions, external perceptions and actions, and Haitian identity. Health professionals were almost five times more likely than patients to report the possibility of other types of psychosocial distress. The findings are consistent with previous studies reporting a higher degree of perceived stigma among unaffected populations compared with people diagnosed with a medical condition. Results suggest that providers may overestimate the likelihood that patients with a stigmatized condition will experience negative consequences. This may negatively affect adherence to TB testing guidelines because of confidentiality concerns. The implications for achieving national TB elimination goals are discussed.
Hepatitis C among Clients of Health Care for the Homeless Primary Care Clinics
Authors: Strehlow Aaron J. , Robertson Marjorie J. , Zerger Suzanne , Rongey Catherine , Arangua Lisa , Farrell Ed , O'Sullivan Adele , Gelberg Lillian
Published: April 2012

Objectives . To describe the prevalence, distribution and risk factors for hepatitis C virus (HCV) infection among homeless adults using eight Health Care for the Homeless (HCH) clinics nationally. Methods . Data were collected for 387 participants through blood draws, structured interviews, chart reviews. Results . Overall prevalence of HCV-antibody positivity was 31.0%, including 70.0% among injection drug users and 15.5% among reported non-injectors. Much HCV infection was hidden as the majority (53.3%) of HCV-antibody positive participants was unaware of their status. Independent risk factors for HCV among the total sample included injection drug use, prison, and tattoos; among injectors, risk factors included prison and three or more years of injection drug use; among reported non-injectors, risk factors included tattoos and prison. Conclusion . These HCH clinics serve high concentrations of HCV-infected injectors, making these and similar clinics priority intervention sites for aggressive screening, education, testing, and treatment for HCV and other blood-borne diseases.
Health Care of Pregnant Women in U.S. State Prisons
Authors: Ferszt Ginette G. , Clarke Jennifer G.
Published: April 2012

Background . Although standards for pregnancy-related health care in correctional facilities have been established, there is no mandatory accreditation that requires adherence to these standards. Furthermore, this information has been difficult to access from correctional facilities across the country. Methods . To examine the health care practices of pregnant women in state prisons, a survey with 62 multiple choice questions and four open-ended questions was developed. Wardens of 50 women's state correctional facilities were contacted to describe the study and request participation. Nineteen facilities completed the survey, for a 38% response rate. Results . The findings of this study provide further evidence of the substandard care that pregnant incarcerated women receive in correctional facilities. In many state prisons, nutritional recommendations for a healthy pregnancy are not met, adequate rest is compromised and lower bunks are not required. Psychosocial support and education are minimal at best. The use of restraints, which can compromise the health and safety of the woman and her baby, continues as a matter of procedure in many facilities even during labor and delivery. Conclusions . The providers of health care for pregnant women fail to use best practices and established standards in many women's state prisons. A concerted effort is urgently needed to address the unmet health care needs of this marginalized population and support legislation to limit the use of restraints with pregnant incarcerated women in all states.
Appraisal of Perceived Threat of Diabetes and the Relation to Adherence for Adults in Appalachia
Authors: Carpenter Roger
Published: April 2012

This study examined appraisal of perceived threat of diabetes and the relation to adherence to self-management behaviors in uninsured Appalachians receiving care at a free clinic. Participants were at least 18 years of age, English-speaking, and uninsured. Participants followed recommendations for taking prescribed oral medications an average of 6.6 days/week, diet 4.1 days/week, and exercise 2.9 days/week. Relationships were found between appraisal and self-management variables. Diabetes was perceived more as challenging than threatening. Although part of a recognized group experiencing health disparities, adherence behaviors did not differ from those of other patient populations. Appraisal of diabetes is an important issue when discussing adherence with patients. Interventions targeting the perception of diabetes as a challenge rather than a threat would contribute to the understanding of adherence. Developing this characterization, rather than emphasizing the poor physiological outcomes associated with diabetes, could improve self-management behaviors and diabetes control.
Provider's Perspectives on the Impact of Immigration and Customs Enforcement (ICE) Activity on Immigrant Health
Authors: Hacker Karen , Chu Jocelyn , Arsenault Lisa , Marlin Robert P.
Published: April 2012

Introduction . Increasing Immigration and Customs Enforcement (ICE) activities such as raids, detention, and deportation may be affecting the health and well-being of immigrants. This study sought to understand the impact of ICE activities on immigrant health from the perspective of health care providers. Methods . An online survey of primary care and emergency medicine providers was conducted to determine whether ICE activity was negatively affecting immigrant patients. Results . Of 327 providers surveyed, 163 responded (50%) and 156 (48%) met criteria for inclusion. Seventy-five (48%) of them observed negative effects of ICE enforcement on the health or health access of immigrant patients. Forty-three providers gave examples of the impact on emotional health, ability to comply with health care recommendations, and access. Conclusions . Health care providers are witnessing the negative effects of ICE activities on their immigrant patients' psychological and physical health. This should be considered an important determinant of immigrant health.
Formulary Expansion to Provide Access to Medications Prescribed by a Specialist in a Low-Income Population
Authors: Robbins Carolyn , Stillwell Tracy , Wilson Sally , Fitzgerald Lynn
Published: April 2012

Summary: The process of expanding a medication formulary as a tool for providing access to medications prescribed by a specialist in a low-income population is described. The formulary optimized use of the 340B Drug Pricing Program and reserved patient assistance programs for costly medications. Collaborating with community physicians and organizations aided success.
Social Gradients in Dental Health among Low-Income Mothers and their Young Children
Authors: Grembowski David , Spiekerman Charles , Milgrom Peter
Published: April 2012

For low-income mothers of children aged 3-6 years, we estimate whether social gradients exist between mothers' income, education, and employment status and mothers' perceptions of self and child dental and general health, and whether these relationships differ by racial/ethnic group. Disproportionate stratified sampling by racial/ethnic group selected 10,909 eligible children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode (web, mail, telephone) survey. Mothers' education had a strong, gradient relationship with mother ratings of self and child dental health that was not explained by other measures. Similar gradients were found for mothers' employment status and income, but some associations were no longer significant (p>.05) after adjusting for oral health beliefs and behaviors, dental insurance, and regular dental care. Associations did not differ significantly by racial/ethnic group.
Study of a Rural Practice Dental Hygienist in a Public Health Setting: Analysis of an Administrative Dataset
Authors: Squillace Joe
Published: April 2012

States are grappling with the lack of access to oral health care for their child populations. This study evaluated a unique administrative dataset collected by a hygienist in rural Missouri who started a new clinic and provided services to a two-county population under what is known as unsupervised practice. Results showed 82% of 2-8 year olds presenting at the clinic had no prior visits to other practicing dental providers, indicating the benefits of new oral health providers in an underserved area. School-aged children (ages 6-12 years) were significantly more likely than other age groups to have higher numbers of recall visits and therefore, subsequently to use prevention services of the unsupervised dental hygienist at the rural clinic. The results suggest that improved systematic collection of data from dental hygienists in public health settings is needed to provide evidence that may affect public oral health policies.
Prevalence of Autism Spectrum Disorder among Nigerian Children with Intellectual Disability: A Stopgap Assessment
Authors: Bakare Muideen O. , Ebigbo Peter O. , Ubochi Vincent N.
Published: April 2012

The prevalence of autism spectrum disorder (ASD) among sub-Saharan African children with intellectual disability is about 0.7% more than three decades ago. During this period, the prevalence of ASD has been on the increase worldwide. Studies are not available in recent times addressing epidemiology of ASD among sub-Saharan African children. The present study assessed the prevalence of ASD among Nigerian children with intellectual disability. Forty four children with intellectual disability were assessed for diagnosis of childhood autism based on criteria specified in F84.0 section of International Classification of Diseases, Tenth Edition (ICD-10) Diagnostic Criteria for Research. Five (11.4%) of the children studied met the diagnostic criteria for childhood autism. Male/female ratio was 4:1. There is need for large scale epidemiological studies of ASD among sub-Saharan African children to clearly define the inter-relationship between ASD and intellectual disability in this population and to help in health care policy formulation.
Using the Framingham Risk Score to Evaluate Immigrant Effect on Cardiovascular Disease Risk in Mexican Americans
Authors: Salinas Jennifer J. , Abdelbary Bassent , Wilson Jeffrey , Hossain Monir , Fisher-Hoch Susan , McCormick Joseph
Published: April 2012

Background . This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. Methods and Results . Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. Conclusions . This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed.
Lost in the Rush to National Reform: Recommendations to Improve Impact on Behavioral Health Providers in Rural Areas
Authors: Semansky Rafael , Willging Cathleen , Ley David J. , Rylko-Bauer Barbara
Published: April 2012

As the United States embarks on the most ambitious national health reform since the 1960s, this article highlights the challenges faced by behavioral health agencies, providers, and clients in rural areas and presents recommendations to improve access to and quality of services. Lessons learned from five years of research on a major systems-change initiative in New Mexico illuminate potential problem areas for rural agencies under national health reform, including insufficient financial resources, shortages of trained staff, particularly clinicians with advanced credentials, and delays in adopting the latest information technology. We recommend that rural states: (1) undertake careful planning for smooth transitions; (2) provide financial resources and technical assistance to expand rural safety-net services and capacity; (3) modify the health home model for the rural context; and (4) engage in ongoing evaluation, which can help ensure the early identification and rectification of unanticipated implementation issues.
The Intersection of Everyday Life and Group Prenatal Care for Women in Two Urban Clinics
Authors: Novick Gina , Sadler Lois S. , Knafl Kathleen A. , Ellen Groce Nora , Kennedy Holly Powell
Published: April 2012

Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features that address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects.
Cancer Control Needs of 2-1-1 Callers in Missouri, North Carolina, Texas, and Washington
Authors: Purnell Jason Q. , Kreuter Matthew W. , Eddens Katherine S. , Ribisl Kurt M. , Hannon Peggy , Williams Rebecca S. , Fernandez Maria E. , Jobe David , Gemmel Susan , Morris Marti , Fagin Debbie
Published: April 2012

Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1 , an information and referral system used by underserved populations, b) compared rates of need with state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers' (N=1,408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared with state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers than for state and national rates, and callers were receptive to referrals. 2-1-1 could be a key partner in efforts to reduce cancer disparities.
Textmania: Text Messaging During the Manic Phase of Bipolar I Disorder
Authors: Emeagwali Nkiruka Anwulika , Bailey Rahn K. , Azim Fatima
Published: April 2012

Advancements in modern technology have brought tremendous changes in human behavior. One such change is in modes of communication such as text messaging, or texting . This form of communication has emerged as one of the dominant modes of communication in the world. This report presents a differential pattern of texting seen during the manic episode of a young adult with bipolar I disorder. We observed all the DSM IV manic symptoms; interestingly the patient's predominant medium for communication was texting. The patient reported a dramatic increase in the quantity of both texting and sex-texting (or sexting ) in addition to a decrease in quality of the message content. In addition, there was a substantial increase in the number of people with whom the patient engaged in simultaneous texting conversations. This case provides evidence for the need to consider non-traditional forms of communication when evaluating a patient's communication pattern during mania.
The Use of Prescription Medications Obtained from Non-medical Sources among Immigrant Latinos in the Rural Southeastern U.S.
Authors: Song Eun-Young , Leichliter Jami S. , Bloom Frederick R. , Vissman Aaron T. , O'Brien Mary Claire , Rhodes Scott D.
Published: April 2012

We explored the relationships between behavioral, socio-cultural, and psychological characteristics and the use of prescription medications obtained from non-medical sources among predominantly Spanish-speaking Latinos in the rural southeastern U.S. Respondent-driven sampling (RDS) was used to identify, recruit, and enroll immigrant Latinos to participate in an interviewer-administered assessment. A total of 164 respondents were interviewed in 2009. Average age was 34 years old, 64% of respondents were female, and nearly 85% reported being from Mexico. Unweighted and RDS-weighted prevalence estimates of any non-medical source of prescription medications were 22.6% and 15.1%, respectively. In multivariable modeling, respondents who perceived their documentation status as a barrier to health care and those with higher educational attainment were significantly more likely to report use of non-medical sources. Interventions are needed to increase knowledge of eligibility to sources of medical care and treatment and ensure culturally congruent services for immigrant communities in the U.S.
Racial Disparities in Intensity of Care at the End-of-Life: Are Trauma Patients the Same as the Rest?
Authors: Cooper Zara , Rivara Frederick P. , Wang Jin , MacKenzie Ellen J. , Jurkovich Gregory J.
Published: April 2012

Introduction . Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods . We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results . Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95% CI, 1.22, 2.30), specialty assessments RR=1.44 (95% CI, 1.12, 1.86) and procedures RR=1.22 (95% CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95% CI, 0.53, 0.98). Conclusion . Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.
Does the Epidemiologic Paradox Hold in the Presence of Risk Factors for Low Birth Weight Infants among Mexican-born Women in Colorado?
Authors: Romero Camila X. , Duke Jodi K. , Dabelea Dana , Romero Tomas E. , Ogden Lorraine G.
Published: April 2012

Objectives . To test whether foreign-born status confers a protective effect against low birth weight (LBW) outcomes among Mexican-origin women in Colorado. Methods . Retrospective cohort study utilizing Colorado birth records from 1989-2004 for multivariate logistic regression analysis. The study population was 66,422 U.S.-born women of Mexican origin (USB) and 85,000 Mexican-born (MB) women with singleton births. Results . Mexican-born women had 24.9% lower odds of LBW (OR 0.751 95% CI 0.782) than USB women. Mexican-born women had a higher prevalence of risk factors for LBW than their USB counterparts (anemia, cardiac disease, hypertension, inadequate prenatal care, less than high school education). After adjusting for these risk factors, MB women had 22.5% lower odds of having LBW infants than USB women (OR 0.775, 95% CI 0.73-0.81). Conclusions . This study supports the epidemiologic paradox of LBW; despite higher prevalence of risk factors, foreign-born status confers an overall protective effect against low birth weight outcomes.
Driving to Better Health: Cancer and Cardiovascular Risk Assessment among Taxi Cab Operators in Chicago
Authors: Apantaku-Onayemi Funmi , Baldyga William , Amuwo Shaffdeen , Adefuye Adedeji , Mason Terry , Mitchell Robin , Blumenthal Daniel S.
Published: April 2012

While a number of investigations of the health of taxi cab drivers have been conducted in Europe, Asia, and Africa, virtually none have been conducted in the United States. We undertook a survey of taxi cab operators in the Chicago area to understand better their health status and health promotion practices. The survey was completed by a convenience sample of 751 Chicago taxi drivers. Taxi drivers had low rates of insurance coverage, fruit and vegetable consumption, and physical activity compared with the general Chicago population. Participation in cancer screening tests was also lower for this group. A high proportion of taxi drivers are immigrants. They tend to be highly educated and report a readiness to engage in more health-promoting behaviors. Further research is needed to develop a targeted intervention for this population.
The Impact of Natural Disaster on Pediatric Surgical Delivery: A Review of Haiti Six Months Before and After the 2010 Earthquake
Authors: Hughes Christopher D. , Nash Katherine A. , Alkire Blake C. , McClain Craig D. , Hagander Lars E. , Smithers C. Jason , Raymonville Maxi , Sullivan Stephen R. , Riviello Robert , Rogers Selwyn O. , Meara John G.
Published: April 2012

Little is known about pediatric surgical disease in resource-poor countries. This study documents the surgical care of children in central Haiti and demonstrates the influence of the 2010 earthquake on pediatric surgical delivery. Methods . We conducted a retrospective review of operations performed at Partners in Health/Zanmi Lasante hospitals in central Haiti. Results . Of 2,057 operations performed prior to the earthquake, 423 were pediatric (20.6%). Congenital anomalies were the most common operative indication (159/423 operations; 33.5%). Pediatric surgical volume increased significantly after the earthquake, with 670 operations performed (23.0% post-earthquake v . 20.6% pre-earthquake, p=.03). Trauma and burns became the most common surgical diagnoses after the disaster, and operations for non-traumatic conditions decreased significantly (p<.01). Conclusion . Congenital anomalies represent a significant proportion of baseline surgical need in Haiti. A natural disaster can change the nature of pediatric surgical practice by significantly increasing demand for operative trauma care for months afterward.
Mining for Future Health Care Providers in Appalachian Kentucky
Authors: Gross David A. , Bates Pamela , Knox Tamara L. , Gayheart Michael W.
Published: April 2012

Recent studies project a significant shortage of U.S. health care providers within the next decade. To address southeastern Kentucky's persistent undersupply of medical professionals, a multi-county Health Career Enrichment Camp for rising 9th and 10th grade students was implemented in 2008. This report describes the annual camp's development and preliminary outcomes.
Federally Qualified Health Center Patients and Generic Drug Discount Programs
Authors: Omojasola Anthony , Hernandez Mike , Sansgiry Sujit , Paxton Raheem , Jones Lovell
Published: April 2012

This study evaluates the factors associated with utilization of generic drug discount program (GDDP) among federally qualified health center (FQHC) patients in Houston, Texas. A survey to determine awareness and use of GDDP was administered to 304 patients at three FQHCs in Houston, Texas. Patients at FQHCs treated with courtesy by pharmacy staff (OR: 14.1, 95% CI: 7.9-25.2), patients with a perception of positive impact of GDDP on their health (OR: 7.6, 95% CI: 4.5-12.7), those who found GDDP easy to use (OR: 6.6, 95% CI: 3.8-11.6), were more likely to utilize GDDP. Approximately 56% of the participants had utilized the GDDP at least once in the past 12 months. Approximately 85% of participants indicated that they would use GDDP if recommended by a physician. It is possible for FQHCs to be good venues for increasing awareness and utilization of GDDP.
Culturally Tailored Health Camps and Cardiovascular Risk among South Asian Immigrants
Authors: Gany Francesca , Levy Andrew , Basu Piali , Misra Shantum , Silberstein Jacob , Bari Sehrish , Gill Pavan , Keller Norma , Changrani Jyotsna , Leng Jennifer C.F.
Published: April 2012

Introduction . South Asians have a high prevalence and early age of onset of diabetes, metabolic syndrome, and cardiovascular disease (CVD). We assess the potential of a culturally responsive intervention, health camps, to identify and inform U.S. South Asian community members at risk for CVD. Methods . We held four culturally and linguistically tailored health camps between October 2009 and November 2010 to educate participants about and screen for CVD risk factors, including diabetes, hypertension, and hypercholesterolemia. Data analysis was conducted in December 2010. Results . Nearly 300 (289) South Asians registered at the health camps: 20% reported a previous diagnosis of diabetes, 34% elevated blood pressure, and 22% hypercholesterolemia. Most (240) participants had their blood glucose measured; 13% had values >200 mg/dl. Most (265) had their blood pressure measured; 32% had elevated values. Over half (57%) of LDLs were <100 mg/dl. Discussion . Health camps are a potentially important component in addressing increased CVD risk in this vulnerable population.
Why Men Experiencing Deep Poverty in Montréal Avoid Using Health and Social Services in Times of Crisis
Authors: Dupéré Sophie , O'Neill Michel , De Koninck Maria
Published: April 2012

This article describes the experiences of men living in deep poverty regarding their decision not to seek out health and social services in moments of crisis, even when they recognized needing help. It presents results from a qualitative research project done in collaboration with a community center in a disadvantaged neighborhood of Montreal, Canada. It was designed to increase understanding of men's experiences of poverty and the role played by health and social services in their lives. Data were collected through 80 days of participant observation, 22 semi-directed interviews, and six group discussions with men living in poverty. The results show that these men are reluctant to use health and social services for three main reasons: 1) the nature of their problems; 2) their difficulty in seeking help; 3) the nature of services offered. The paper concludes with implications of the findings for future research and interventions.