bluuebunny/crossref_metadata_2025 huggingface dataset:
Meeting the Needs of Deaf and Hard of Hearing Students with Additional Disabilities Through Professional Teacher Development
Authors: Bruce Susan , DiNatale Patrice , Ford Jeremiah
Published: November 2008

According to even the most conservative estimates, at least a quarter of deaf children have additional disabilities. Most teacher preparation programs do not sufficiently prepare teacher candidates for the challenges posed by these children. This article describes a professional development effort to prepare in-service educators of the deaf to work with students with additional disabilities. Over a 3-year period, teachers selected these in-service topics: etiologies, vision conditions, behavior, transition, sensory integration, seizures, alternate assessment, and instructional strategies. In-class consultation was requested for support in the areas of formal assessment instruments, behavior, and student performance. Elements of effective professional development programs, such as honoring teachers’ choices about topics and participation, responding to teachers’ immediate classroom concerns, and providing inclass follow-up support, facilitated the success of this effort.
Child Abuse and Deafness: An Overview
Authors: Sebald Ann M.
Published: November 2008

The professional literature contains research and anecdotal in-formation on various maltreatments affecting children and youth with and without disabilities. Unfortunately, little information exists on abused children with hearing loss. Reasons relate to a lack of quantity and quality in research on this population; challenges in conducting research using sound methodological principles that consider the population’s heterogeneity (e.g., mode of communication, language level, parental perspective on deafness, educational placement); and scarce intervention services with professionals trained in the unique needs of children with hearing loss. The present article discusses types of abuse prevalent within the overall population of children and that of children with hearing loss, shares a rationale for practitioners and those training future practitioners to understand abuse among this unique population, proposes a research agenda based on existing information, and provides suggestions for supporting children who are deaf or hard of hearing and abused.
Apartheid in Deaf Education: Examining Workforce Diversity
Authors: Simms Laurene , Rusher Melissa , Andrews Jean F. , Coryell Judy
Published: November 2008

A survey of 3,227 professionals in 313 deaf education programs found that 22.0% of teachers and 14.5% of administrators were deaf—a less than 10% increase in deaf professionals since 1993. Additionally, 21.7% of teachers and 6.1% of administrators were professionals of color. Of these minority teachers, only 2.5% were deaf persons of color. Only 3 deaf administrators of color were identified. The study describes how “apartheid” or “intellectual oppression” may result from unchanged hiring practices in K–12 programs for the deaf and in postsecondary institutions. Using a bottle metaphor, the researchers describe how deaf persons of color are often stuck in “a bottleneck on the highway to opportunity.” Relevant data underscore that the field of deaf education must diversify its professional force in order to utilize the intellectual, linguistic, and multicultural proficiencies of hearing teachers of color, deaf teachers, and deaf teachers of color.
The Role of Phonology and Phonologically Related Skills in Reading Instruction for Students Who Are Deaf or Hard of Hearing
Authors: Wang Ye , Trezek Beverly J. , Luckner John L. , Paul Peter V.
Published: November 2008

The article challenges educators to rethink reading instruction practices for students who are deaf or hard of hearing. The authors begin with a discussion of the role of phonology in reading, then summarize the evidence of phonological coding among skilled deaf readers and investigate alternative routes for acquiring phonologically related skills such as the use of speechreading, articulatory feedback, Visual Phonics, and Cued Speech. Finally, they present recent intervention studies and proposed procedures to employ phonics-based instruction with students who are deaf or hard of hearing. The authors conclude with the assertion that the teaching of phonologically related skills by means of instructional tools such as Visual Phonics and Cued Speech can and should be incorporated into reading instruction for students who are deaf or hard of hearing. The authors recommend additional research in this important area.
Fertility effects of abortion and birth control pill access for minors
Authors: Guldi Melanie
Published: November 2008

This article empirically assesses whether age-restricted access to abortion and the birth control pill influence minors’ fertility in the United States. There is not a strong consensus in previous literature regarding the relationship between laws restricting minors’ access to abortion and minors’ birthrates. This is the first study to recognize that state laws in place prior to the 1973 Roe v. Wade decision enabled minors to legally consent to surgical treatment—including abortion—in some states but not in others, and to construct abortion access variables reflecting this. In this article, age-specific policy variables measure either a minor’s legal ability to obtain an abortion or to obtain the birth control pill without parental involvement. I find fairly strong evidence that young women’s birthrates dropped as a result of abortion access as well as evidence that birth control pill access led to a drop in birthrates among whites.
Spousal Mobility and Earnings
Authors: McKinnish Terra
Published: November 2008

An important finding in the literature on migration has been that the earnings of married women typically decrease with a move, while the earnings of married men often increase with a move, suggesting that married women are more likely to act as the “trailing spouse.” This article considers a related but largely unexplored question: what is the effect of having an occupation that is associated with frequent migration on the migration decisions of a household and on the earnings of the spouse? Further, how do these effects differ between men and women? The Public Use Microdata Sample from the 2000 U.S. decennial census is used to calculate migration rates by occupation and education. The analysis estimates the effects of these occupational mobility measures on the migration of couples and the earnings of married individuals. I find that migration rates in both the husband’s and wife’s occupations affect the household migration decision, but mobility in the husband’s occupation matters considerably more. For couples in which the husband has a college degree (regardless of the wife’s educational level), a husband’s mobility has a large, significant negative effect on his wife’s earnings, whereas a wife’s mobility has no effect on her husband’s earnings. This negative effect does not exist for college-educated wives married to non-college-educated husbands.
Wives and ex-wives: A new test for homogamy bias in the widowhood effect
Authors: Elwert Felix , Christakis Nicholas A.
Published: November 2008

Increased mortality following the death of a spouse (the “widowhood effect”) may be due to (1) causation, (2) bias from spousal similarity (homogamy), or (3) bias from shared environmental exposures. This article proposes new tests for bias in the widowhood effect by examining husbands, wives, and ex-wives in a longitudinal sample of over 1 million elderly Americans. If the death of an ex-wife has no causal effect on the mortality of her husband, then an observed association between the mortality of an ex-wife and her husband may indicate bias, while the absence of an effect of an ex-wife’s death on her husband’s mortality would discount the possibility of homogamy bias (and also of one type of shared-exposure bias). Results from three empirical tests provide strong evidence for an effect of a current wife’s death on her husband’s mortality yet no statistically signifi cant evidence for an effect of an ex-wife’s death on her husband’s mortality. These results strengthen the causal interpretation of the widowhood effect by suggesting that the widowhood effect is not due to homogamy bias to any substantial degree.
No trend in the intergenerational transmission of divorce
Authors: Li Jui-Chung Allen , Wu Lawrence L.
Published: November 2008

Previous studies on trends in the intergenerational transmission of divorce have produced mixed findings, with two studies (McLanahan and Bumpass 1988; Teachman 2002) reporting no trend in divorce transmission and one study (Wolfinger 1999) finding that divorce transmission has weakened substantially. Using a stratified Cox proportional hazard model, we analyze data from the National Survey of Families and Households and find no evidence for any trend in divorce transmission. To reconcile apparent differences in results, we note that the General Social Survey data used by Wolfinger lack information on marital duration, permitting analysis only for whether respondents have divorced by interview. As a result, an apparent decline in divorce transmission could be due to inadequate adjustments for the longer exposures to risk by earlier marriage cohorts, yielding a higher probability of divorce by interview for earlier cohorts relative to more recent cohorts even if divorce risks are identical across all marriage cohorts. We confirm this possibility by using a series of discrete-time hazard logistic regressions to investigate the sensitivity of estimates of trends in divorce transmission to different adjustments for exposure to risk. We conclude that there has been no trend in the intergenerational transmission of divorce.
When to promote, and when to avoid, a population perspective
Authors: Duncan Greg J.
Published: November 2008

Demography’s population perspective, and the sampling methods that help produce it, are powerful but underutilized research tools. The first half of this article makes the case for more vigorous promotion of a population perspective throughout the sciences. It briefly reviews the basic elements of population sampling and then provides examples from both developed and developing countries of how population sampling can enrich random-assignment policy experiments, multisite studies, and qualitative research. At the same time, an ill-considered application of a population perspective to the problem of causal inference can hinder social and behavioral science. The second half of the article describes the “slippery slope” by which some demographic studies slide from providing a highly useful description about the population to using regressions to estimate causal models for that population. It then suggests that causal modeling is sometimes well served by a highly selective look at small subsets of a population with interesting variability in independent variables of interest. A robust understanding of causal effects, however, rests on convergence between selective and population-wide perspectives.
Prenatal health investment decisions: Does the child’s sex matter?
Authors: Lhila Aparna , Simon Kosali I.
Published: November 2008

Individuals invest in their own health, but children rely on parents to act on their behalf, especially in the case of prenatal health. In this article, we ask, Do parents in the United States who choose to give birth allocate resources differently in the prenatal health of their sons and daughters when the sex of the child is known in advance? We pay special attention to prenatal health behaviors, which can be viewed as investment decisions, of first-generation immigrant parents from India and China, two countries with demonstrated son preference. Ultrasound receipt proxies for knowing fetal gender, enabling us to separate child sex-related biological differences from investment differences in sons’ and daughters’ health. There is evidence consistent with sex-selective abortions among Indian and Chinese populations, but among parents who choose to carry the pregnancy to term, our findings do not suggest that knowledge of child sex drives prenatal health investments in the United States, neither in the population as a whole nor among Indian and Chinese immigrants.
A decomposition method based on a model of continuous change
Authors: Horiuchi Shiro , Wilmoth John R. , Pletcher Scott D.
Published: November 2008

A demographic measure is often expressed as a deterministic or stochastic function of multiple variables (covariates), and a general problem (the decomposition problem) is to assess contributions of individual covariates to a difference in the demographic measure (dependent variable) between two populations. We propose a method of decomposition analysis based on an assumption that covariates change continuously along an actual or hypothetical dimension. This assumption leads to a general model that logically justifies the additivity of covariate effects and the elimination of interaction terms, even if the dependent variable itself is a nonadditive function. A comparison with earlier methods illustrates other practical advantages of the method: in addition to an absence of residuals or interaction terms, the method can easily handle a large number of covariates and does not require a logically meaningful ordering of covariates. Two empirical examples show that the method can be applied flexibly to a wide variety of decomposition problems. This study also suggests that when data are available at multiple time points over a long interval, it is more accurate to compute an aggregated decomposition based on multiple subintervals than to compute a single decomposition for the entire study period.
Gender, resources across the life course, and cognitive functioning in Egypt
Authors: Yount Kathryn M.
Published: November 2008

In this article, I evaluate the life-course determinants of cognitive functioning among 1,003 women and men aged 50 and older in Ismailia, Egypt. Three questions motivate this analysis: (1) Do older women have poorer cognitive functioning than do older men?; (2) Do cognitive resources accrued in childhood and adulthood have net positive associations with later-life cognitive functioning for women and men?; and (3) To what extent do differences in the amounts and effects of women’s and men’s cognitive resources account for gaps in their cognitive functioning? Compared with men, women have lower Modified-Mini Mental Status Exam (M-MMSE) scores for overall cognitive functioning. Cognitive resources in childhood and adulthood are jointly associated with the M-MMSE score. About 83% of the gender gap in mean M-MMSE scores is attributable to gaps in men’s and women’s attributes across the life course. Gender gaps in childhood cognitive resources—and especially schooling attainment—account for the largest share (18%) of the residual gender gap in cognitive functioning.
Urbanization and fertility: An event-history analysis of Coastal Ghana
Authors: White Michael J. , Muhidin Salut , Andrzejewski Catherine , Tagoe Eva , Knight Rodney , Reed Holly
Published: November 2008

In this article, we undertake an event-history analysis of fertility in Ghana. We exploit detailed life history calendar data to conduct a more refined and definitive analysis of the relationship among personal traits, urban residence, and fertility. Although urbanization is generally associated with lower fertility in developing countries, inferences in most studies have been hampered by a lack of information about the timing of residence in relationship to childbearing. We find that the effect of urbanization itself is strong, evident, and complex, and persists after we control for the effects of age, cohort, union status, and education. Our discrete-time event-history analysis shows that urban women exhibit fertility rates that are, on average, 11% lower than those of rural women, but the effects vary by parity. Differences in urban population traits would augment the effects of urban adaptation itself. Extensions of the analysis point to the operation of a selection effect in rural-to-urban mobility but provide limited evidence for disruption effects. The possibility of further selection of urbanward migrants on unmeasured traits remains. The analysis also demonstrates the utility of an annual life history calendar for collecting such data in the field.
The Legacy of the Tuskegee Syphilis Study: Assessing its Impact on Willingness to Participate in Biomedical Studies
Authors: Katz Ralph V. , Green B. Lee , Kressin Nancy R. , Kegeles S. Stephen , Wang Min Qi , James Sherman A. , Russell Stefanie L. , Claudio Cristina , McCallum Jan M.
Published: November 2008

The phrase, legacy of the Tuskegee Syphilis Study , is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932–72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people’s willingness to participate in research. Future studies should explore this.
Association between the Level of Housing Instability, Economic Standing and Health Care Access: A Meta-Regression
Authors: Reid Kristen W. , Vittinghoff Eric , Kushel Margot B.
Published: November 2008

Introduction . To determine the relationship between housing instability, economic standing, and access to health care and use of acute care services.
Methods . We performed a meta-regression using four nationally representative surveys. The independent variable was an ordered measure of economic and housing instability: 1) the general population, 2) low-income population, 3) never homeless users-of-subsistence-services, 4) unstably housed, 5) formerly homeless, and 6) the actively homeless. Dependent variables were four measures of health care access and three measures of acute health care utilization.
Results . Worsening housing instability and economic standing was associated with poorer access: being uninsured (5.4% per unit increase, 95% CI 1.7–9.2%, p=.011), postponing needed care (3.3%, 95% CI 1.9–4.7%, p=.001), postponing medications (6.1%, 95% CI 1.5–10.6%, p=.035), and with one measure of acute health care utilization: higher hospitalization rates (2.9%, 95% CI 1.2–4.6%, p=.008).
Discussion . Economic and housing instability should be considered a graded risk factor for poor access to health care.
Persistent Disparities in Health Insurance Coverage: Hispanic Children, 1996 to 2005
Authors: Van Wie Alissa , Ziegenfuss Jeanette , Blewett Lynn A. , Davern Michael
Published: November 2008

Objective . To identify how health insurance coverage trends changed for Hispanic children between 1996 and 2005. Methods . Data from the Current Population Survey Annual Social and Economic Supplement were analyzed to determine health insurance coverage rates for Hispanic children and logistic regression was used to determine the role of race/ethnicity on health insurance status, adjusting for citizenship status, child characteristics, migration status, and geography. Results . The proportion of uninsured Hispanic children decreased significantly. However, the increased likelihood of a Hispanic child being uninsured relative to non-Hispanic White children did not change during this period. Conclusions . Expansions in public health insurance programs between 1996 and 2005 increased health insurance coverage for Hispanic children but disparities between Hispanic and non-Hispanic White children persist.
Infectious Disease Exposures and Contact Tracing in Homeless Shelters
Authors: Hwang Stephen W. , Kiss Alex , Ho Minnie M. , Leung Cheryl S. , Gundlapalli Adi V.
Published: November 2008

An outbreak among homeless shelter users of a communicable disease with a short generation time would pose serious public health challenges. Data from Toronto were used to examine the number of shelter residents potentially exposed in the event of such an outbreak. A shelter user had contact with a mean of 97 other residents (range, 1–292) in one day and a mean of 120 (range, 2–624) in eight days. After a single week, contact tracing becomes difficult due to the challenge of locating homeless people who have left the shelter system. Over an 8-day period, individuals who used more than one shelter had contact with an average of 98 more other shelter residents than those who stayed in a single shelter had. At the onset of a serious outbreak, it may be desirable to institute policies that strongly encourage individuals to remain at their current shelter for the duration of the outbreak.
Early and Later Onset Type 2 Diabetes in Uninsured Patients: Clinical and Behavioral Differences
Authors: Smith Tracie L.S. , Drum Melinda L. , Miernik Jadwiga , Fogelfeld Leon A. , Lipton Rebecca B.
Published: November 2008

Objective . The national burden of type 2 diabetes mellitus (T2DM) is increasing rapidly. This study investigated a) clinical differences between early onset and later onset T2DM; and b) if specific risk factors were associated with age at diagnosis or clinical outcomes among uninsured adults in a large urban setting.
Methods . We compared 417 adults diagnosed under age 30 with 968 adults diagnosed ages 50–58 on clinical and social measures using standard parametric tests.
Results . Early onset patients had higher hemoglobin A1c, were more likely to smoke and to be depressed, and had more emergency department visits. Insulin monotherapy was more common in early onset patients (32% vs. 11%). Complications were already present in 11% of early onset patients and 29% of later onset patients within one year of diagnosis.
Conclusion . Early onset patients had more acute beta-cell failure and coped less well with their diabetes. It is crucial to expand specialized diabetes resources for young, medically indigent patients.
Cost-Sharing for Low-Income Workers: Health Insurance in the On-Your-Ownership Society
Authors: Von Korff Michael , Oliver Malia , Fishman Paul , Burbank John
Published: November 2008

Effects of increased cost-sharing in Washington State’s Basic Health Plan (BHP) were assessed among adult BHP beneficiaries (N=14,515) and age-sex-residence matched controls enrolled in Group Health Cooperative. The BHP enrollees had higher disenrollment than controls before and after cost-sharing increases, but disenrollment did not change with increased cost-sharing. Basic Health Plan enrollees’ out-of-pocket-costs increased 100% in two years, compared with 42% for controls. Out-of-pocket costs for BHP enrollees with diabetes increased 61% (from $675 to $1,086), while the 90th percentile increased 74%, from $1,358 to $2,365. Basic Health Plan enrollees had somewhat fewer visits than controls after cost-sharing increases, but total costs, timeliness of glucose monitoring, and glycemic control were unaffected. Cost-sharing changes increased out-of-pocket costs for BHP enrollees without affecting total costs, disenrollment, or diabetes quality of care indicators. The predominant effect of increased cost-sharing was to increase costs for low-income workers, particularly those with chronic disease.
Reports and Ratings of Care: Black and White Medicare Enrollees
Authors: Fongwa Marie N. , Cunningham William , Weech-Maldonado Robert , Gutierrez Peter R. , Hays Ron D.
Published: November 2008

Purpose. This study compared African American/Black and White Medicare enrollees’ perceptions of care.
Design and methods . Analyses of the 2002 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) 3.0 survey of 101,189 (White) and 8,791 (Black) Medicare enrollees (82% response rate) randomly sampled from 321 health plans, with data collected via mail (84%) and telephone (16%). Multivariate linear regression models were conducted with the CAHPS® composites and global ratings as dependent variables, controlling for case-mix variables.
Results . Blacks reported significantly (p≤.0001, p≤.05) worse experiences with getting care quickly, office staff helpfulness, getting needed care, health plan customer service, rating of specialist care, and rating of the health plan (effect sizes ranging from 0.02 to 0.21). However, they reported better provider communication and rated their personal doctors/nurses and health care more positively (effect sizes ranging from 0.02 to 0.09).
Black/White Disparity in Self-Reported Hypertension: The Role of Nativity Status
Authors: Borrell Luisa N. , Crawford Natalie D. , Barrington Debbie S. , Maglo Koffi N.
Published: November 2008

This study investigates the association between race and self-reported hypertension and whether this association varies with nativity status in the National Health Interview Survey, 1997–2005. Logistic regression was used to estimate the association between race and self-reported hypertension before and after adjusting for selected characteristics. The overall prevalence of hypertension was 25.3%, with non-Hispanic Blacks (30.6%) exhibiting higher prevalence than non-Hispanic Whites (24.4%, p<.01). In the adjusted analysis, non-Hispanic Blacks, regardless of their nativity status, had 47% (95% CI 1.40–1.54) greater odds of reported hypertension than non-Hispanic Whites. Foreign-born non-Hispanic Blacks with more than 10 years in the U.S. had 58% (95% CI 1.27–1.96) greater odds of reporting hypertension than their White counterparts. The finding of no effect for nativity but for length of stay for foreign-born with more than 10 years in the U.S. is important in itself, suggesting that there may be selection factors deleterious to foreign-born Blacks’ health after entering the U.S.
Effectiveness of a Community Health Worker as Sole Diabetes Educator: Comparison of CoDE with Similar Culturally Appropriate Interventions
Authors: Culica Dan , Walton James W. , Harker Karen , Prezio Elizabeth A.
Published: November 2008

The feasibility of a newly designed Community Diabetes Education (CoDE) intervention was evaluated in preparation for the development of a pilot study of this program. A comparison between CoDE and similar culturally appropriate diabetes management programs developed specifically for Hispanic Americans demonstrates its unique features. Patient insurance status, duration of the intervention, delivery in individual and/or group settings, the characteristics of the diabetes educator(s), the other professional resources involved in these interventions, the associated costs, and the reported health outcomes were used in the comparison. The significant improvement in hemoglobin A1c observed in patients who completed one year of CoDE suggests that a community health worker can serve as the primary patient educator in the absence of more highly educated personnel required by American Diabetes Association–certified diabetes education programs. This low-cost model can be reproduced de novo in community health centers or inserted into existing diabetes management interventions.
Applying the Community Health Worker Model to Diabetes Management: Using Mixed Methods to Assess Implementation and Effectiveness
Authors: Cherrington Andrea , Ayala Guadalupe X. , Amick Halle , Scarinci Isabel , Allison Jeroan , Corbie-Smith Giselle
Published: November 2008

Introduction . The community health worker (CHW) model is a popular method for reaching vulnerable populations with diabetes. This study assessed implementation and effectiveness of the model within diabetes programs.
Methods . Four databases were searched to identify diabetes programs implementing the CHW model. Corresponding articles were reviewed and semi-structured interviews were conducted with directors of each program.
Results . Eight studies met inclusion criteria for review and their program managers were interviewed. Five CHW roles were identified: educator, case manager, role model, program facilitator, and advocate. Roles, responsibilities and training varied greatly across programs. Selected outcomes also varied, ranging from physiologic measures, to health behaviors, to measures of health care utilization and cost.
Conclusions . Research regarding application of the community health worker model in diabetes management is limited and consensus regarding the scope of the CHW’s role is lacking. Future studies should rigorously examine how best to integrate this promising model into chronic disease management.
Diabetes and Obesity Risks in African American Young Adult Freshmen Attending a Historically Black College/University
Authors: Owens Chequita Smith
Published: November 2008

Convincing African American and other young adults that obesity increases their risk for diabetes and its complications is challenging for health educators and clinicians. At a historically Black university (HBCU) this question was examined, Do overweight and obese African American freshmen have higher risks for diabetes through low physical activity or toning and poor nutritional habits? Survey data found 40% of the 101 respondents sampled there were obese (defined as body mass index of 30 or more kg/m 2 ), which is a higher proportion of obesity than found in other college health surveys. Scores reflecting higher risks of diabetes mellitus were significantly related to higher BMI values and low aerobic physical activity. Students had low levels of physical activity and toning than reported in general college populations. To reduce diabetes-disparity risks and obesity-related behaviors, African American younger adult freshmen may benefit from effective intervention strategies targeting them.
Glycemic and Lipid Control among Patients with Diabetes at Six U.S. Public Hospitals
Authors: Chew Lisa D. , Schillinger Dean , Maynard Charles , Lessler Daniel S. , Quality Consortium
Published: November 2008

Objective . Public hospital systems share a mission to provide access to healthcare regardless of ability to pay. While public hospital systems care for large numbers of socioeconomically vulnerable and ethnically diverse populations who have diabetes, little is known about the quality of diabetes care provided in these sites.
Methods . We assessed the measurement and control of hemoglobin A1c (HbA1c) and lipids (LDL) in a sample of patients with diabetes with ≥2 outpatient visits per year in two consecutive years at one of 6 public hospitals (N=14,222).
Results . High proportions of patients had at least one HbA1c and LDL measurement within 2 years (89% and 88%, respectively). Thirty-five percent had HbA1c<7.0%; 21% had HbA1c≥9.5%; 36% had LDL<100 mg/dl; 10% had LDL>160 mg/dl. Non-White patients and patients who were never insured were most at risk for poor glycemic and lipid control.
Conclusions . The quality of care, as measured by glycemic and lipid monitoring and control among ongoing users of public hospital systems, was similar to that of other health systems, but disparities exist across race/ethnicity and insurance status. Because of the critical role these institutions play in providing care to the underserved, research is needed to explore factors contributing to differences in glycemic and lipid control and develop strategies to improve chronic disease management in these systems.
Obtaining Health Care Services for Low-Income Children: A Hierarchy of Needs
Authors: Devoe Jennifer E. , Graham Alan S. , Angier Heather , Baez Alia , Krois Lisa
Published: November 2008

Introduction . Basic health care is beyond the reach of many families, partly due to lack of health insurance. Many of those with insurance also experience unmet need and limited access. In this study, low-income parents illuminate barriers to obtaining health care services for their children.
Methods . We surveyed a random sample of families from Oregon’s food stamp population with children eligible for public insurance, based on household income. Mixed-methods included: (1) multivariable analysis of data from 2,681 completed surveys, and (2) qualitative study of written narratives from 722 parents.
Results . Lack of health insurance was the most consistent predictor of unmet health care needs in the quantitative analysis. Qualitatively, health insurance instability, lack of access to services despite having insurance, and unaffordable costs were major concerns.
Conclusions . Parents in this low-income population view insurance coverage as different from access to services, and reported a hierarchy of needs. Insurance was the primary concern; access and costs were secondary.
Asthma Education in a Subsidized Preschool Setting
Authors: Purmort Jessica , Coady Micaela H. , Bucciarelli Angela , Bonner Sebastian
Published: November 2008

The Inspire education program, with nine modules, was developed to improve medical management of asthma and was piloted among parents of preschool children in an economically disadvantaged community of color with high asthma prevalence. Program flexibility, individualized educational modules, a case management approach, and institutional involvement were key elements.
Cultural Perceptions of Health and Diabetes among Native American Men
Authors: Cavanaugh Casey L. , Taylor Christopher A. , Keim Kathryn S. , Clutter Jill E. , Geraghty Maureen E.
Published: November 2008

Diabetes continues to affect minority populations disproportionately, especially Native Americans. Identifying culturally-specific definitions of health and diabetes is critically important for relevant and effective diabetes prevention programs. Qualitative interviews were conducted with 20 Native American men from two tribal clinics. Verbatim transcripts were analyzed by means of grounded theory, to identify culturally-specific definitions of health and diabetes. The men defined health in terms of physical capabilities and presence of disease. Conversely, the men viewed diabetes as an inexorable downward course that slowly manifests itself through various complications and ultimately results in death. Men feared for their own diagnoses as well as the diagnosis of family or community members whom they considered to be at-risk. Additional information about the perceptions of health and diabetes in racial and ethnic minority populations will significantly contribute to the development of effective diabetes prevention programs.
Influenza Immunization Disparities in Primary Care Offices—A Comparative Case Study
Authors: Roemheld-Hamm Beatrix , Isaacson Nicole , Winston Carla , Scott John , Hudson Shawna , Crabtree Benjamin
Published: November 2008

Without insight into the primary care environment, further improvements in influenza immunization rates are unlikely. We conducted a comparative case study of family medicine offices during the 2003 influenza immunization season. Practice 1 (P1) served an urban African American population, practice 2 (P2) served a suburban non-minority population, practice 3 (P3) served an urban Hispanic population. Influenza immunization rates among patients age 65 years and older in P1, P2, and P3 were 32%, 33%, and 67% by medical chart. Rates were highest in P3, where medical staff supported vaccination, promoted communication with patients and staff, and made use of systems to identify eligible patients. Characteristics that appear to affect influenza immunization in the primary care environment include the presence of a practice champion, issues of communication and collaboration, and the use of systems approaches. These data support the need for investigation of how these factors affect population level disparities.
Predictors of Appropriate Use of Interpreters: Identifying Professional Development Training Needs for Labor and Delivery Clinical Staff Serving Spanish-Speaking Patients
Authors: Gurman Tilly A. , Moran Allisyn
Published: November 2008

Assuring quality health care services to limited English proficient patients requires certain skills, including the ability to communicate through interpreters. This study identifies predictors of appropriate use of interpreters by maternal labor and delivery service providers. Clinical labor and delivery staff ( N =200) at five hospitals in an Eastern U.S. city completed a survey about providing care to Latinas. Multivariate logistic regression identified significant predictors for appropriate use of interpreters. The strongest association with appropriately using interpreters was relying less often on general mass media for medical information ( OR =2.25; p =.03). Other statistically significant variables included agreeing that learning about Latino history and culture could improve quality of care ( OR =2.07; p =02) and seeking medical information from colleagues at the same hospital ( OR =1.83; p =.03). Study findings have implications for training professionals about working with interpreters.
Strangers in a Strange Land: Health Care Experiences for Recent Latino Immigrants in Midwest Communities
Authors: Harari Nurit , Davis Matthew , Heisler Michele
Published: November 2008

Latino immigrants in recent years are moving to U.S. communities that have little experience with immigration from Latin America. Although public health initiatives have been created to expand health care services to uninsured adults and children, little is known about whether and to what extent new immigrants benefit from such resources.
Methods . We conducted 50 in-depth, semi-structured interviews with recent Latino immigrants residing in the Ann Arbor/Ypsilanti area of southeast Michigan to explore (a) these immigrants’ perceptions of access to public health resources; (b) their assessments of their own health status, social and health needs, and patterns of use of health care services; (c) barriers to health care utilization; (d) strategies they have adopted to approach these barriers; and (e) how best to address the needs of growing immigrant communities.
Results . Latino immigrants often are not using and are unaware of local public health programs and other health resources. The principal barriers to care noted included lack of insurance, language barriers, and isolation in new communities. Many strategies, both effective and ineffective, have been adopted to overcome these barriers.
Conclusion . With the dynamic flux of new immigrants into many communities, outreach efforts must be continuously renewed and re-oriented to reach new arrivals.
Social Stigma and the Dilemmas of Providing Care to Substance Users in a Safety-Net Emergency Department
Authors: Henderson Stuart , Stacey Clare L. , Dohan Daniel
Published: November 2008

There has been increasing interest in how social stigma affects health care delivery to vulnerable patients but few examples of the dilemmas that may arise for providers who care for stigma-vulnerable populations. Using qualitative data, the authors examine care delivery in a safety-net emergency department where many patients were socially disadvantaged and vulnerable to stigma because of substance use problems. Analysis of our data revealed five themes related to the dilemmas of providing care for this patient population: 1) providers valued assisting vulnerable and underserved patients; 2) providers’ interactions with patients could be challenging; 3) providers did not know if substance involved patients provided accurate medical histories; 4) providers were concerned about drug-seeking behavior; and 5) providers had to balance substance-involved patients’ needs with the necessity of managing limited resources. We discuss how these themes relate to care dynamics and social stigma in the safety-net setting.
The Use Of Electronic Medical Records For Homeless Outreach
Authors: Cavacuiti Chris , Svoboda Tomislav
Published: November 2008

Objectives. To assess the features of Electronic Medical Records (EMRs) used by North American homeless outreach organizations.
Methods. Twenty-eight homeless outreach agencies throughout North America were contacted. Nine used EMRs for homeless outreach. Service providers from these nine agencies were interviewed to learn more about their EMRs.
Results. While all of the agencies we interviewed were using different EMR systems, the important features of these EMRs were quite similar. Two of the most frequently cited essential features were: 1) the ability of different sites and providers to access medical information; and 2) the capacity to collect aggregated client data (such as numbers of clients served, services provided, and outcomes) for planning, evaluation, and advocacy purposes.
Conclusion. An electronic medical record (EMR) available at multiple locations to multiple providers is a powerful tool with the potential to improve the coordination, safety, efficiency, and quality of care to people who are homeless.
Breast Cancer Fatalism: The Role of Women’s Perceptions of the Health Care System
Authors: Hall Allyson G. , Khoury Amal J. , Lopez Ellen D. S. , Lisovicz Nedra , Avis-Williams Amanda , Mitra Amal
Published: November 2008

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents’ knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.
Predictors of Trust in Low-Income, Minority Neighborhoods in Texas
Authors: Franzini Luisa
Published: November 2008

Given the importance of trust to population health, it is also important to understand individual and neighborhood predictors of trust among residents of low-income and minority communities. In this paper, we investigate predictors of trust among residents of 98 low-income and minority neighborhoods in Texas. Census data and survey data on 1,966 residents provided information on individual and neighborhood characteristics. Predictors of trust were modeled using multi-level probit models. We found that linguistic heterogeneities, but not racial/ethnic diversity nor income inequality, were associated with general trust. More detailed analyses indicated that people tend to trust people in the neighborhood more than those who belong to the same racial/ethnic group. Interventions in diverse communities should focus on increasing social integration among residents in order to reach higher levels of trust, contributing to positive health outcomes.
Dietary and Lifestyle Practices of Hmong in California
Authors: Yang Richard C. , Mills Paul K.
Published: November 2008

As Hmong adapt to life in Fresno, California, their dietary and lifestyle patterns are examined. Data on tobacco and alcohol use, dietary practices, and socio-demographic variables were collected from a convenience sample, stratified by age and sex. The 248 participants were interviewed. Descriptive analyses reveal that more than 63% of Hmong adults were either overweight or obese. Only 57% could speak English fluently, and 71% were economically impoverished. Hmong do not consume tobacco and alcoholic products excessively. Rice, chicken, beef, and eggs were the most frequently identified food items. Fruits and vegetables were also identified. Low alcohol and tobacco consumption may offer Hmong some protection against certain diseases. However, low socioeconomic status and rapid urbanization may have resulted in a shift from a high-energy expenditure lifestyle and high fiber diets to a sedentary lifestyle with high saturated fat food diets, which may be detrimental to the health of many Hmong.
Immigrant and Native Fertility in Greece: New Estimates and Population Prospects (2005-2025)
Authors: Tsimbos Cleon
Published: November 2008

This paper uses the first available vital statistics by citizenship for Greece to estimate current fertility among immigrants and natives. Subsequently, population projections are employed to assess the demographic effects of migrant/native fertility and of immigration on the country's population for the period 2005-2025. It is estimated (2005) that immigrants exhibit earlier childbearing and higher total fertility (2.12) than natives (1.24). Of the ethnic groups considered, Albanians have the highest and Bulgarians the lowest rates. Although births to immigrants represent a considerable share (16.5%) their impact on overall fertility is very limited. The projections reveal that the ageing of the country's population is inevitable as the effects of variant levels of foreign/native fertility are minor and immigration, in spite of being the most important component having a favorable impact, cannot offset this process. The concept of Replacement Migration is an infeasible solution as it would require an unattainable intake of 4 million newcomers.
Examining Out-of-Pocket Expenditures on Reproductive and Sexual Health among the Urban Population of Nepal
Authors: Puri Mahesh , Horstman Ronald , Matthews Zoë , Falkingham Jane , Padmadas Sabu , Devkota Sekhar
Published: November 2008

Poor health is unpredictable and, in circumstances where a significant fraction of the household expenditure is required for purchasing health care, can have disruptive impact on household budgets and an impoverishing effect on living standards. This article provides an account of a recently-completed representative cross-sectional survey on out-of-pocket costs for reproductive and sexual health (RSH) care in urban Nepal. The study, which is the first of its kind, was conducted in nine towns of Nepal covering about 50% of the total urban population of the country. The survey used a two-stage cluster sample design and face-to-face structured interviews were carried out with 1,669 respondents from 992 households. Overall, 1.1% of total annual household expenditure was spent on RSH excluding HIV/AIDS care and 2.9% was directed towards costs associated with HIV/AIDS care. The costs related to emergency obstetric care were the highest; 9% of the total health care expenditure went on the payments for obstetric care alone. The distribution of out-of pocket expenditure by the major components of RSH care services shows that almost half of all out-of-pocket payments were spent on maternal care (46%), followed by STIs (27%) and RTIs (13%) respectively. Out-of-pocket expenditure on family planning and related care was modest, accounting for about 7% of overall RSH spending. This is attributed to the supply of contraceptives and related services free-of-charge mainly from public facilities. A high share of out-of-pocket expenditure to total health financing is considered as a major concern in any health financing system, and in Nepal this can be seen as a major impediment to achieving poverty reduction and the Millennium Development Goals.