bluuebunny/crossref_metadata_2025 huggingface dataset:
Explaining Race Differences in Mortality among the Tennessee Medicare Elderly: The Role of Physician Services
Authors: Sherkat Darren E , Kilbourne Barbara S , Cain Van A , Hull Pamela C , Levine Robert S , Husaini Baqar A
Published: July 2012

We investigated the impact of socioeconomic conditions, patterns of morbidity, and physician service utilization on race differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician Billing File data and the Medicare Enrollment Database (EDB) were analyzed to assess physician-diagnosed morbidity, health service use, and mortality, among the population of Medicare beneficiaries in Tennessee (N=665,887). Proportional hazards models were used to examine the effects of race, socioeconomic status, morbidity, and physician service utilization on mortality. Race differences in physician visits explain the largest portion of mortality differentials between African Americans and Whites. Race disparities in mortality associated with particular forms of morbidity are also mostly a function of differences in physician service use. Our examination suggested that race differences in patterns of physician service use principally explain race disparities in mortality. Further, race differences in the use of physician services were substantially responsible for race disparities in mortality associated with particular forms of morbidity.
Universal Health Care Coverage for Children: Impact on Pediatric Health Care Providers
Authors: Chamberlain Lisa J , Hughes Dana C , Bishop Janine S , Matsuda Donald H , Sassoubre Lauren
Published: July 2012

A Northern California county expanded health coverage to cover nearly all children in the state through a new insurance program. In two years, 75,500 children entered a health care system near capacity. We hypothesized that the influx of thousands of previously uninsured children into the health system would affect providers in many ways. This cross-sectional study sought to investigate how this influx affected provider practices, job satisfaction, access to specialists, and overarching views about the program. Qualitative analyses of expert interviews were performed. Providers reported improved access to health care, specialists, and medications for patients. They cited increased job satisfaction for providers due to fewer limits on care, improved referral process, and decreased patient family financial stress. Providers noted the persistence of long appointment wait times for specialist care. After moving to near universal coverage, safety net providers described increased job satisfaction. Because this study examined safety-net providers, future research requires a more representative sample of providers.
Detection of Depression among Low-income Mexican Americans In Primary Care
Authors: Schmaling Karen B , Hernandez Dolores V
Published: July 2012

Between one and two thirds of depressive disorders go undetected in primary care settings. Four hundred ninety-six Mexican American primary care patients from high-poverty areas were screened for depressive symptoms, and 41% endorsed depressive symptoms. Eighty percent of screened patients with depressive symptoms agreed to structured diagnostic interviews and 90% of those interviewed met diagnostic criteria for one or more depressive disorders. Cases of depression detected through this systematic process were compared with evidence of depression detected by providers in medical charts. Provider and study evaluation agreement was poor (kappa= 0.13); providers noted depression in 21% of patients with depressive disorders based on the systematic evaluation. More work is needed to enhance detection of depression in primary care, especially in minority populations.
Catalyzing System Changes to Make HIV Care More Accessible
Authors: Conviser Richard
Published: July 2012

Although a comprehensive evaluation of the Care System Assessment Project is still several years off, the project quickly catalyzed changes in each of the communities in which it was piloted. All the sites found the system assessment model useful in identifying gaps in services. The project also clarified ways to engage underserved minorities in both care and planning for HIV care, and it helped to create community consensus in shaping initiatives to bring these populations into care. At all three sites, immigrant and refugee populations had to change beliefs that tended to delay their entry into care, and HIV-related stigma remained a significant barrier to entering care. However, all three communities also faced financial constraints that were likely to impede their ability to implement needed changes quickly. All of the sites identified needs for expanded public information campaigns and support services.
Evaluating the CSAD Process: Challenges and Strategies
Authors: Mejía Luis
Published: July 2012

This article describes the evaluation procedure that was applied to the Care System Assessment Demonstration (CSAD) Project. The article examines issues related to the methods and design of the evaluation activities, the way the local teams were set up and trained, how the project's tools were adapted to local realities, and how the project's monetary needs were addressed.
The Impact of Pay-for-Performance on Diabetes Care in a Large Network of Community Health Centers
Authors: Coleman Katie , Reiter Kristin L , Fulwiler Daniel
Published: July 2012

Pay-for-performance programs are being developed to improve quality of care despite limited empirical evidence demonstrating their effectiveness, especially in underserved communities. Using data on 1,166 patients treated by 46 primary care physicians, this paper examines the effect of an innovative pay-for-performance program implemented in 2004 at the nation's largest federally qualified health center on hemoglobin A1c (HbA1c) testing and HbA1c scores. Univariate analysis and logistic regression results show that the pay-for-performance program significantly increased the likelihood that patients received two HbA1c tests per year as recommended by the American Diabetes Association. Ordinary least squares (OLS) regression results reveal that physicians' baseline performance was positively related to performance after program implementation. Finally, OLS regression results suggest that the program did not contribute to improved blood sugar control. The pay-for-performance program appeared to improve compliance with HbA1c testing recommendations, but a more comprehensive strategy, including increased patient support, may be necessary to improve health outcomes in disadvantaged populations.
UCLA Mobile Clinic Project
Authors: Hastings Joseph , Zulman Donna , Wali Soma
Published: July 2012

We report on a man seeking care at the UCLA mobile clinic, illustrating and then discussing the challenges of caring for people who are homeless (especially mental illness and potential distrust of providers). Student-run free clinics can be beneficial but further research must examine how well such clinics meet homeless patients' needs.
Health and Housing among Low-Income Adults with Physical Disabilities
Authors: Ho Pei-Shu , Kroll Thilo , Kehn Matthew , Anderson Penny , Pearson Katherine M
Published: July 2012

The purpose of this study was to understand the impact of living environment on the health and access to health care of low-income working-age adults with physical disabilities. We conducted focus groups of participants with physical disabilities in the District of Columbia living in each of three housing situations (a homeless shelter, a nursing home, and an inaccessible house or apartment). Twenty-eight people participated in the focus groups. Most were male (79%) and African American (93%). Participants from a homeless shelter expressed concerns about accessibility and sanitation at the shelter. Nursing home participants expressed a need for privacy and autonomy that would foster consumer-directed care. Participants living in inaccessible apartments or houses worried about their ability to maintain daily living and social activities. Participants perceived barrier-free housing conditions to be a prerequisite for independent living and for ensuring their basic health and well-being.
Unmet Needs for Specialty, Dental, Mental, and Allied Health Care among Children with Special Health Care Needs: Are There Racial/Ethnic Disparities?
Authors: Ngui Emmanuel M , Flores Glenn
Published: July 2012

We examined racial/ethnic disparities in unmet specialty, dental, mental, and allied health care needs among children with special health care needs (CSHCN) using data on 38,866 children in the National Survey of CSHCN. Compared with White CSHCN, Black CSHCN had significantly greater unmet specialty (9.6% vs. 6.7%), dental (16% vs. 8.7%), and mental (27% vs. 17%) health care needs. Hispanic CSHCN had greater unmet dental care needs (15.8% vs. 8.7%). Black females had greater unmet mental health care needs than other groups (41% vs. 13–20%). Most disparities disappeared after multivariate adjustment. Significant risk factors for unmet health care needs included uninsurance, having no personal doctor/nurse, poverty, and condition stability and severity. Eliminating unmet specialty, dental, and mental health care needs for all CSHCN, and especially minority CSHCN, may require greater efforts to reduce poverty and increase insurance coverage among CSHCN, better mental health care assessment of Black female CSHCN, and ensuring all CSHCN have a medical home.
Oral Cancer Screening in a High-Risk Underserved Community: Vancouver Downtown Eastside
Authors: Poh Catherine F , Hislop Gregory , Currie Brenda , Lee Rick , Sikorski Sean , Zed Chris , Zhang Lewei , MacAulay Calum , Rosin Miriam Pearl
Published: July 2012

The objective of this study was to evaluate a clinic-centered oral cancer screening initiative in one of the poorest communities in Canada, assessing the need for screening and the acceptance of screening and identifying hindrances to both screening and follow-up. The study group included 204 people in the Vancouver Downtown Eastside (DTES). This was shown to be a high-risk community based on risk factors, lack of access to care, and the high frequency of oral mucosal anomalies. Acceptance of screening was high (98%); however, acceptance of biopsy for abnormal findings and follow-up was low. Among the 12 patients with clinical leukoplakia who were biopsied, 10 showed cancer or precancer. In summary, these data show a need for screening in this population and an ability to recruit patients to screening. They support a future expansion of this initiative to create a more comprehensive strategy for outreach to this underserved community that extends to screening, diagnostic work-up, and treatment.
Inner-City Hospitals: A Call for Research
Authors: Gautam Kanak , Arrington Barbara , Campbell Claudia
Published: July 2012

Inner-city hospitals serve as safety nets for poor and underserved populations. They cope with serious issues of uncompensated care, aging facilities, and inadequate reimbursement. Yet, little research exists on their needs and problems. The authors argue that research on inner-city institutions is necessary to obtain "policy" attention, legitimize demand for resources, reframe inner-city health issues as a delivery problem, and gain insights on better ways to manage inner-city hospitals. They provide data-based illustrations of future research questions related to issues of inefficiency, overstuffing, case severity, and facility renovation that can contribute to better policymaking on inner-city hospitals. The authors recognize systemic barriers to research including the unpopularity of access issues, lack of data, and absence of input from practitioners working in inner-city institutions. To remove such barriers, they suggest creation of a representative forum, original databases, increased linkage with research and policy agencies, and increased cooperation between inner-city professionals and researchers.
Prenatal Care Use in Nonmetropolitan and Metropolitan America: Racial/Ethnic Differences
Authors: Clarke Leslie L. , Bono Christine A. , Miller Michael K. , Malone Susan C.
Published: July 2012

Pregnant women in nonmetropolitan communities are believed to use prenatal care services at lower rates than are metropolitan residents due to higher levels of poverty, lower levels of insurance coverage, and declining numbers of local hospitals and physicians. Yet scarce data exist on actual patterns of prenatal care use in nonmetropolitan areas. This study provides national estimates of prenatal care use among African American, White, and Hispanic women who delivered in 1988 in nonmetropolitan and metropolitan areas of the United States. This study finds that nonmetropolitan residents are no more likely than metropolitan residents to go without care, to enter care late, or to make fewer visits. Nonmetropolitan residents are more likely to receive "inadequate" prenatal care as measured by the Kotelchuck Adequacy of Prenatal Care Utilization Index, with Hispanic residents having the highest rates of inadequate care. These findings are consistent with recent state-level reports, and they suggest the need to target prenatal care policies for populations in greatest need.
Obese Children Should Be Screened for Hypercholesterolemia
Authors: Douglas Montgomery B. , Birrer Richard B. , Medidi Subhakararao , Schlussel Yvette R.
Published: July 2012

Screening only those with a positive family history misses many children with hypercholesterolemia. This study investigated whether sensitivity improved by adding obesity as a criterion when screening children for cholesterol. During a two-year period screenings were conducted on 506 inner-city subjects aged 5-19. Demographic, clinical, and dietary information was also recorded. Mean age of participants was 11 ± 4 years; 52 percent were female, 53 percent black, 39 percent Hispanic, and 8 percent other. Mean cholesterol level was 4.14 mmol/l (160 mg/dl). In multivariate analysis obesity was an independent risk factor for hypercholesterolemia, F = 23.14, p < 0.001. The sensitivity of obesity as a screening tool for hypercholesterolemia was better than that for positive family history (42 vs. 24 percent, respectively). Combining the two improved the sensitivity to 49 percent. The authors recommend expanding the indications for screening children to include obesity, in addition to positive family history of hypercholesterolemia or premature cardiovascular disease.
Health Care Access Among Mexican Americans With Different Health Insurance Coverage
Authors: Treviño Robert P. , Treviño Fernando M. , Medina Rolando , Ramirez Gilbert , Ramirez Robert R.
Published: July 2012

This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.
Preterm Delivery Among Women in the South Carolina Medicaid High Risk Channeling Project
Authors: Schulman Elizabeth D.
Published: July 2012

The purpose of this study was to determine the association of various demographic characteristics, medical risks, and prenatal interventions with birth outcomes of women in the South Carolina Medicaid High Risk Channeling Project. The study population consisted of 5,012 mothers who delivered between January 1989 and June 1991; each was matched with her infant. Logistic regression was used to calculate the odds ratios for the independent effects of various maternal factors on gestational age. Analyses of preterm delivery indicated that high-risk African American women were 60 percent more likely to deliver a preterm baby than high-risk White women. The mean gestational age was 37.3 weeks for African American newborns and 38.2 weeks for White newborns. Prenatal nutritional education had a significantly positive association with gestational duration. This study confirms that high-risk African American women are more likely than high-risk White women to experience a preterm delivery. Further research is needed regarding the positive association between prenatal nutrition education and the prevention of preterm deliveries.
The Oregon Health Plan: A Rational Approach to Care for the Underserved
Authors: Bussman John W.
Published: July 2012

The Oregon Health Plan addresses the needs of 450,000 Oregonians presently without health insurance, among them 120,000 living in poverty who are not now Medicaid-eligible. This is accomplished by expanding eligibility for Medicaid to individuals and families with incomes at 100 percent of the federal poverty level. To help expand access within the limitations of the state budget, certain services, determined to be of limited value or effectiveness, are not covered for payment. This concept of rationing health care reimbursement stands in contrast to existing mechanisms of rationing employed by every state and the nation. The Oregon Health Plan introduces a rational plan for expanding services to the entire population of the state, while acknowledging the limitations of funding resources.
Managed Competition for the Poor: More Promise than Value?
Authors: Weil Thomas P.
Published: July 2012

President Clinton and many other elected officials have proposed that managed companion be the cornerstone of health care reform. However, experiences of Medicaid recipients with managed care plans are at best mixed. These capitated programs report higher costs than do fee-for-service arrangements. Fortunately, these additional expenditures are partially offset by at least a perception of improved access to care. Due to difficulties in determining eligibility, delivering benefits, paying for needed services, and similar concerns, providing care for the poor and underserved will be complicated and expensive for the proposed sponsors of managed competition plans.
Medicaid Beneficiaries' Experiences in HMO and Fee-for-Service Health Care
Authors: Piña Darlene L.
Published: July 2012

How do HMO-enrolled Medicaid beneficiaries' ratings of access to, and satisfaction with, their health care compare with the ratings of those beneficiaries receiving care in fee-for-service settings? Do poor single mothers report differences in access to, and satisfaction with, their HMO health care compared with those living in other family structures? These questions were examined with survey data from 961 California Medicaid recipients in 1991. Medicaid recipients enrolled in HMOs reported more difficulty gaining access to, and less satisfaction with, various aspects of the health care system. HMO-enrolled single mothers reported particularly negative experiences with their health care. The findings suggest a potential lack of fit between the health needs of the poor and the aims of managed health care.
Race, Biology, and Health Care: Reassessing a Relationship
Authors: Byrd W. Michael
Published: July 2012

Recent reports reaffirm huge disparities in the health of blacks compared to other Americans. These disparities persist in part because of the current attempt by health policy makers to frame racially based health differences in non-racial terms. Yet an historical analysis shows that since ancient times, blacks have been the victims of racism in the biomedical sciences; health-system discrimination and deprivation; and later, medical and scientific exploitation. Race- and class-based structuring of the health delivery system has combined with other factors, including physicians' attitudes conditioned by their participation in slavery, and the scientific myth of black biological and intellectual inferiority, to establish a "slave health deficit" that has never been corrected. Until the persistent institutional racism and racial discrimination in health policy, health delivery, and medical educational systems are eradicated, African-Americans will continue to experience poor health outcome.
Hypertension in Community-Dwelling Elders from a Statewide Study: Implications for Nonpharmacologic Therapy
Authors: Ciesla James R. , Piane Ginamarie , Rubens Arthur J.
Published: July 2012

This study used multivariate analysis to determine the sociodemographic variables that predict whether hypertensive elders who are aware of their disease deliberately make lifestyle modifications aimed at controlling their hypertension. The data are from the 1990 Panel Study of Older South Carolinians ( n = 6,473). The researchers performed five separate logistic regressions, each to predict the odds that the elders made specific lifestyle changes to reduce their hypertension. The dependent variable in the first regression was 1 = quit smoking to reduce hypertension and 0 = did not quit smoking to reduce hypertension. Changing diet, exercising, taking medication, and using stress management techniques were the dependent variables in the second, third, fourth, and fifth regressions, respectively. Significant determinants included age, gender, marital status, socioeconomic status, previous medical history, and social participation. This paper discussed implications for prevention programs.
Bodies at Rest: Rousing Officialdom to the Peril of Domestic Mercury Pollution
Authors: Wendroff AP
Published: July 2012

The chance remark of a Brooklyn junior-high-school science student suggested to his teacher—a medical sociologist by training—a widespread and hitherto unreported magico-religious use of elemental mercury in the home. Interested and concerned, the teacher undertook a preliminary investigation into the nature and geographical distribution of such occult mercury use, and the possible pathology resulting from it. His investigation issued in "the first mention [in the literature] of widespread domestic exposure to mercury vapor." 1 With confirmation of a potentially serious public-health threat, a one-man campaign was begun to alert health authorities and medical scientists to problems posed by this novel form of domestic mercury pollution. The campaign involved calling, writing, and meeting with health and regulatory personnel and with members of the scientific press and the mass media. A detailed log of all contacts was kept. These activist efforts to rouse officialdom produced tangible results: actions by several federal regulatory agencies, numerous state and city health-department investigations, and a federally sponsored clinical research project. The campaign is ultimately the reason why several foreign health agencies have also launched, or are contemplating, similar investigations into the sale and use of mercury for occult purposes, and why there is now, in general, a greatly heightened awareness of the need to monitor and, if necessary, regulate the trade in elemental mercury.
Does Race Influence the Provision of Care to Persons With Sickle Cell Disease?: Perceptions of Multidisciplinary Providers
Authors: Telfair Joseph , Myers Jennifer , Drezner Sherree
Published: July 2012

This study examined whether multidisciplinary health care providers (HCPs) perceived race of persons with sickle cell disease (SCD) as an influence in the delivery of health care. A total of 227 multidisciplinary HCPs completed the three-item Influence of Patient Race on Provision of Health Care Services Index (Cronbach's alpha = 0.77). Results suggest that African American HCPs were more likely to perceive race as an influence along all scale items, whereas Caucasian and other race HCPs did not. Female HCPs and those who serve adults were more likely than male HCPs and those who serve children to perceive race as having an influence on the quality of health care. Findings suggest a need for the examination of the health care delivery systems in which persons with SCD receive care to determine if race does, in fact, affect the delivery of health care and to explain the discrepancies in the perceptions of the HCPs.
Smoking Cessation among Blacks
Authors: Stotts R. Craig , Glynn Thomas J. , Baquet Claudia R.
Published: July 2012

The burden of cancer on the U.S. black population has been compounded by a high prevalence of smoking among blacks. Lung cancer among blacks is a serious public health problem, with a mortality rate of 119 per 100,000 among black males compared to 81 per 100,000 for white males. Blacks, both male and female, have lower quit rates for smoking than does the general U.S. population. Why more blacks than whites continue to smoke is not clear, but the National Cancer Institute has recently funded several research projects to facilitate smoking cessation among blacks. It appears from preliminary findings that smoking cessation efforts among blacks are most successful if they use broadcast media that reach black audiences, if they tailor their print materials to address the needs of black smokers, and if black community networks are utilized.
African American Administrators in Community/Migrant Health Centers
Authors: Glover Saundra H. , Shi Leiyu , Samuels Michael E.
Published: July 2012

Community and migrant health centers (CHC/MHCs) play a secondary role as avenues for the development of minority and women health care professionals, groups traditionally underrepresented in administrative and managerial positions within the health care system. This paper focuses on the role of CHC/MHCs in eliminating the barriers that typically limit the professional advancement of these groups. In a survey of both rural and urban CHC/MHC administrators, it was found that CHC/MHCs have higher percentages of minorities in top management positions than general management but do not necessarily reflect the minority composition of those being served. Of the CHC/MHC administrators, 10 percent were African American, less than the population served (31 percent) but greater than the percentage of African Americans in the general U.S. population (12 percent). This suggests that CHC/MHCs have partially met the original goal of upward mobility and that there is room for improvement.
Women in Residential Drug Treatment: Differences by Program Type and Pregnancy
Authors: Grella Christine E.
Published: July 2012

This study compared the characteristics of 4,117 women treated in publicly funded residential drug treatment programs in Los Angeles County between 1987 and 1994 by pregnancy status and program gender composition, that is, women-only and mixed-gender programs. A logistic regression analysis determined the predictors of program completion. Women in women-only programs were more likely than women in mixed-gender programs to be pregnant, homeless, or on probation; to use methamphetamines; to use alcohol; and have prior drug treatment. Pregnant women were younger, more likely to be homeless, had fewer years of drug use, were more often referred by other service providers, and were less likely to have injected drugs or have prior drug treatment than non-pregnant women. Although women in women-only programs had more problems, they spent more time in treatment and were more than twice as likely to complete treatment as compared with women in mixed-gender programs.
Effects on Navajo Birthrate from Loss of the Intrauterine Device
Authors: Williams Robert L.
Published: July 2012

The concerns of relatively powerless groups may not be adequately addressed by health-care decisions based on market forces and on considerations of the general population. Calculations of the number of Navajo women at risk of unintended pregnancy suggest that several hundred such pregnancies would have occurred as a result of the withdrawal of intrauterine devices from the United States' market. Analysis of birthrate data confirms this estimate: approximately four to five percent of Navajo births in 1988 may have been due to this market withdrawal. Available data are limited in their ability to assess impacts on small groups of health-policy decisions made for the population as a whole. A mechanism for surveilling such effects needs to be established to protect the interests of such groups, particularly when they have restricted alternatives.
A Harvest of Shame Revisited: Substance Use and Abuse Within the Delmarva Migrant Stream
Authors: Wright DF , Jacobsen M
Published: July 2012

After realizing some 15 years ago that we had not "turned the corner" on drug abuse, the substance abuse treatment community became more deliberate in waging this war by developing culturally, ethnically, age-, and gender-specific intervention modalities to ensure a more equitable continuum of care. Additionally, research efforts began to reflect the disparities of health and longevity between ethnic minority and nonethnic minority populations which culminated in the U.S. Department of Health and Human Services Task Force on Black and Minority Health Report of 1986. This comprehensive and much acclaimed report contributed significantly to a knowledge base and provided a frame of reference for health planning and service delivery. But the information contained therein was overwhelmingly focused on urban areas. A literature review reveals a paucity of information on access to care in rural communities, especially those with populations consisting of seasonal and migrant farmworkers. This population has received little visibility since "Harvest of Shame" was aired on national television 30 years ago. An analysis of substance use and abuse among this population in the Delmarva (Delaware, Maryland, Virginia) peninsula as well as an assessment of services available to them is the intent of this report. Information for this report was developed from secondary analysis of program reports, needs assessments, policy analyses, and interviews with service providers. A preliminary analysis suggests that there appears to be increased substance abuse and drug trafficking among this population. There also tends to be a greater understanding of Hispanic American use and abuse than that of black Americans and other ethnic groups (e.g., Mexicans, Guatemalans, Haitians) in the migrant stream. Finally, substance abuse is encouraged and access to care is hampered by sociocultural factors and stresses such as school-related problems, lack of vertical mobility, language problems, and poor integration and coordination of the service delivery systems.
Evaluation of a Managed Care Program for the Non-Medicaid Urban Poor
Authors: Douglass Richard L. , Torres Roberto E.
Published: July 2012

In 1988, Detroit and surrounding Wayne County, Michigan, began CountyCare, an innovative managed care program designed to deliver health care services to the very poor while reducing excessive emergency-room and inpatient care. We interviewed 279 former CountyCare participants to assess differences in off-program utilization, use of clinical services, hospitalization, and patient satisfaction among respondents assigned to one of four CountyCare provider groups. Patients responded favorably to CountyCare, although off-program utilization was substantial and emergency-room and inpatient care were not significantly reduced. We conclude that how such a program is managed and administered, and a provider's degree of motivation, govern the extent to which it succeeds in reducing health care costs and increasing patient satisfaction.
African-American Women and Abortion: A Neglected History
Authors: Ross Loretta J.
Published: July 2012

The history of African-American women's efforts to control their fertility is largely unknown. From slavery to the present, the growth rate of the African-American population has been cut in half. Demographers and historians frequently attribute this change to external factors such as poverty, disease, and coerced birth control, rather than the deliberate agency of African-American women. This essay assembles a brief historical record of the ways African-American women have sought to control their fertility through the use of abortion and birth control. It also examines the activism of African-American women in the establishment of family planning clinics and in defense of abortion rights.
National Health Care Reform and Community and Migrant Health Centers
Authors: Gardner Roland J.
Published: July 2012

Community and migrant health centers (CHCs) have been shown to increase access to health care, improve health status, and reduce health care costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national health care reform whose aim is universal, affordable access. To benefit the poor, such a plan should be federally administered and progressively financed, with comprehensible enrollment procedures, easy paperwork, and clearly delineated limits and benefits.
Decreasing the Field Strength of the National Health Service Corps: Will Access to Care Suffer?
Authors: Stone Valerie E. , Brown Jeffrey , Sidel Victor W.
Published: July 2012

To study the effect that the decline in physicians in the National Health Service Corps (NHSC) pipeline will have on access to care for patients at sites to which NHSC physicians are assigned, a survey was sent to all NHSC physicians completing their obligated service in 1989. Seventy-four (74) percent of the respondents believed that the decreased number of NHSC doctors in the pipeline would threaten the existence of their site and 52 percent reported that no doctors or clinic sites would be able to provide free or subsidized care if their NHSC site were forced to close. Of the physicians who stated that their NHSC patients would be able to find an alternative source of care, the most commonly cited (33 percent) alternative was the local hospital emergency room. We conclude that access to care for patients at NHSC sites will be seriously impaired by the decline in physicians in the NHSC pipeline.
The African-American Cancer Crisis, Part I: The Problem
Authors: Clayton Linda A. , Byrd W. Michael
Published: July 2012

Over the past 40 years, increasing numbers of Americans have benefited from cancer prevention, early detection, and improved treatment. But a review of site-specific cancer data from 1950 to the present shows that contemporary African-Americans have the highest age-adjusted rates of cancer incidence and mortality of any racial or ethnic group in the United States. Compared to whites, blacks have significantly higher incidence rates for cancers of the lung, prostate, breast (under age 40), colon, pancreas, esophagus, cervix, larynx, stomach, and multiple myeloma. Blacks have significantly higher mortality rates for cancers of the lung, prostate, breast (all ages), colon, pancreas, esophagus, cervix, uterine corpus, larynx, stomach, and multiple myeloma. Moreover, the gap between whites and blacks is widening dramatically. These startling statistics suggest that cancer researchers and policymakers, and the institutions they represent, may not fully appreciate the black cancer experience.
Public Health, Medical Care, and Mortality Rates
Authors: Shi Leiyu
Published: July 2012

This study examined the association between public health spending and leading mortality rates in the United States. Results indicate that government spending on public health is significantly associated with improving the life chances of the population. Public health spending was consistently associated with reduced total mortality and with lower mortalities due to heart disease, cancer, and stroke—the leading causes of death in the United States. However, medical care expenditures on hospital care and prescription drugs were significantly associated with increased total mortality and mortalities due to heart disease, cancer, and stroke. The policy implication is to reorient the currently expensive, clinically based, treatment-focused medical care system toward a more cost-effective health care system oriented toward public health and prevention. A more balanced health care system, with concomitant emphasis on medical care and public health, should be established.
Patterns of Hospital and Physician Utilization among the Uninsured
Authors: Hafner-Eaton Chris
Published: July 2012

Despite numerous studies of access to care by the uninsured, few researchers have examined whether access to hospitals among the uninsured differs from access to physicians. This study employs a correlational, two-group design (n=102,055) to analyze cross-sectional data from the 1989 National Health Interview Survey. Multiple logistic regression was used to compare the likelihood of hospitalization for the uninsured and insured in chronically ill, acutely ill, and well nonelderly subpopulations. When compared to data from a previous study on physician visits, disparities in hospitalization among the three subgroups differed in both magnitude and relative order from disparities in physician visits. The disparities between the insured and uninsured clustered at 38 percent for hospitalization, and 20 percent for physician visits. Overall, being uninsured resulted in a larger difference for hospital utilization than for physician utilization. These findings suggest that the uninsured face even greater access barriers for hospitalization than they do for physician care.
The Effect of Race and Ethnicity on the Use of Selected Health Care Procedures: A Comparison of South Central Los Angeles and the Remainder of Los Angeles County
Authors: Carlisle David M. , Leake Barbara D. , Brook Robert H. , Shapiro Martin F.
Published: July 2012

The purpose of this study was to compare the use of eight hospital-based procedures (appendectomy, cesarean section, coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy, hysterectomy, mastectomy, and transurethral prostate resection) in South Central Los Angeles (SCLA) to the remainder of Los Angeles County. The authors used age- and gender-adjusted procedure rates and population-weighted multivariate regression techniques, adjusting for illness proxies, physician distribution, hospital distance, income, and ethnicity variation to quantitate the effect of SCLA residence. Four procedures were performed at significantly lower rates among residents of SCLA: PTCA, CABG, carotid endarterectomy, and cesarean section. In multivariate regression models, SCLA was also a significant predictor for appendectomy, mastectomy, and transurethral prostatectomy (TURP). The SCLA effect was diminished but not eliminated when ethnicity variables were incorporated into regression models. The use of selected procedures by residents of SCLA frequently differs from that of residents of the remainder of Los Angeles County. Some differences are not attributable to level of health, income, ethnicity, or the availability of medical resources.
Barriers to Vaccinating Preschool Children
Authors: Orenstein Walter A. , Atkinson William , Mason Dean , Bernier Roger H.
Published: July 2012

Immunization represents one of the most effective tools in preventive medicine. But despite what should be a universal practice, preschool children, particularly in the inner cities, are not being adequately vaccinated. The responsibility for low immunization levels does not rest solely with the parents. Major obstacles within the health care system provide disincentives to immunization. Local resource problems such as inadequate clinic staff, hours, and locations make immunizations difficult to obtain. When comprehensive care is not easily accessible (e.g., requiring appointments weeks or months in advance), policies which require immunization to take place only within such a setting are further barriers. Many opportunities for vaccination are lost when children interact with the health care system but do not receive all the immunizations they need. Policies must be changed to facilitate immunization and to take advantage of all health care visits to provide vaccines.
Access to Infant Immunizations for Poor, Inner-City Families: What is the Impact of Managed Care?
Authors: Wood David , Halfon Neal , Sherbourne Cathy , Grabowsky Mark
Published: July 2012

California plans to enroll half of its Medicaid population, 75 percent of which are children, into managed care. To measure the impact of managed care on utilization of preventive services, we surveyed 867 families in two inner-city areas of Los Angeles and assessed the relationship between insurance type, source of care, and access to immunization services. Compared to children in public health clinics, those in private physicians' offices or health maintenance organizations (HMOs) had odds of being up-to-date on immunizations of 0.43 (p<.01) and 0.24 (p<.01), respectively. We conclude that in the absence of meaningful financial incentives to encourage private physicians and HMOs to provide immunizations to inner-city children, managed care is unlikely to improve immunization rates among this vulnerable population.
Consumer Responsibility in the HMO Environment
Authors: Cebrun Anthony J.
Published: July 2012

Successful managed care requires two-way responsibility. Providers must design health plans that market services intelligently, communicate with enrolled clients effectively, solicit frequent feedback from consumers, and are genuinely responsive to the needs of patients. Consumers are responsible for demonstrating self-care, consuming medical resources wisely, and exercising personal initiative to help make managed care work.
Post-Hospital Care for the Underserved: A Review
Authors: Wallace Paul E.
Published: July 2012

Policies that encourage rapid discharge of hospitalized patients often fail to consider barriers that underserved populations face in gaining access to post-discharge facilities such as nursing homes. Because of these barriers, long-stay patients (LSPs) remain hospitalized even after the successful treatment of their acute medical conditions. While the number of LSPs has increased in recent years, the plight of these patients has not been thoroughly examined. This review summarizes the characteristics of LSPs, the obstacles they encounter in obtaining post-acute care, and the potential impact of health care reform on access for underserved LSPs. It also discusses issues that policymakers must address to improve this populations's access to post-acute care.
Effects of Reporting Methods on Infant Mortality Rate Estimates for Racial and Ethnic Subgroups
Authors: Farley Donna O. , Richards Toni , Bell Robert M.
Published: July 2012

Estimation of infant mortality rates for racial and ethnic subgroups has been plagued by uncertainties. Yet policymakers need accurate estimates to allocate resources toward the goal of reducing infant mortality. The authors compared hospital discharge records and death certificate information to birth certificate information from the California Birth Cohort (years 1985-1987) and 1986 Annual Hospital Discharge Abstract. They found discrepancies in infant mortality rates between reporting methods and underreporting of some non-White groups. Infant mortality rates based on death certificates underestimated non-White mortality, particularly for Native Americans and East Asians. Compared to infants who died soon after birth, larger discrepancies in reported race and ethnicity between birth certificates and death certificates for infants who died later also indicated possible errors in hospital reporting methods. These findings extend prior research that documents that standard methods of reporting infant mortality underestimate non-White mortality rates.
Psychosocial Factors and Birth Outcome: African American Women in Case Management
Authors: Gonzalez-Calvo Judith , Jackson Jacqueline , Hansford Centhy , Woodman Connie
Published: July 2012

The relationship between psychosocial risk factors and birth outcomes among African American pregnant women is explored. The study focuses on social/environmental stressors and proposes a workable model for delivery of services based on case management principles. Unstable income, perinatal medical problems, alcohol use, smoking, access to prenatal care, internal barriers to care, compliance problems, negative experiences with providers, depression, unresolved grief, and fetal substance exposure were significantly associated with low birthweight. Unstable income, compliance problems, internal barriers to care, and poor access to care were significantly associated with preterm delivery. Specific interventions aimed at providing social support, facilitating access to care, health education, and encouragement to verbalize feelings about problems were significantly associated with the number of problems that the client was able to solve. The data indicated the importance of psychosocial, environmental, and medical risk factors in the prediction of low birthweight and preterm delivery in a high-risk population.
On and Off the Playing Field: Ethics in Medicine
Authors: Young Roscoe C. , Bowen Renée Ewing
Published: July 2012

The sportscasters' metaphor, "on and off the playing field," is used to describe the altruistic demeanor of good ethical and moral behavior and empathy toward patients that is required of medical students and physicians. It has been noted that these altruistic qualities often compete unsuccessfully with scientific skills and scholarly pursuits. Many schools hold the "White Coat Ceremony" annually and host a chapter of the Honor Medical Society to instill these traits in students. Teaching of altruistic demeanor is most successful using a combination of techniques, which include philosophy, virtue theory, small-group discussions using case vignettes, and the structured objective clinical examination with "standardized patients." On the playing field, current major issues are intellectual honesty, mandatory testing/treatment for HIV/AIDS, abortion, end-of-life issues, and gene therapy. Off the playing field, family, religion, community service, and leadership will immortalize medical students in the mythical Health Care Hall of Fame.
Community Wellness: A Group Empowerment Model for Rural America
Authors: Jenkins Susan
Published: July 2012

Because answers to rural health problems no longer reside solely at the federal or state level, county Extension agents in Georgia are playing a pivotal role in helping communities empower themselves with the Community Wellness program. Community Wellness is a process-oriented program that encompasses community-based program planning; facilitates interventions based on an assessment of community-specific health needs; encourages empowerment of the community; and develops a community-wide support system. County Extension agents and other leaders serve as catalysts to bring together members of the community to identify health needs, develop strategies to solve problems, and implement solutions. Four case histories describe how this model has strengthened community infrastructure, developed human capital, and created rural leadership. A discussion of barriers to implementation and lessons learned follows.
Visits to Specialists Under Medicare: Socioeconomic Advantage and Access to Care
Authors: Blustein Jan , Weiss Linda J.
Published: July 2012

This study examines the relationship between socioeconomic advantage and the likelihood of receiving specialty care in a nationally representative sample of older Americans participating in fee-for-service Medicare. In 1992, 62.9 percent of Americans aged 65 and older visited a specialist physician at least once. Being white, having more education, and having a higher income were each independently associated with a higher likelihood of visiting a specialist. Having insurance to supplement basic Medicare coverage was also independently associated with an increased likelihood of visiting a specialist; disadvantaged elders are less likely to have such supplemental insurance. Therefore, based both upon socioeconomic disadvantage and a lack of insurance to supplement the basic Medicare benefit, black, less educated and low-income elders are less likely to receive specialty services under fee-for-service Medicare. As the program evolves, it will be important to continue to monitor access to specialty care in vulnerable, socioeconomically disadvantaged populations.