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Lower Income (lower + income)
Terms modified by Lower Income Selected AbstractsAdverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional ResultsALCOHOLISM, Issue 4 2009Anna-Marie Vilamovska Objective:, To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community. Methods:, A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences,DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility). Results:, In this sample, we found drinking patterns,bingeing, drinking outdoors, drinking in the morning,to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score. Conclusions:, A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences. [source] Increasing Support for Those on Lower Incomes: Is the Saving Gateway the Best Policy Response?FISCAL STUDIES, Issue 2 2003Carl Emmerson Abstract The government is committed to introducing a new savings account for people on lower incomes. This will provide a strong incentive for eligible individuals to save, or at least to hold financial assets, in these accounts. This paper describes possible rationales for this government intervention. It then presents new evidence on the characteristics of people with lower incomes and finds that many already have some financial assets, while those who do not often appear to have good reasons for why they may not want to be currently saving. The result is that the proposed Saving Gateway will be extremely difficult to target at those who might benefit in the way the government hopes. The danger is that the policy will be expensive relative to the number of genuine new savers and savings that it generates. [source] Reasons for terminating psychotherapy: a general population studyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 9 2010Robin Westmacott Abstract Clients' (N=693) reasons for ending psychotherapy and their associations with demographics, mental disorder caseness, and type of mental health care service provider were examined. The most frequently reported reason for termination was feeling better, however, a substantial minority of individuals reported terminating because of treatment dissatisfaction or wanting to solve problems independently. Lower income was associated with lower odds of termination because of feeling better and higher odds of termination because of a perception that therapy was not helping. Meeting criteria for an anxiety disorder, a mood disorder, or substance dependence decreased the odds of termination because of feeling better. These findings provide important information on the challenges to the successful completion of psychotherapy. © 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:1,13, 2010. [source] The social and economic consequences of childhood-onset Type 1 diabetes mellitus across the lifecourse: a systematic reviewDIABETIC MEDICINE, Issue 8 2006B. Milton Abstract Background The incidence of childhood-onset (Type 1) diabetes is high, and increasing, particularly among the very young. The aim of this review was to determine the longer-term social consequences of having diabetes as a child and to determine whether adverse consequences are more severe for disadvantaged children. Methods Results from published and unpublished studies were synthesized narratively to examine the impact of diabetes on education, employment and income in adulthood. The question of whether the impact differed for different social groups was also examined. Results Case-control studies found that children with diabetes missed more school than healthy children. Most studies of attainment found no differences between children with diabetes and non-diabetic control subjects or the local population, although poor metabolic control, early-onset, longer illness duration and serious hypoglycaemic events were associated with underachievement. People with childhood-onset diabetes may experience disadvantage in employment, and have a lower income in adulthood, although diabetic complications appear to be the most important determinant of social consequences in later life. Conclusions Many children with diabetes,especially late-onset,perform equally well at school despite increased rates of absence, but it is not yet clear whether specific subgroups are at greater risk of educational underperformance. People with childhood-onset diabetes, however, do appear to experience some disadvantage in adult employment. Qualitative research and cohort studies are needed to fill key gaps in the existing evidence base. Future research must also examine the impact of diabetes-related risk factors on socio-economic consequences. [source] Alcohol use trajectories among adults in an urban area after a disaster: evidence from a population-based cohort studyADDICTION, Issue 8 2008Magdalena Cerda ABSTRACT Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. Aims To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. Design We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. Setting The NYC metropolitan area. Participants A total of 2752 non-institutionalized adult residents of NYC. Measurements We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. Findings We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. Conclusions While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term. [source] Cannabis use and later life outcomesADDICTION, Issue 6 2008David M. Fergusson ABSTRACT Aim To examine the associations between the extent of cannabis use during adolescence and young adulthood and later education, economic, employment, relationship satisfaction and life satisfaction outcomes. Design A longitudinal study of a New Zealand birth cohort studied to age 25 years. Measurements Measures of: cannabis use at ages 14,25; university degree attainment to age 25; income at age 25; welfare dependence during the period 21,25 years; unemployment 21,25 years; relationship quality; life satisfaction. Also, measures of childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioural adjustment and cognitive ability and adolescent and young adult mental health and substance use. Findings There were statistically significant bivariate associations between increasing levels of cannabis use at ages 14,21 and: lower levels of degree attainment by age 25 (P < 0.0001); lower income at age 25 (P < 0.01); higher levels of welfare dependence (P < 0.0001); higher unemployment (P < 0.0001); lower levels of relationship satisfaction (P < 0.001); and lower levels of life satisfaction (P < 0.0001). These associations were adjusted for a range of potentially confounding factors including: family socio-economic background; family functioning; exposure to child abuse; childhood and adolescent adjustment; early adolescent academic achievement; and comorbid mental disorders and substance use. After adjustment, the associations between increasing cannabis use and all outcome measures remained statistically significant (P < 0.05). Conclusions The results of the present study suggest that increasing cannabis use in late adolescence and early adulthood is associated with a range of adverse outcomes in later life. High levels of cannabis use are related to poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction. The findings add to a growing body of knowledge regarding the adverse consequences of heavy cannabis use. [source] Socioeconomic Prognosis after a Newly Diagnosed Unprovoked Epileptic Seizure in Adults: A Population-based Case,Control StudyEPILEPSIA, Issue 10 2002Hans Lindsten Summary: , Purpose: To investigate the socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults. Methods: Sixty-three patients 17 years or older with a newly diagnosed unprovoked epileptic seizure from 1985 through 1987 and 107 sex- and age- matched controls were followed up for 10 years to 1996. Studied variables were income, source of income, sickness periods, incapacity rate, diagnosis-specific incapacity rate, vocational status, and education. Results: Relative growth of income was similar between patients and controls during follow-up. Patients had lower income than did controls 2 years before seizure onset and during the entire follow-up. This was related to higher morbidity among patients, as measured by sickness periods and incapacity rate. Employment rates did not evolve negatively among patients after seizure onset and were close to employment rates of controls during follow-up time. There was no difference between patients and controls regarding education. Conclusions: After a newly diagnosed unprovoked epileptic seizure in adults, no negative development regarding employment and education occurs. Income development is positive unless refractory seizures evolve. However, income is lower among patients with epilepsy than among controls, and this difference can be related to overall morbidity. [source] Are patient assistance programmes able to meet the needs of New York City women with breast cancer?EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2009Women's perspectives Women with breast cancer report needs that may interfere with their ability to obtain necessary treatments. High-quality community-based patient assistance programmes exist; however, their ability to identify and meet women's needs is unknown. We surveyed women with breast cancer attending such programmes to assess programmes' ability to identify and meet their needs. We surveyed 117 (42% minority) women utilizing nine programmes in the New York City area about expectations, needs and experiences. Ninety-two (89%) women wanted information, 102 (95%) psychosocial support and 15 (20%) practical assistance. Seventy-three per cent had all or most of their needs identified, and 74% had all or most of their needs met. Seventy per cent stated programmes met needs they were not previously aware they had. Needs identified and met were lower among minority women (57% vs. 84%; P = 0.003), those with lower income (46% vs. 79%; P = 0.02) and those in poor physical health (56% vs. 78%; P = 0.04), independent of the type of need. High-quality community-based patient assistance programmes effectively identify and meet the needs of women with breast cancer but traditionally at-risk women appear less likely to have needs identified and met. Programmes should enhance the systemization and sensitivity of needs assessments to improve women's experience with cancer. [source] Emergency Department Utilization by Noninstitutionalized EldersACADEMIC EMERGENCY MEDICINE, Issue 3 2001Manish N. Shah MD Abstract. Objectives: To the best of the authors knowledge, no nationally representative, population-based study has characterized the proportion of elders using the emergency department (ED) and factors associated with ED use by elders. This article describes the proportion of elder Medicare beneficiaries using the ED and identifies attributes associated with elder ED users as compared with nonusers. Methods: The 1993 Medicare Current Beneficiary Survey was used, a national, population-based, cross-sectional survey of Medicare beneficiaries linked with Medicare claims data. The study population was limited to 9,784 noninstitutionalized individuals aged 66 years or older. The Andersen model of health service utilization was used, which explains variation in ED use through a combination of predisposing (demographic and social), enabling (access to care), and need (comorbidity and health status) characteristics. Results: Eighteen percent of the sample used the ED at least once during 1993. Univariate analysis showed ED users were older; were less educated and lived alone; had lower income and higher Charlson Comorbidity Index scores; and were less satisfied with their ability to access care than nonusers (p < 0.01, chi-square). Logistic regression identified older age, less education, living alone, higher comorbidity scores, worse reported health, and increased difficulties with activities of daily living as factors associated with ED use (p < 0.05). Need characteristics predicted ED use with the greatest accuracy. Conclusions: The proportion of elder ED users is slightly higher than previously reported among Medicare beneficiaries. Need (comorbidity and health status) characteristics predict ED utilization with the greatest accuracy. [source] Breast Cancer Knowledge and Preventive Behaviors An Urban Emergency Department-based SurveyACADEMIC EMERGENCY MEDICINE, Issue 12 2000Kevin M. Takakuwa MA Abstract. Objective: To assess general knowledge and preventive behaviors regarding breast cancer among women who present to an urban emergency department. Methods: During a six-month study period, a convenience sampling of women aged 21 years and older who were in treatment and waiting areas was surveyed. The anonymous written survey asked about demographic variables, knowledge, and preventive behaviors regarding breast cancer. Knowledge was assessed with questions about the recommended frequency of breast self-examination and the recommended age for first mammography. Performance was assessed by questions about breast self-exam and mammography. Subgroup analysis was done by age (above and below 40 years old), race, income (above and below the median), insurance type, history of breast lump, and family history (FH) of breast cancer. Results: Four hundred women completed surveys. Two hundred twelve (53%) correctly knew the answers to the two knowledge questions. Knowledge was greater in women with private insurance. Knowledge of the frequency of breast self-exam was significantly greater among whites and Native Americans than among African Americans, Asians, or Hispanics. Stated performance of preventive behaviors was 72% (288) for breast self-exam and for mammography. Preventive behaviors were significantly more likely to be performed by higher-income and privately-insured women. Breast self-exam was more likely to be done in older women, those with a history of a breast lump, and those with a FH of breast cancer. Conclusions: Women with lower income and without private insurance were less likely to be knowledgeable and practice preventive measures for detecting breast disease. [source] Effect of an Expenditure Cap on Low-Income Seniors' Drug Use and Spending in a State Pharmacy Assistance ProgramHEALTH SERVICES RESEARCH, Issue 3 2009Christine E. Bishop Objective. To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. Data Sources and Setting. Claims and enrollment files for the first year ( June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Research Design. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. Principle Findings. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p<.01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Conclusions. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds. [source] Kaiser Permanente Community Partners Project: Improving Geriatric Care Management PracticesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Susan M. Enguidanos MPH This article describes a geriatric care management project that is testing whether geriatric care management plus a brief purchase of service (POS) intervention will lower medical costs, improve satisfaction with care, increase care plan adherence, and improve perceived quality of life. Kaiser Permanente members aged 65 and older who were eligible for geriatric care management and consented to participate in the study were randomized to one of four study groups: information and referral via mail, telephone care management, geriatric care management, or geriatric care management with POS capability. The POS intervention provides up to $2,000 of designated, paid services including in-home supportive services, transportation, respite, or medical equipment within the first 6 months of care management enrollment. Approximately 1,400 senior members were referred to the geriatric care management program, and 451 were randomly assigned to one of the four study groups. Those enrolled in the geriatric care management program were significantly more likely to be ethnic minorities and have lower income than the general Kaiser Permanente senior enrollment. Barriers encountered in implementing the POS intervention included establishing contractual agreements between Kaiser Permanente and private and community agencies, locating adequate and sufficient community agencies to provided needed services, monitoring service contracts, and delaying use of the POS benefit. [source] Itch in the community: associations with psychosocial factors among adultsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 2007F Dalgard Abstract Background, Itch is a major symptom in dermatology but is little explored epidemiologically. Objective, To describe the prevalence and the severity of itch, and to explore its relation to psychosocial factors. Methods, The design was cross-sectional and population-based. A total of 40 880 adults in Oslo were invited to answer a questionnaire. Results, Twenty-seven per cent report itch. Individuals reporting itch were younger, the majority were female, were non-Norwegian, had lower income, were more distressed, had experienced more negative life events and had poorer social support. Individuals with poor support who had experienced more negative life events reported more itch than individuals with good support (15. 6% compared to 10. 9%). The strong association with psychosocial factors was confirmed in a logistic regression. Conclusion, There is a strong association between itch and psychosocial factors in the general population. [source] Chronic pain in South Australia , population levels that interfere extremely with activities of daily livingAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010David C. Currow Abstract Objective: The prevalence of chronic pain in Australia has only been previously estimated for the state of New South Wales. The aim of this study was to focus estimates on pain severe enough to interfere markedly with daily function irrespective of contact with health services in another region, South Australia. Methods: A whole of population random face-to-face survey method (n=2,973) was used, directly standardised against the whole population for age, gender, country of birth and rurality. Respondents were asked about chronic pain and the degree to which it interfered with daily activities. Results: The prevalence of chronic pain was 17.9%, and pain that interfered extremely with activity 5.0%. Chronic pain was associated with older age, living alone, lower income, not being in full-time work and lower educational levels in bivariate analyses, however in multifactor analyses the only significant associations were not currently working (p<0.001) and lower levels of educational achievement (p=0.042). Pain that interfered extremely with activity in multifactor analysis was associated with work status where the odds ratio for work-related injury compared to those in full time work was 19.3 (95% CI 7.30-51.3; p<0.001). Conclusions: This study highlights the high levels of pain with extreme effects on day-to-day life (one in 20 people), the complex inter-relationships of the factors (educational achievement, work status) associated with chronic pain and the impacts that these factors have on the people experiencing such disabling pain in the long-term. [source] Social factors associated with Major Depressive Disorder in homosexually active, gay men attending general practices in urban AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2009Limin Mao Abstract Objectives: Social factors associated with Major Depressive Disorder (MDD) were identified among gay men attending high HIV caseload general practices in Sydney and Adelaide. Methods: Men who visited four participating practices were invited to self-complete a survey. A self-screening tool (PHQ-9), based on the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV), was used to measure depressive disorders. Results: The rate of MDD (PHQ-9 score 10 or above) among the 195 HIV-positive gay men was significantly higher than that among the 314 non-HIV-positive gay men (31.8% vs 20.1%, p=0.002). Current MDD was independently associated with younger age, lower income, recent major adverse life events, adopting denial and isolation as coping strategies, less social support, less gay community involvement and recent sexual problems. HIV-status, however, was not independently associated with MDD. Conclusion: Socio-economic hardship, interpersonal isolation and personal withdrawal were significantly and independently associated with major depression in this population of gay men. Implications: The study provides further evidence of health inequity affecting gay men in Australia. Structural health promotion approaches focused on homophobia and discrimination, as well as community-engaged primary health care responses are called for to mitigate this inequity. [source] Multicenter Study of Limited Health Literacy in Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 6 2008Adit A. Ginde MD Abstract Objectives:, The objective was to evaluate the prevalence of limited health literacy and its association with sociodemographic variables in emergency department (ED) patients. Methods:, This was a cross-sectional survey in three Boston EDs. The authors enrolled consecutive adult patients during two 24-hour periods at each site. They measured health literacy by the short version of the Test of Functional Health Literacy in Adults (S-TOFHLA). Using multivariate logistic regression, the authors evaluated associations between sociodemographic variables and limited health literacy, as classified by S-TOFHLA scores. Results:, The authors enrolled 300 patients (77% of eligible). Overall, 75 (25%; 95% confidence interval [CI] = 20% to 30%) of participants had limited health literacy. Limited health literacy was independently associated with older age (compared to 18,44 years, odds ratio [OR] 4.3 [95% CI = 2.0 to 9.2] for 45,64 years and OR 3.4 [95% CI = 1.4 to 8.5] for ,65 years), less education (compared to high school graduates, OR 2.7 [95% CI = 1.1 to 7.3] for some high school or lower and OR 0.43 [95% CI = 0.21 to 0.88] for some college or higher), and lower income (OR 2.8 [95% CI = 1.2 to 6.6] for ,$40,000 compared to >$40,000). Although ethnicity, race, and language were associated with limited health literacy in unadjusted analyses, the associations were not significant on multivariate analysis. Conclusions:, In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study. [source] Witnessing Intimate Partner Violence as a Child Does Not Increase the Likelihood of Becoming an Adult Intimate Partner Violence VictimACADEMIC EMERGENCY MEDICINE, Issue 5 2007Amy A. Ernst MD ObjectivesTo determine whether adults who witnessed intimate partner violence (IPV) as children would have an increased rate of being victims of ongoing IPV, as measured by the Ongoing Violence Assessment Tool (OVAT), compared with adult controls who did not witness IPV as children. The authors also sought to determine whether there were differences in demographics in these two groups. MethodsThis was a cross sectional cohort study of patients presenting to a high-volume academic emergency department. Emergency department patients presenting from November 16, 2005, to January 5, 2006, during 46 randomized four-hour shifts were included. A confidential computer touch-screen data entry program was used for collecting demographic data, including witnessing IPV as a child and the OVAT. Main outcome measures were witnessing IPV as a child, ongoing IPV, and associated demographics. Assuming a prevalence of IPV of 20% and a clinically significant difference of 20% between adults who witnessed IPV as children and adult controls who did not witness IPV as children, the study was powered at 80%, with 215 subjects included. ResultsA total of 280 subjects were entered; 256 had complete data sets. Forty-nine percent of subjects were male, 45% were Hispanic, 72 (28%) were adults who witnessed IPV as children, and 184 (72%) were adult controls who did not witness IPV as children. Sixty-three (23.5%) were positive for ongoing IPV. There was no correlation of adults who witnessed IPV as children with the presence of ongoing IPV, as determined by univariate and bivariate analysis. Twenty-three of 72 (32%) of the adults who witnessed IPV as children, and 39 of 184 (21%) of the adult controls who did not witness IPV as children, were positive for IPV (difference, 11%; 95% confidence interval [CI] =,2% to 23%). Significant correlations with having witnessed IPV as a child included age younger than 40 years (odds ratio [OR], 4.2; 95% CI = 1.7 to 9.1), income less than 20,000/year (OR, 5.1; 95% CI = 1.6 to 12.5), and abuse as a child (OR, 9.1; 95% CI = 4.2 to 19.6). Other demographics were not significantly correlated with having witnessed IPV as a child. ConclusionsAdults who witnessed IPV as children were more likely to have a lower income, be younger, and have been abused as a child, but not more likely to be positive for ongoing IPV, when compared with patients who had not witnessed IPV. [source] Antithrombotic management of ischaemic stroke and transient ischaemic attack in China: A consecutive cross-sectional surveyCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 8 2010Yi-Long Wang Summary 1.,Little is known about the prevention of secondary stroke in China. In the present study, we assessed the status of antithrombotic management of stroke patients in clinics across China. 2.,A cross-sectional survey was conducted in 19 urban neurological clinics. All subjects diagnosed with ischaemic stroke (IS) or transient ischaemic attack (TIA) were enrolled consecutively in the study. Face-to-face interviews were conducted by research assistants using questionnaires on the day of enrolment. The data recorded included demographic and clinical characteristics, medication and reasons for not using medication. Independent predictors for the prescription of antiplatelet drugs were determined using multivariate logistic regression models. 3.,Of the 2283 patients with IS or TIA enrolled in the study (34.7% women; mean ( ± SD) age 65.8 ± 11.6 years), 1719 (75.3%) had a prescription for antiplatelet therapy. Of the 108 patients with atrial fibrillation, only 14 (13.0%) were receiving warfarin therapy. The main independent factors significantly associated with being on antiplatelet therapy were having basic health insurance (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.09,1.99), government insurance and labour insurance (OR 1.63; 95% CI 1.03,2.59) and a monthly income of > 500 yuan (US$66.70; OR 2.14; 95% CI 1.51,3.03). Being older (OR 0.70; 95% CI 0.50,0.99) and having a severe disability (OR 0.68; 95% CI 0.49,0.97) were associated with lower odds of receiving antiplatelet therapy. 4.,Based on the survey results, adherence to guidelines for antithrombotic management in neurological clinics in China is poor. The main reasons contributing to the less than optimal management of stroke patients include negative attitudes among neurologists, a lack of medical insurance, a lower income and being elderly and/or severely disabled. [source] Public Pension Reform in the United Kingdom: What Effect on the Financial Well-Being of Current and Future Pensioners?,FISCAL STUDIES, Issue 1 2005Richard Disney Abstract Unlike many tax and benefit changes, reforms to public pension programmes take many years to have their full effect. This paper examines the effect of reforms to the public pension programme in the United Kingdom on the state retirement incomes of current generations of pensioners and on the prospective state incomes of future generations of pensioners. We show that, for an individual with lifetime earnings close to male average earnings, the UK pension system is at its most generous to those reaching the state pension age around the year 2000, but that the introduction of the state second pension and the pension credit postpones this peak for individuals on lower incomes and for those with substantial periods out of paid employment spent with caring responsibilities. We also consider how the ,mix' of benefits, particularly between the contributory and income-tested sectors, could change over time, and the impact that this would have on incentives to save for retirement. [source] Increasing Support for Those on Lower Incomes: Is the Saving Gateway the Best Policy Response?FISCAL STUDIES, Issue 2 2003Carl Emmerson Abstract The government is committed to introducing a new savings account for people on lower incomes. This will provide a strong incentive for eligible individuals to save, or at least to hold financial assets, in these accounts. This paper describes possible rationales for this government intervention. It then presents new evidence on the characteristics of people with lower incomes and finds that many already have some financial assets, while those who do not often appear to have good reasons for why they may not want to be currently saving. The result is that the proposed Saving Gateway will be extremely difficult to target at those who might benefit in the way the government hopes. The danger is that the policy will be expensive relative to the number of genuine new savers and savings that it generates. [source] Comparing United States versus International Medical School Graduate Physicians Who Serve African- American and White ElderlyHEALTH SERVICES RESEARCH, Issue 6 2006Daniel L. Howard Objective. To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. Data Sources. Secondary data analysis of the 1986,1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. Study Design. Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and ,2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. Data Collection/Extraction Methods. Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. Principal Findings. Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. Conclusion. IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations. [source] IS ECONOMIC GROWTH GOOD FOR THE POOR?INTERNATIONAL ECONOMIC REVIEW, Issue 4 2008TRACKING LOW INCOMES USING GENERAL MEANS We propose the use of an alternative methodology to track low incomes based on Atkinson's "equally distributed equivalent income" functions or "general means" and present a new characterization to justify their application. To evaluate the effects of growth on lower incomes, growth rates are compared for two income standards: the ordinary mean and a low-income-sensitive general mean. The question is: How closely related are these two variables? After estimating the growth elasticity, we find that it is not significantly different from zero. Thus, it cannot be concluded that poorer incomes grow proportionately to increases in the average income. [source] Attitudes Toward Nurse Practitioners: Influence of Gender, Age, Ethnicity, Education and IncomeJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2000Carol Y. Phillips PhD ABSTRACT Survey research was undertaken to measure relationships between gender, age, ethnicity, education, income level, and an individual's attitude toward using a nurse practitioner (NP) for health care. Pender's Health Promotion Model provided the theoretical basis for the research initiative and instrument design. Following initial pilot work, 238 individuals were surveyed. While no significant differences on the basis of gender and race were found, high school graduates demonstrated significantly more positive attitudes toward NPs than non-high school graduates, and older subjects and those with lower incomes were less positively inclined to use NP services. These findings have implications for the marketing of NP services, NP education, and public education, and should be used as a basis for additional research in this area. [source] Nausea and vomiting in pregnancy: maternal characteristics and risk factorsPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2006Carol Louik Summary Nausea with or without vomiting (NVP) is probably the most frequently reported medical complaint of pregnancy, but few studies have considered risk factors for its development. We used data from an ongoing epidemiological study of pregnancies in four regional centres. Mothers of infants with congenital malformations (n = 17 158) and a sample of normal infants (n = 5329) were interviewed within 6 months of delivery by trained nurse-interviewers using a standardised questionnaire. For all risk factors investigated, odds ratios and 95% confidence intervals were calculated using multiple logistic regression, controlling for potential confounders. The cumulative incidence (risk) of NVP was 67%. The risk of NVP and its timing during pregnancy were similar for mothers of malformed and normal infants, so data were combined. No changes in the NVP risk were observed over the 20-year study period. The risk decreased with increasing age, but increased with increasing gravidity. The risk also increased with increasing number of prior miscarriages. Further, within each gravidity category, the risk was higher for twin births than for singletons. Women who reported onset of NVP after the first trimester differed demographically from women whose NVP began earlier: they were less-well educated, had lower incomes, and were more likely to be black. The finding that the number of prior pregnancies, both complete and incomplete, and number of fetuses independently appear to increase the risk of NVP suggests a fetal ,dose' effect. Together with selected demographic characteristics that differentiate early- vs. late-onset NVP, these findings warrant further investigation. [source] Rural,Urban Differences in Primary Care Physicians' Practice Patterns, Characteristics, and IncomesTHE JOURNAL OF RURAL HEALTH, Issue 2 2008William B. Weeks MD ABSTRACT:,Context:Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings. Purpose: To examine rural,urban differences in physician work effort, physician characteristics, and practice characteristics, and to determine whether, after adjusting for any observed differences, rural primary care physicians' incomes were lower than those of urban primary care physicians. Methods: Using survey data from actively practicing office-based general practitioners (1,157), family physicians (1,378), general internists (2,811), or pediatricians (1,752) who responded to the American Medical Association's annual survey of physicians between 1992 and 2002, we used linear regression modeling to determine the association between practicing in a rural (nonmetropolitan) or urban (standard metropolitan statistical area) setting and physicians' annual incomes after controlling for specialty, work effort, provider characteristics, and practice characteristics. Findings: Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients. After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts (95% confidence intervals: ,$14,569, ,$4,602, P < .001). In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts. Conclusions: Addressing rural physicians' lower incomes, longer work hours, and greater dependence on Medicaid reimbursement may improve the ability to ensure that an adequate supply of primary care physicians practice in rural settings. [source] Alcohol and Drug Use in Rural Colonias and Adjacent Urban Areas of the Texas BorderTHE JOURNAL OF RURAL HEALTH, Issue 2007Richard T. Spence PhD ABSTRACT:,Context: Little is known about substance use and treatment utilization in rural communities of the United States/Mexico border. Purpose: To compare substance use and need and desire for treatment in rural colonias and urban areas of the border. Methods: Interviews were conducted in 2002-2003 with a random sample of adults living in the lower Rio Grande Valley of Texas, adjacent to the Mexican border. The present analysis compares responses from 400 residents of rural colonias to those of 395 residents of cities and towns in the same geographic region. Findings: While the prevalence of drug use and drug-related problems was similar in both areas, binge drinking and alcohol dependence were higher in rural colonias than in urban areas and remained so after taking demographic and neighborhood variables into account. An increase in illicit drug use and substance-related problems in rural but not urban areas was seen when comparing results from this study with those of a previous survey conducted in 1996. The percentage of adults in potential need of treatment and the percentage motivated to seek it were similar in both urban and rural areas. However, colonia residents were more likely than their urban counterparts to be recent immigrants and to have lower incomes and educational attainment, factors that can increase the barriers they face in getting needed services. Conclusions: Rural areas are "catching up" with urban areas in problematic substance use. Given the potential barriers to accessing treatment services in rural areas, efforts should be focused on reaching those residents. [source] Pediatric Out-of-hospital Emergency Medical Services Utilization in Kansas City, MissouriACADEMIC EMERGENCY MEDICINE, Issue 6 2009Melissa K. Miller MD Abstract Objectives:, The objective was to describe epidemiologic features and usage patterns of pediatric emergency medical services (EMS) transports in Kansas City, Missouri. Methods:, The study consisted of a retrospective analysis of transports from January 1, 2002, to December 31, 2004, for Kansas City, Missouri, residents younger than 15 years of age (excluding interfacility transports. Data included demographics, insurance, day and time of transport, patient zip code, chief complaint, and number of individual transports. Rates were calculated using intercensal estimates for the denominator. All rates were expressed as number of transports per 1,000 persons per year (PPY). Results:, A total of 5,717 pediatric transports occurred in the 3-year study period. Transport rates were 18 PPY for all users, 42 PPY for those <1 year old, 23 PPY for ages 1,4 years, 12 PPY for ages 5,9 years, and 14 PPY for ages 10,14 years. Infants <1 year were more likely than children aged 5,9 years to use EMS (relative risk [RR] = 3.7, 95% confidence interval [CI] = 3.4 to 4.0). Males were more likely than females to use EMS (RR = 1.2, 95% CI = 1.1 to 1.3). Most (64%) were insured by Medicaid. Transports peaked between 4 pm and 8 pm, and lowest usage was 4 am to 8 am (p < 0.001). Overall usage did not vary by weekday or season. Respiratory transports were more common in the fall and winter, while trauma transports were more common in the summer (p < 0.001). The most common diagnoses were trauma (27%), neurologic (19%), and respiratory (18%). Eleven percent of users accessed EMS more than once (26% of all transports). There was a significant inverse linear relationship between transport rate and median family income by zip code (r = ,0.36, p < 0.001). Conclusions:, Children in zip codes with lower incomes, infants, and males were more likely to use EMS. Factors related to these increased transport rates are unknown. [source] Health behaviours of young, rural residents: A case studyAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2009Lisa Bourke Abstract Objective:,To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours. Methods:,Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours. Results:,Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences. Conclusion and implications:,The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required. [source] The Saving Gateway: Implications for Optimal Saving,FISCAL STUDIES, Issue 2 2010Matthew D. Rablen D91; H30 Abstract The Saving Gateway is a government saving initiative aiming to ,kick-start a saving habit among people on lower incomes'. Funds saved in a Saving Gateway account up to a monthly limit are matched by the government after two years at a rate of £0.50 per £1 saved. In this paper, a Saving Gateway account is embedded alongside an ordinary interest-bearing account in a simple life-cycle model of saving to assess the implications of the scheme for optimal saving. Among the findings are that, for agents with access to credit, the Saving Gateway is associated with a fall in saving during the life of the account and a rise in consumption. However, the scheme increases saving by the credit-constrained. On their own, empirically plausible levels of habit formation in consumption preferences have too small an effect on saving to justify the scheme. [source] | |||||||||||||