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The author offers observation on the importance for the U.S. to invest more in breastfeeding support ensuring that the needs and wants of people of color and other socio-economically disadvantaged groups are met. Topics discussed include breastfeeding inequities and importance, barriers for improving breastfeeding, and information on the Baby Friendly Hospital Initiative Ten Steps.

Objectives. To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens. [ABSTRACT FROM AUTHOR]

An introduction to an article published in the journal about the topic of successful smoking cessation efforts among maternal smokers with low incomes, and the role of the federal program Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

An editorial is presented in which the authors discuss how the economic and public health consequences of what is termed the 2008 Great Recession might be applicable to the aftermath of the COVID-19 pandemic in the U.S., particularly concerning the social determinants of health, employment, and economic well-being among low-income Americans.

Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion affected well-being in the low-income and general adult US populations. Methods. We obtained data from adults aged 18 to 64 years in the nationally representative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We used a difference-in-differences analysis to compare access to and difficulty affording health care and subjective well-being outcomes (happiness, sadness, worry, stress, and life satisfaction) before and after Medicaid expansion in states that did and did not expand Medicaid. Results. Access to health care increased, and difficulty affording health care declined following the Medicaid expansion. Medicaid expansion was not associated with changes to emotional states or life satisfaction over the study period in either the low-income population who newly gained health insurance or in the general adult population as a spillover effect of the policy change. Conclusions. Although the public health benefits of the Medicaid expansion are increasingly apparent, improved population well-being does not appear to be among them. Public Health Implications. Subjective well-being indicators may not be informative enough to evaluate the public health impact of expanded health insurance. [ABSTRACT FROM AUTHOR]

Objectives. To investigate use of electronic nicotine delivery systems (ENDS) among priority populations. Methods. Using 2016 through 2017 US nationally representative surveys (n = 11 688), we examined ENDS use by sociodemographic variables (age, education, poverty status, insurance, employment, race/ethnicity, sexual orientation) and combustible tobacco use. Results. Among individuals who currently use noncigarette combustible tobacco, those from certain backgrounds (young adults, those living below the poverty level, those less educated, sexual minorities, Blacks, Hispanics, and those without health insurance) were more likely to use ENDS. Among current cigarette smokers, those who were younger, living at or above poverty (ever use), with higher education (current use), sexual minority, and non-Black were more likely to use ENDS. Conclusions. Associations between sociodemographic variables and ENDS use varied depending on combustible tobacco use status, highlighting the need to consider multiple types of tobacco products to understand ENDS use among priority populations. The impact on tobacco disparities will ultimately depend on whether ENDS are used to transition completely away from combustible tobacco products and how this may differ across priority populations who use diverse tobacco products. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the association between rates of police-related deaths and neighborhood residential segregation (by income, race/ethnicity, or both combined) in the United States. Methods. We identified police-related deaths that occurred in the United States (2015–2016) using a data set from the Guardian newspaper. We used census data to estimate expected police-related death counts for all US census tracts and to calculate the Index of Concentration at the Extremes as a segregation measure. We used multilevel negative binomial models for the analyses. Results. Overall, police-related death rates were highest in neighborhoods with the greatest concentrations of low-income residents (vs high-income residents) and residents of color (vs non-Hispanic White residents). For non-Hispanic Blacks, however, the risk was greater in the quintile of neighborhoods with the highest concentration of non-Hispanic White residents than in certain neighborhoods with relatively higher concentrations of residents of color (the third and fourth quintiles). Conclusions. Neighborhood context matters—beyond individual race/ethnicity—for understanding, preventing, and responding to the occurrence of police-related deaths. Public Health Implications. Efforts to monitor, prevent, and respond to police-related deaths should consider neighborhood context, including levels of segregation by income and race/ethnicity. [ABSTRACT FROM AUTHOR]

In low-income neighborhoods without supermarkets, lack of healthy food access often is exacerbated by the saturation of small corner stores with tobacco and unhealthy foods and beverages. We describe a municipal healthy retail program in San Francisco, California, focusing on the role of a local coalition in program implementation and outcomes in the city's low income Tenderloin neighborhood. By incentivizing selected corner stores to become healthy retailers, and through community engagement and cross-sector partnerships, the program is seeing promising outcomes, including a "ripple effect" of improvement across nonparticipating neighborhood stores. [ABSTRACT FROM AUTHOR]

An editorial is presented in which the authors discuss the alternate care site hotel model of health services in Baltimore, Maryland, established in response to the COVID-19 pandemic and health care for disadvantaged people. It examines the admission criteria for hotel alternate care sites (ACSS). The article also briefly discusses ACS hotel models in China, Chicago, Illinois, and Los Angeles, California.

Objectives. To evaluate rates of member compliance with Iowa’s Medicaid expansion premium disincentive program. Methods. We used 2014 to 2015 Iowa Medicaid data to construct rolling 12-month cohorts of Wellness Plan and Marketplace Choice members (Iowa’s 2 Medicaid expansion waiver programs for individuals £ 100% and 101%–138% of the federal poverty level, respectively), calculated completion rates for required activities (i.e., wellness examinations and health risk assessments), and identified factors associated with program compliance. Results. Overall, 18.5% of Wellness Plan and 12.5% of Marketplace Choice members completed both activities (P< .001). From 2014 to 2015, completion rates for both activities decreased for Wellness Plan members but increased for Marketplace Choice members. Members who were younger, male, or non-White were less likely to complete required activities. Conclusions. Approximately 81% of Wellness Plan members and 87% of Marketplace Choice members failed to comply with program requirements and should have been subject to paying premiums the following year or face disenrollment. Disparities in completion rates may exacerbate disparities in insurance coverage and health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. Methods: We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. Results: Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. Conclusions: A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether access to housing assistance is associated with better health among low-income adults. Methods. We used National Health Interview Survey data (1999-2012) linked to US Department of Housing and Urban Development (HUD) administrative records (1999-2014) to examine differences in reported fair or poor health and psychological distress. We used multivariable models to compare those currently receiving HUD housing assistance (public housing, housing choice vouchers, and multifamily housing) with those who will receive housing assistance within 2 years (the average duration of HUD waitlists) to account for selection into HUD assistance. Results. We found reduced odds of fair or poor health for current public housing (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.57, 0.97) and multifamily housing (OR = 0.75; 95% CI = 0.60, 0.95) residents compared with future residents. Public housing residents also had reduced odds of psychological distress (OR = 0.59; 95%CI = 0.40, 0.86). These differences were not mediated by neighborhood-level characteristics, and we did not find any health benefits for current housing choice voucher recipients. Conclusions. Housing assistance is associated with improved health and psychological well-being for individuals entering public housing and multifamily housing programs. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B virus (HBV) screening among low-income, underserved Vietnamese Americans at high risk. Methods. We conducted a cluster randomized trial involving 36 Vietnamese community-based organizations and 2337 participants in Pennsylvania, New Jersey, and New York City between 2009 and 2014. We randomly assigned 18 community-based organizations to a community-based multilevel HBV screening intervention (n = 1131). We randomly assigned the remaining 18 community-based organizations to a general cancer education program (n = 1206), which included information about HBV-related liver cancer prevention. We assessed HBV screening rates at 6-month follow-up. Results. Intervention participants were significantly more likely to have undergone HBV screening (88.1%) than were control group participants (4.6%). In a Cochran- Mantel-Haenszel analysis, the intervention effect on screening outcomes remained statistically significant after adjustment for demographic and health care access variables, including income, having health insurance, having a regular health provider, and English proficiency. Conclusions. A community-based, culturally appropriate, multilevel HBV screening intervention effectively increases screening rates in a high-risk, hard-to-reach Vietnamese American population. [ABSTRACT FROM AUTHOR]

Objectives. We examined the effects of market income inequality (income inequality before taxes and transfers) and income redistribution via taxes and transfers on inequality in longevity. Methods. We used life tables to compute Gini coefficients of longevity inequality for all individuals and for individuals who survived to at least 10 years of age. We regressed longevity inequality on market income inequality and income redistribution, and we controlled for potential confounders, in a cross-sectional time-series sample of up to 28 predominantly Western developed countries and up to 37 years (1974-2011). Results. Income inequality before taxes and transfers was positively associated with inequality in the number of years lived; income redistribution (the difference between market income inequality and income inequality after taxes and transfers were accounted for) was negatively associated with longevity inequality. Conclusions. To the extent that our estimated effects derived from observational data are causal, governments can reduce longevity inequality not only via public health policies, but also via their influence on market income inequality and the redistribution of incomes from the relatively rich to the relatively poor. [ABSTRACT FROM AUTHOR]

Objectives. We designed this study to examine differences in receipt of mental health treatment between low-income uninsured nonelderly adults with serious mental illness (SMI) who were eligible for Medicaid under the Affordable Care Act (ACA) and their existing Medicaid counterparts. Assessing these differences might estimate the impact of the Medicaid expansion efforts under the ACA on receipt of mental health treatment among uninsured nonelderly adults with SMI. Methods. We examined data from 2000 persons aged 18 to 64 years who participated in the 2008 to 2013 National Survey on Drug Use and Health, had income below 138% of the federal poverty level, met SMI criteria, and either were uninsured (n= 1000) or had Medicaid-only coverage (n = 1000). We defined SMI according to the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. We used descriptive analyses and logistic regression modeling. Results. In the 28 states currently expanding Medicaid, the model-adjusted prevalence (MAP) of receiving mental health treatment among Medicaid-only enrollees with SMI (MAP = 71.3%; 95% confidence interval [CI] = 65.74%, 76.29%) was 30.1% greater than their uninsured counterparts (MAP = 54.8%; 95% CI = 48.16%, 61.33%). In the United States, the MAP of receiving mental health treatment among Medicaid-only enrolleeswith SMI (MAP = 70.4%; 95% CI = 65.67%, 74.70%) was 35.9% higher than their uninsured counterparts (MAP = 51.8%; 95% CI = 46.98%, 56.65%). Conclusions. Estimated increases in receipt of mental health treatment because of enrolling in Medicaid among low-income uninsured adults with SMI might help inform planning and implementation efforts for the Medicaid expansion under the ACA. [ABSTRACT FROM AUTHOR]

The article discusses research regarding the support for policies to strengthen the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP) to improve the health of low-income families in California. Topics include the benefits of monetary incentives for fruits and vegetables, restricting purchases of sugary beverages, and providing more total benefits, and the cost-effectiveness and impact of SNAP to reduce diet-related disease in low-income populations.

Objectives. To determine the prevalence trends of osteoarthritis (OA), rheumatoid arthritis (RA), and other types of arthritis in the United States from 1999 to 2014. Methods. We analyzed data on 43 706 community-dwelling adults aged 20 years and older who participated in the 1999–2014 National Health and Nutrition Examination Surveys. We accounted for survey design and sampling weights so that estimates were nationally representative. We assessed temporal trends in age-standardized arthritis prevalence by using joinpoint regression. Results. Age-adjusted prevalence of arthritis was 24.7% (OA = 9.7%; RA = 4.2%; other arthritis = 2.8%; “don’t know” type = 8.0%). Prevalence of OA increased from 6.6% to 14.3%, whereas RA prevalence decreased from 5.9% to 3.8%. Increase in OA prevalence was significant in both genders; in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics; and in people with high socioeconomic status. Decrease in RA prevalence was more pronounced in men, non-Hispanic Blacks, and participants with low income or obesity. Conclusions. Between 1999 and 2014, nearly one quarter of American adults reported arthritis. The prevalence of OA has more than doubled over time, whereas RA prevalence has declined. [ABSTRACT FROM AUTHOR]

Objectives. To determine enrollment rates and predictors of enrollment for newly eligible low-income adults in California following the Affordable Care Act's (ACA's) Medicaid expansion. Methods. We used data from the 2014 to 2015 California Health Interview Survey to examine post-ACA Medicaid enrollment rates and multivariable logistic regression to assess the association of demographic factors, income, and health with enrollment. Results.Wefound a 78.5% enrollment rate for the newly eligible Medicaid population, translating to 3.8 million adults enrolled and 1.1 million adults who were eligible but did not enroll. Significant predictors of enrollment were participating in a public welfare program (odds ratio [OR] = 6.59; 95% confidence interval [CI] = 3.09, 14.04), having heart disease (OR = 4.03; 95% CI = 1.34, 12.15), being in the top quartile of income (OR = 3.59; 95% CI = 1.64, 7.85), enrolling in 2015 (OR = 3.28; 95% CI = 1.94, 5.56), being unemployed (OR = 2.10; 95% CI = 1.15, 3.82), and being female (OR = 1.71; 95% CI = 1.03, 2.85).Wedid not find significant disparities across race/ethnicity, education level, or geography. Conclusions. Repeal of Medicaid expansion would have a substantial effect on health insurance coverage among California's low-income adults, many of whom report chronic health conditions and no alternative sources of affordable coverage. Future research should examine the mechanisms explaining the higher enrollment rates among California's Medicaid expansion population. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the effectiveness of the Sure Start project, which was implemented in 7 districts of Uttar Pradesh, India, to improve maternal and newborn health. Methods. Interventions were implemented at 2 randomly assigned levels of intensity. Forty percent of the areas received a more intense intervention, including community-level meetings with expectant mothers. A baseline survey consisted of 12 000 women who completed pregnancy in 2007; a follow-up survey was conducted for women in 2010 in the same villages. Our quantitative analyses provide an account of the project’s impact. Results. We observed significant health improvements in both intervention areas over time; in the more intensive intervention areas, we found greater improvements in care-seeking and healthy behaviors. The more intensive intervention areas did not experience a significantly greater decline in neonatal mortality. Conclusions. This study demonstrates that community-based efforts, especially mothers’ group meetings designed to increase care-seeking and healthy behaviors, are effective and can be implemented at large scale. [ABSTRACT FROM AUTHOR]

The author reflects on dental benefits in relation to the limits that are associated with America's Medicaid health insurance program as of 2016, and it mentions a follow up to the article "Effect of Cuts in Medicaid on Dental-related Visits and Costs at a Safety-net Hospital" by M. Neely, J.A. Jones, S. Rich, L.S. Gutierrez, and P. Mehra which appears in a 2016 issue of the journal. Health benefits for low-income Americans are examined, along with preventive dental care services.

The article presents information about public health concerning topics including the significance of COVID-19 deaths and SARS-CoV-2 infection classification, the impact of the COVID-19 pandemic upon lower-income workers in Bangladesh, and COVID contact tracing with Quick Response (QR) posters.

Although the term "patient dumping" was rarely used before the 1960s, the practice started much earlier. In the late 1870s, the New York Times began to report that private hospitals were using ambulances to shift poor, moribund patients to Bellevue, the city's preeminent public facility. Many trips had serious medical consequences. Private hospitals also instructed ambulances to take critically ill patients directly to Bellevue regardless of the distance. Efforts to combat such practices took various forms. When transfers resulted in death, Manhattan coroners held inquests. In 1902, the Commissioner of Charities issued an order requiring that he be sent a full report from the superintendent of any hospital in which a patient transferred from another facility died within three days after admission. Four years later, the city passed an ordinance imposing a severe penalty on any hospital official who transferred an ill patient. Those reforms were only partially effective at deterring such transfers. [ABSTRACT FROM AUTHOR]

Objectives. We used recent data to reexamine whether the exclusion of adults from households with no telephone or only wireless phones may bias estimates derived from health-related telephone surveys. Methods. We calculated the difference between estimates for the full population of adults and estimates for adults with landline phones; data were from the 2007 National Health Interview Survey. Results. When data from landline telephone surveys were weighted to match demographic characteristics of the full population, bias was generally less than 2 percentage points (range=0.1-2.4). However, among young adults and low-income adults, we found greater bias (range=1.7-5.9) for estimates of health insurance, smoking, binge drinking, influenza vaccination, and having a usual place for care. Conclusions. From 2004 to 2007, the potential for noncoverage bias increased. Bias can be reduced through weighting adjustments. Therefore, telephone surveys limited to landline households may still be appropriate for health surveys of all adults and for surveys of subpopulations regarding health status. However, for some behavioral risk factors and health care service use indicators, caution is warranted when using landline surveys to draw inferences about young or low-income adults. (Am J Public Health. 2009;99:1806-1810. doi:10. 2105/AJPH.2008.152835) [ABSTRACT FROM AUTHOR]

Objectives. We compared the health of older US, English, and other European adults, stratified by wealth. Methods. Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n=17481), England (n=6527), and the United States (n=9940). We calculated prevalence rates of 6 chronic diseases and functional limitations. Results. American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI=1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations. Conclusions. American adults are Jess healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans. [ABSTRACT FROM AUTHOR]

Objectives. We developed a method to evaluate geographic and temporal variations in community-level risk factors and prevalence estimates, and used that method to identify communities in Massachusetts that should be considered high priority communities for smoking interventions. Methods. We integrated individual-level data from the Behavioral Risk Factor Surveillance System from 1999 to 2005 with community-level data in Massachusetts. We used small-area estimation models to assess the associations of adults' smoking status with both individual- and community-level characteristics and to estimate community-specific smoking prevalence in 398 communities. We classified communities into 8 groups according to their prevalence estimates, the precision of the estimates, and temporal trends. Results. Community-level prevalence of current cigarette smoking among adults ranged from 5% to 36% in 2005 and declined in all but 16 (4%) communities between 1999 and 2005. However, less than 15% of the communities met the national prevalence goal of 12% or less. High smoking prevalence remained in communities with lower income, higher percentage of blue-collar workers, and higher density of tobacco outlets. Conclusions. Prioritizing communities for intervention can be accomplished through the use of small-area estimation models. In Massachusetts, socioeconomically disadvantaged communities have high smoking prevalence rates and should be of high priority to those working to control tobacco use. [ABSTRACT FROM AUTHOR]

Objectives. We sought to update income-specific secular trends in obesity in Brazil to assess the hypothesis that the disease burden is shifting toward the poor. Methods. We compared overall and income-specific obesity prevalence rates estimated for Brazilian men and women from national surveys conducted in 1975, 1989, and 2003. We calculated age-adjusted prevalence ratios to assess time trends. Results. In the first 14-year period examined (1975-1989), obesity rates among men and women increased by 92% and 63%, respectively, and increases were relatively higher among individuals in lower income groups. In the second 14-year period (1989-2003), there were further increases in obesity among men, and again increases were larger among the poor. In this second period, the obesity rate remained virtually stable in the overall female population, but it increased by 26% among women in the 2 lower income quintiles and decreased by 10% among women in the 3 higher income quintiles. Conclusions. The burden of obesity is shifting toward the poor and can no longer be considered a disease of the socioeconomic elite. Policymakers need to design policy and programs that reach all members of society, but especially the poor. (Am J Public Health. 2007;97:1808-1812. doi:10.2105/AJPH.2006.099630) [ABSTRACT FROM AUTHOR]

Objectives. We studied the experience of Hurricane Katrina evacuees to better understand factors influencing evacuation decisions in impoverished, mainly minority communities that were most severely affected by the disaster. Methods. We performed qualitative interviews with 58 randomly selected evacuees living in Houston's major evacuation centers from September 9 to 12, 2005. Transcripts were content analyzed using grounded theory methodology. Results. Participants were mainly African American, had low incomes, and were from New Orleans. Participants' strong ties to extended family, friends, and community groups influenced other factors affecting evacuation, including transportation, access to shelter, and perception of evacuation messages. These social connections cut both ways, which facilitated and hindered evacuation decisions. Conclusions. Effective disaster plans must account for the specific obstacles encountered by vulnerable and minority communities. Removing the more apparent obstacles of shelter and transportation will likely be insufficient for improving disaster plans for impoverished, minority communities. The important influence of extended families and social networks demand better community-based communication and preparation strategies. (Am J Public Health. 2007;97: S109-S115. doi: 10.2105/AJPH.2005.084335) [ABSTRACT FROM AUTHOR]

The author discusses government funding of the Ryan White Program which provides economic assistance to poor HIV patients. He mentions President Donald Trump's plans to end HIV but decreased funding requests for the Ryan White program and other HIV-related projects in the 2018 and 2019 federal budget.

Objectives. We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools, Methods. We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. Results. Among 11 490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. Conclusions. There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities. (Am J Public Health. 2006;96: 1599-1603. doi:10.2105/AJPH.2005.071514) [ABSTRACT FROM AUTHOR]

Objective. We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics. Methods. Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity. Results. A total of 18800 patients with diabetes experienced 30528 hospital admissions, for a hospitalization rate of 0.35 per person-year. Rates rose with age and with the interaction of male gender and age. Rates for non-Hispanic Whites were higher than those for African Americans, whereas those for Hispanics, Asian Americans, and "others" were lower. Patients who were hospitalized at least 5 times made up 10.5% of the study population and accounted for 64% of hospital admissions and hospital charges in this cohort. Conclusions. Hospitalization rates for this low-income cohort with access to primary care and pharmacy services were comparable to those of other diabetic patient populations, suggesting that reducing financial barriers to care may have benefited these patients. A subgroup of patients with multiple hospitalizations accounted for the majority of hospital admissions. (Am J Public Health. 2006;96: 1260-1264.) [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the author's views about the primers published in this issue of the journal which deal with America's food, nutrition, and public health policies, and it mentions direct food aid to the poor and a link between health and agricultural policies. The U.S. Department of Agriculture's food assistance programs such as Supplemental Nutrition Assistance Program (SNAP) are assessed.

The traditional view that excise taxes are regressive has been challenged. I document the history of the term regressive tax. show that traditional definitions have always found cigarette taxes to be regressive. and illustrate the implications of the greater price responsiveness observed among the poor. I explain the different definitions of tax burden: accounting, welfare-based willingness to pay, and welfare-based time inconsistent. Progressivity (equity across income groups) is sensitive to the way in which tax burden is assessed. Analysis of horizontal equity (fairness within a given income group) shows that cigarette taxes heavily burden poor smokers who do not quit, no matter how tax burden is assessed. (Am J Public Health. 2004;94:225-229) [ABSTRACT FROM AUTHOR]

Objectives. We sought to identify factors associated with adult or child hunger. Methods. Low-income housed and homeless mothers were interviewed about socioeconomic, psychosocial, health, and food sufficiency information. Multinomial logistic regression produced models predicting adult or child hunger. Results. Predictors of adult hunger included mothers' childhood sexual molestation and current parenting difficulties, or "hassles." Risk factors for child hunger included mothers' childhood sexual molestation, housing subsidies, brief local residence, having more or older children, and substandard housing. Conclusions. This study found that the odds of hunger, although affected by resource constraints in low-income female-headed families, were also worsened by mothers' poor physical and mental health. Eliminating hunger thus may require broader interventions than food programs. (Am J Public Health. 2004;94:109-115) [ABSTRACT FROM AUTHOR]

In 1920, Indiana's Division of Infant and Child Hygiene inaugurated its first Better Babies Contest at the state fair. For the next 12 years, these contests were the centerpiece of a dynamic infant and maternal welfare program that took shape in Indiana during the decade of the federal Sheppard--Towner act. More than just a lively spectacle for fairgoers, these contests brought public health, "race betterment," and animal breeding together in a unique manner. This article describes one of the most popular expressions of public health and race betterment in rural America. It also raises questions about the intersections between hereditarian and medical conceptions of human improvement during the early 20th century, especially with respect to child breeding and rearing. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated risk for hepatitis C virus (HCV) infection in women residing in low-income neighborhoods of northern California. Methods. A population-based sample of 1707 women, aged 18 to 29, were surveyed and screened for sexually transmitted infections and HCV. Results. Women infected with HCV (2.5%) were more likely to have a history of injection and noninjection drug use, to exchange sex for money or drugs, and to have sexually transmitted infections. HCV was independently associated with history of injection drug use, herpes simplex virus type 2 (HSV-2) infection, and heroin and cocaine use. Conclusions. Injection drug use is the highest risk exposure for HCV, but HSV-2 and noninjection drug use contribute significantly to increased risk. HCV prevention programs in impoverished areas should integrate drug treatment and sexually transmitted infection control. (Am J Public Health. 2002; 92:670-676) [ABSTRACT FROM AUTHOR]

Many investigators report difficulties recruiting low income Latinos into health research projects, especially when they seek to enroll more than one family member. We developed a series of strategies that proved effective in motivating candidates who were initially reluctant to enroll. There is a possibility that these strategies biased the composition of the sample. Predictably, the reasons participants gave for enrolling were correlated with the recruitment strategy that had brought them into the study. Furthermore, we found statistically significant associations between recruitment technique and key study variables (e.g., the domestic stability of the couple). By increasing investigators' ability to recruit Latinos, however, the strategies outlined should help to ensure that Latinos' experiences are given due weight in the deliberations of medical professions and policymakers. [ABSTRACT FROM AUTHOR]

Conclusions. As safety net clinics confront the financial strain of implementing mandatory Medicaid managed care while also dealing with declining Medicaid caseloads and increasing numbers of uninsured, their ability to sustain the policies and services that support primary care accessibility may be threatened. (Am J Public Health. 2001;91:1240-1245) [ABSTRACT FROM AUTHOR]

Objectives. This study determined the prevalence of food insecurity and hunger in low-income legal immigrants. Methods. We conducted a cross-sectional survey of Latino and Asian legal immigrants attending urban clinics and community centers in California, Texas, and Illinois with a food security questionnaire. Results. Among 630 respondents, 40% of the households were food insecure without hunger and 41% were food insecure with hunger. Independent predictors of hunger were income below federal poverty level (odds ratio [OR] = 2.72, 95% confidence interval [CI] = 1.72, 4.30), receipt of food stamps (OR = 2.53, 95% CI = 1.57, 4.09), Latino ethnicity (OR = 2.39, 95% CI = 1.49, 3.82), and poor English (OR = 1.76, 95% CI = 1.10,2.82). Conclusions. The prevalence of hunger among low-income legal immigrants is unacceptably high. Access to food assistance programs is important for the health and well-being of this population. (Am d Public Health. 2000;90: 1629-1633) [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to evaluate whether Put Prevention Into Practice (PPIP) materials affected the delivery of 8 clinical preventive services. Methods. Program materials were provided to a family medicine serving a diverse, low-income population. Appropriate use of clinical preventive services was assessed via medical record reviews at baseline, 6 months, 18 months, and 30 months at both intervention and control sites. Results. The delivery rates of 7 clinical preventive services were higher the intervention site at 6 months. These rates had flattened or decreased by 30 months. Conclusions. Use of PPIP materials modestly improved delivery of certain clinical preventive services. Sustained improvement will require substantial system changes and ongoing support. (Am d Public Health. 2000;90: 1622-1625) [ABSTRACT FROM AUTHOR]

Objectives. This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. Methods. A 1994/95 cross-sectional statewide survey of 10 132 postpartum women was used. Results. Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). Conclusions. This study's results indicate that low-income women are the mainstream maternity population, not a "special needs" subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites. [ABSTRACT FROM AUTHOR]

Individuals in the gray area between Medicaid eligibility and sufficient income to meet the costs of health care, the near poor, utilize health services less than other groups. As part of a study of health care behavior in an inner-city area based on a house-hold survey of three distinct populations (HMO members, public housing project residents, and a defined geographic area), we examined this question more thoroughly. Survey results show that the near poor had lower levels of use than Medicaid recipients when other factors were controlled. Particularly among those classified as in poor health, the near poor were more likely to be non-users and less likely to make multiple visits. However, differences in use between the near poor and the Medicaid recipients are substantially and consistently smaller for the HMO users (whose costs were covered by a special contract) than for users of a hospital outpatient department. The patterns persist for regular care received for a chronic condition but not for care sought for episodes of illness. These findings point to the special disadvantage faced by low income individuals who are not receiving Medicaid. [ABSTRACT FROM AUTHOR]

Many of the traditional approaches to the problem of appointment-keeping behavior have ignored the organizational factors that may be implicated in differentially high broken appointment rates leading to an implicit assumption that low-income and ethnic minority patients will be more likely to break appointments. A case study at a Model Cities Health Center which maintains a kept appointment rate of 85 per cent examined the relationship of broken appointments to age, sex, ethnic background, and payment mechanisms. The results suggest alternative explanations for differentially high broken appointments centering on the role of the institution in reinforcing appointment-keeping behavior. [ABSTRACT FROM AUTHOR]

The article presents the study which describes the yield from a battery of screening test, included as part of the health care program, to patients age 16 years and above in a low income neighborhood. The 595 residents served by the Terrace Village Health Center have undergone a battery of screening test, interview of medical history and physical examination. In the net yield of screening, it has discovered diseases requiring treatment and known untreated conditions requiring treatment. Details related to the discovery of diseases including hypertension, liver diseases, and diabetes are included.

Objectives. To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-in-come Peruvian infants. Methods. Cut-offs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. Results. Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition. Conclusions. Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetites. [ABSTRACT FROM AUTHOR]

Objectives. Because few data are available concerning physical activity among minority and low-income persons, we characterized physical activity patterns among public housing residents. Methods. Two separate cross-sectional surveys were conducted 1 year apart of randomly selected residents of eight rental communities administered by the housing authority of Birmingham, Ala. Indigenous interviewers completed 687 interviews in survey 1 and 599 in survey 2. Results. In both surveys, respondents were most frequently young adult African-American women, reflecting the predominance of women in these communities. Participants were generally poorly educated and either unemployed or working in service occupations. Thirty percent of the respondents in both surveys reported no participation in any of 13 physical activities in the previous year; approximately half reported activity levels equivalent to or less than walking 4 hours per week for 8 months of the year. Respondents who were younger and male were significantly more likely to have higher activity levels. Conclusions. A sedentary life-style is common among this low-income minority group, and, thus, interventions to promote exercise in these communities are needed. [ABSTRACT FROM AUTHOR]

Objectives. The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. Methods. Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. Results. Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nointravenous drug use and high-risk sexual activity was most prevalent among African-American women. Conclusions. The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic back-grounds and acculturation levels to address specialized areas of concern. [ABSTRACT FROM AUTHOR]

Abstract: This study describes the perinatal characteristics of Cambodian refugees in Massachusetts. Data were abstracted from the records of 452 consecutive pregnancies among Cambodian women and 110 low-income Whites receiving obstetrical services at the same clinic and hospital in Lowell, Massachusetts. Pregnancies of Cambodian women were marked by a higher proportion of older mothers, grand multiparas, previous adverse birth outcomes, and short interpregnancy intervals. We identified maternal anemia (29.9 percent with hemoglobin <110 g/L) and inadequate utilization of prenatal care (32.3 percent with first visit in the 3rd trimester) as possible risk factors for the Cambodians. The prevalence of primary cesarean birth was only 6.3 percent in the Cambodians, compared to 15.6 percent in the comparison group, largely due to the infrequent occurrence of prolonged labor among multiparas. Despite the prominence of several risk factors for adverse birth outcomes in this population, major pregnancy complications were less common and the prevalence of low birthweight (6.4 percent) was close to the state average. Logistic regression analysis of risk factors for low birthweight identified young maternal age and short stature as the strongest factors operative in this community. Many of our findings are consistent with a strong cultural emphasis on managing the size of the baby to avoid a difficult labor and delivery. (Am J Public Health 1989; 79:1251-1257.) INSET: New Curriculum Available to Upgrade Drug Abuse Counseling Skills. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated the determinants of physician use by low-income children, with an emphasis on the effect of Medicaid. Data are from the 1980 National Medical Care Utilization and Expenditure Survey. Regression analysis revealed that Medicaid children were more likely than both privately insured and uninsured children to visit an office-based physician. Also, Medicaid children with at least one visit to any setting had a higher number of visits than uninsured children. Such factors as age, health status, number of children in the family, educational status, and income also accounted for differences within the low-income population. The results suggest that access to physicians' services (including office-based physicians) can be increased by expanding Medicaid eligibility to uninsured low-income children and by improving private health insurance benefits among the underinsured. (Am J Public Health 1989; 79:1220-1226.) INSET: New 800 Number for National Aids Information Clearinghouse. [ABSTRACT FROM AUTHOR]

As part of a smoke detector give-away program, 388 adults were surveyed to characterize smoke detector ownership in a low-income population and to identify those who would acquire a free smoke detector following their child's visit to the hospital. Factors associated with smoke detector ownership included higher education, home ownership (vs public housing), knowledge of the city smoke detector law, and the practice of other injury prevention measures. Regardless of ownership, the great majority of parents (82 per cent) acquired a free smoke detector, but those previously without a smoke detector were more likely to do so. These characteristics of smoke detector usage and acquisition should be considered in targeting future intervention strategies. [ABSTRACT FROM AUTHOR]

The high cost of life-saving antiretroviral (ARV) therapy for HIV represents an expense that impedes accessibility and affordability by patients. This price structure also appears to motivate the diversion of ARVs and the targeting of HIV-positive patients by pill brokers in the illicit market. Our field research with indigent, HIV-positive substance abusers links ARV diversion to high levels of competing needs, including psychiatric disorders, HIV stigma, and homelessness. Interventions to reduce diversion must address the needs of highly vulnerable patients. [ABSTRACT FROM AUTHOR]