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Using Foster-Greer-Thorbecke poverty indices, this paper shows that although the incidence of poverty was higher in nonmetropolitan than metropolitan areas throughout the 1990s, the poverty-gap index was only statistically significantly, higher in nonmetropolitan areas in six of the 10 years, and the squared poverty-gap index was worse in only three years. This paper also provides design-corrected standard errors for the indices, which result in more than doubling the uncorrected estimates. An examination of the ratio of the poverty-gap to the head count index establishes that the average shortfall of the poor as a fraction of the poverty line was worse in the metropolitan areas during all 10 years of the 1990s. Similarly, the distribution of income divided by the poverty line indicates that disproportionately more of the nonmetropolitan poor subsisted on incomes near the poverty line, whereas the metropolitan poor were relatively more likely to be living in extreme poverty. [ABSTRACT FROM AUTHOR]

Objectives: To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups.Data Sources/study Setting: Existing literature on PCMH utilization among health care organizations serving low-income populations.Study Design: Systematic review and meta-analysis.Data Collection/extraction Methods: We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria.Principal Findings: Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality.Conclusions: Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed. [ABSTRACT FROM AUTHOR]

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Background: High‐income countries offer social assistance (welfare) programs to help alleviate poverty for people with little or no income. These programs have become increasingly conditional and stringent in recent decades based on the premise that transitioning people from government support to paid work will improve their circumstances. However, many people end up with low‐paying and precarious jobs that may cause more poverty because they lose benefits such as housing subsidies and health and dental insurance, while incurring job‐related expenses. Conditional assistance programs are also expensive to administer and cause stigma. A guaranteed basic income (GBI) has been proposed as a more effective approach for alleviating poverty, and several experiments have been conducted in high‐income countries to investigate whether GBI leads to improved outcomes compared to existing social programs. Objectives: The aim of this review was to conduct a synthesis of quantitative evidence on GBI interventions in high‐income countries, to compare the effectiveness of various types of GBI versus "usual care" (including existing social assistance programs) in improving poverty‐related outcomes. Search Methods: Searches of 16 academic databases were conducted in May 2022, using both keywords and database‐specific controlled vocabulary, without limits or restrictions on language or date. Sources of gray literature (conference, governmental, and institutional websites) were searched in September 2022. We also searched reference lists of review articles, citations of included articles, and tables of contents of relevant journals in September 2022. Hand searching for recent publications was conducted until December 2022. Selection Criteria: We included all quantitative study designs except cross‐sectional (at one timepoint), with or without control groups. We included studies in high income countries with any population and with interventions meeting our criteria for GBI: unconditional, with regular payments in cash (not in‐kind) that were fixed or predictable in amount. Although two primary outcomes of interest were selected a priori (food insecurity, and poverty level assessed using official, national, or international measures), we did not screen studies on the basis of reported outcomes because it was not possible to define all potentially relevant poverty‐related outcomes in advance. Data Collection and Analysis: We followed the Campbell Collaboration conduct and reporting guidelines to ensure a rigorous methodology. The risk of bias was assessed across seven domains: confounding, selection, attrition, motivation, implementation, measurement, and analysis/reporting. We conducted meta‐analyses where results could be combined; otherwise, we presented the results in tables. We reported effect estimates as standard mean differences (SMDs) if the included studies reported them or provided sufficient data for us to calculate them. To compare the effects of different types of interventions, we developed a GBI typology based on the characteristics of experimental interventions as well as theoretical conceptualizations of GBI. Eligible poverty‐related outcomes were classified into categories and sub‐categories, to facilitate the synthesis of the individual findings. Because most of the included studies analyzed experiments conducted by other researchers, it was necessary to divide our analysis according to the "experiment" stage (i.e. design, recruitment, intervention, data collection) and the "study" stage (data analysis and reporting of results). Main Results: Our searches yielded 24,476 records from databases and 80 from other sources. After screening by title and abstract, the full texts of 294 potentially eligible articles were retrieved and screened, resulting in 27 included studies on 10 experiments. Eight of the experiments were RCTs, one included both an RCT site and a "saturation" site, and one used a repeated cross‐sectional design. The duration ranged from one to 5 years. The control groups in all 10 experiments received "usual care" (i.e. no GBI intervention). The total number of participants was unknown because some of the studies did not report exact sample sizes. Of the studies that did, the smallest had 138 participants and the largest had 8019. The risk of bias assessments found "some concerns" for at least one domain in all 27 studies and "high risk" for at least one domain in 25 studies. The risk of bias was assessed as high in 21 studies due to attrition and in 22 studies due to analysis and reporting bias. To compare the interventions, we developed a classification framework of five GBI types, four of which were implemented in the experiments, and one that is used in new experiments now underway. The included studies reported 176 poverty‐related outcomes, including one pre‐defined primary outcome: food insecurity. The second primary outcome (poverty level assessed using official, national, or international measures) was not reported in any of the included studies. We classified the reported outcomes into seven categories: food insecurity (as a category), economic/material, physical health, psychological/mental health, social, educational, and individual choice/agency. Food insecurity was reported in two studies, both showing improvements (SMD = −0.57, 95% CI: −0.65 to −0.49, and SMD = −0.41, 95% CI: −0.57 to −0.26) which were not pooled because of different study designs. We conducted meta‐analyses on four secondary outcomes that were reported in more than one study: subjective financial well‐being, self‐rated overall physical health, self‐rated life satisfaction, and self‐rated mental distress. Improvements were reported, except for overall physical health or if the intervention was similar to existing social assistance. The results for the remaining 170 outcomes, each reported in only one study, were summarized in tables by category and subcategory. Adverse effects were reported in some studies, but only for specific subgroups of participants, and not consistently, so these results may have been due to chance. Authors' Conclusions: The results of the included studies were difficult to synthesize because of the heterogeneity in the reported outcomes. This was due in part to poverty being multidimensional, so outcomes covered various aspects of life (economic, social, psychological, educational, agency, mental and physical health). Evidence from future studies would be easier to assess if outcomes were measured using more common, validated instruments. Based on our analysis of the included studies, a supplemental type of GBI (provided along with existing programs) may be effective in alleviating poverty‐related outcomes. This approach may also be safer than a wholesale reform of existing social assistance approaches, which could have unintended consequences. [ABSTRACT FROM AUTHOR]

This paper uses an unprecedentedly rich data set to estimate the cost of agricultural cargo preference (ACP) restrictions on United States food aid programs, and to document some of the programs' competitiveness and national security impacts. ACP cost U.S. taxpayers $140 million in 2006, 46% more than competitive freight costs would have. This roughly equals the cost of non-emergency food aid to Africa. Furthermore, 70% of ACP vessels did not satisfy the criteria that deem them militarily useful, a large share were ultimately owned by foreign corporations, and no ACP vessel crew has been mobilized for national service. [ABSTRACT FROM AUTHOR]

The Supreme Court has ruled that asking for money is a form of protected speech. However, it has also ruled that restrictions on the time, place, and manner of begging are constitutional. This paper examines 71 U.S. cities to determine what factors influence a city's propensity to enact anti-begging regulations. The logistic regression results indicate that cities with higher welfare benefits are less likely to regulate begging. Cities with higher crime rates, higher proportions of disabled citizens, and higher proportions of college-educated citizens, and cities that are more densely populated are more likely to regulate begging.While historians, ethnographers, and legal scholars have studied issues related to begging, economists generally have not. This paper uses the traditional economic model of rational choice to examine why some U.S. cities regulate begging and others do not. [ABSTRACT FROM AUTHOR]

Sixteen percent of children 6–11 years of age were classified as overweight in 1999–2002, four times the percentage in 1965. Although poverty has traditionally been associated with underweight as a result of poor diet, researchers have recently pointed to a paradox in the U.S., which is that low income and obesity can coexist in the same population. This paper first examines whether income is linked to overweight in school-age children. Second, it explores whether food programs such as the Food Stamp Program, the National School Lunch Program, and the School Breakfast Program are associated with overweight among children in different income groups. The data come from the nationally representative 1997 Panel Study of Income Dynamics Child Development Supplement. No evidence either that poor children are more likely to be overweight or that food programs contribute to overweight among poor children was found. © 2005 by the Association for Public Policy Analysis and Management [ABSTRACT FROM AUTHOR]

Prior research suggests that poverty can be detrimental to low-income children's development. Is this relation capturing the effects of poverty or the effects of other characteristics of low-income families associated with poverty? Can low-income children benefit from increases in income? In this paper, an instrumental variables estimation strategy is used with data on nearly 900 children from a random assignment evaluation of a pilot welfare reform program in Minnesota in order to answer these questions and to identify the causal effects of income on children's development. There are some suggestions that increased income improves the development of low-income children, at least with regard to their school engagement and positive social behavior. Results are discussed with regard to their implication for analysis, as well as research and policy. [ABSTRACT FROM AUTHOR]

ABSTRACT. Despite recent progress in reducing poverty, the fight against hunger remains a challenge in the United States. Charities have set up soup kitchens in order to reach out to the poor and hungry. Unfortunately, the way in which some soup kitchens are run is not appealing. One may wonder if waiting in line for a bowl of soup provided out of a van contributes to self-esteem. Beyond hunger, the poor suffer from isolation and a lack of respect from society. It may be worth looking at the experience of other countries that provide hunger relief in a more humane manner. In this paper, we analyze the experience of a soup kitchen in Namur, Belgium, whose cozy atmosphere has led its customers to come as much for socialization as for food. [ABSTRACT FROM AUTHOR]

This paper argues for a social structural understanding of poverty that views poverty rates as a function of local opportunity. The individual-level focus on the allocation of poverty, "who is poor," neglects the processes that create poverty level positions in the social structure. My description of poverty as opportunity defines poverty rates as a function of the industrial structure and the relative power of labor in a locality. Data on poverty rates, industrial structure, and labor markets in South Carolina counties generally confirm the theoretical model. [ABSTRACT FROM AUTHOR]

Official statistics in the United States and the United Kingdom show a rise in poverty between the 1970's and the 1980's but scepticism has been expressed with regard to these findings. In particular, the methods employed in the measurement of poverty have been the subject of criticism. This paper re-examines three basic issues in measuring poverty: the choice of the poverty line, the index of poverty, and the relation between poverty and inequality. One general theme running through the paper is that there is a diversity of judgments which enter the measurement of poverty and that it is necessary to recognize these explicitly in the procedures adopted. There is likely to be disagreement about the choice of poverty line, affecting both its level and its structure. In this situation, we may only be able to make comparisons and not to measure differences, and the comparisons may lead only to a partial rather than a complete ordering. The first section of the paper discusses the stochastic dominance conditions which allow such comparisons, illustrating their application by reference to data for the United States. The choice of poverty measure has been the subject of an extensive literature and a variety of measures have been proposed. In the second section of the paper a different approach is suggested, considering a class of measures satisfying certain general properties and seeking conditions under which all members of the class (which includes many of those proposed) give the same ranking. Those sceptical about measures of poverty often assert that poverty and inequality are being confounded. The third section of the paper distinguishes four different viewpoints and relates them to theories of justice and views of social welfare. [ABSTRACT FROM AUTHOR]

Contemporary immigration to the United States and the formation of new ethnic groups are the complex and unintended social consequences of the expansion of the nation to its post-World War II position of global hegemony. Immigrant communities in the United States today are related to a history of American military, political, economic, and cultural involvement and intervention in the sending countries, especially in Asia and the Caribbean Basin, and to the linkages that are formed in the process that open a variety of legal and illegal migration pathways. The 19.8 million foreign-born persons counted in the 1990 U.S. census formed the largest immigrant population in the world, though in relative terms, only 7.9% of the U.S. population was foreign-born, a lower proportion than earlier in this century. Today's immigrants are extraordinarily diverse, a reflection of polar-opposite types of migrations embedded in very different historical and structural contexts. Also, unlike the expanding economy that absorbed earlier flows from Europe, since the 1970s new immigrants have entered an "hourglass" economy with reduced opportunities for social mobility, particularly among the less educated, and new waves of refugees have entered a welfare state with expanded opportunities for public assistance. This paper seeks to make sense of the new diversify. A typology of contemporary immigrants is presented, and their patterns of settlement, their distinctive social and economic characteristics compared to major native-born racial-ethnic groups, and their different modes of incorporation in - and consequences for - American society are considered. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate associations of Medicaid expansion with health care access for adults with obesity and to explore racial/ethnic differences in these changes in health care access.Methods: Using 2011 to 2017 Behavioral Risk Factor Surveillance System data, the study compared health care access measures among adults who were aged ≥18 years and who had BMI ≥ 30 kg/m2 and household income ≤ 138% of the federal poverty line by state Medicaid expansion status using a difference-in-differences approach with logistic regression. The authors further stratified the main analysis by race/ethnicity.Results: Medicaid expansion was associated with improvements in health care access, including lower proportions of those without a usual source of care (-3.6%, 95% confidence interval [CI]: -5.8% to -1.4%, p < 0.01) and cost as a barrier to medical care (-4.5%, 95% CI: -7.0% to -1.9%, p < 0.01). No significant changes were found in routine medical checkups in the last year (-1.8%, 95% CI: -4.4% to 0.8%, p = 0.12). However, across these measures, Medicaid expansion was consistently associated with better access among non-Hispanic White adults (-6.0% to -7.9%, p < 0.01) and not at all among non-Hispanic Black and Hispanic adults (p > 0.05).Conclusions: Medicaid expansion was associated with significant improvements in health care access among adults with obesity, but these improvements were variable across race and ethnicity. [ABSTRACT FROM AUTHOR]

The article focuses on the differences between relative and absolute measures of poverty as discussed at the International Conference on Measuring Poverty, Income Inequality, and Social Exclusion: Lessons from Europe jointly hosted by the Organisation for Economic Co-operation and Development (OECD) and the University of Maryland. The author systematically compared and contrasted European Union (EU) and U.S. poverty measurement methods and their fundamental differences using the expositional method developed by M. Forster and M. M. d'Ercole. Tables showing European poverty rates by member state using alternative solidarity group medians and state child poverty rates in the U.S. using alternative solidarity group medians are offered.

The article discusses the poverty measurement used by European nations that apply a relative poverty threshold that is 50 or 60 percent of the median income which is higher than the U.S. It notes that the European nations do a better job in reducing poverty compared to the U.S. and its poverty threshold does not increase in real value when the standard of living rises unlike the European model. It cites a 1995 National Research Council report that advises the U.S. to follow Europe by adopting a relative threshold adjusted every year by changes in food spending, clothing and shelter.

The article focuses on the inadequacy of absolute and relative measures of poverty to assess the overall social impact of poverty in the U.S. and Europe as discussed in the conference "Measuring Poverty, Income Inequality, and Social Exclusion: Lessons from Europe," in Paris, France jointly hosted by the Organisation for Economic Cooperation and Development (OECD) and the University of Maryland. The author explores the results of studies presented during the convention including one which assesses the multidimensional nature of poverty by integrating it to the broader concept of social inclusion and another according to household income, wealth and consumption. He concludes that developing multidimensional measures enables policymakers to address a wide range of poverty-related problems.

Objective. This article compares recent levels and trends in economic inequality in industrialized nations, largely those belonging to the Organization for Economic Cooperation and Development. We also examine the effects of government policies and social spending efforts on inequality. Method. We use data from the Luxembourg Income Study and the U.S. Congressional Budget Office to measure disposable money income on an annual basis for 30 nations around the end of the 20th century. We also convert the incomes of a set of rich nations into real 2000 U.S. dollars, using a standard measure of purchasing power parity to examine absolute differences in income inequality. Results. The United States has the highest overall level of inequality of any rich OECD nation at the beginning of the 21st century. Moreover, increases in the dispersion of total household income in the United States have been as large as, or larger than, those experienced elsewhere between 1979 and 2002. Government policies and social spending have lesser effects in the United States than in any other rich nation, and both low spending and low wages have a great impact on the final income distribution, especially among the nonelderly. Conclusion. We speculate on the role policy plays in the final determination of income inequality. We argue that these differences cannot be explained by demography (single parents, immigrants, elders) but are more likely to be attributed to American institutions and lack of spending effort on behalf of low-income working families. [ABSTRACT FROM AUTHOR]

The article discusses changes in poverty rates in the U.S., to analyze the strength of spatial externalities in poverty reduction at the tract level, and to examine how the effect of job growth on poverty reduction is mediated by initial poverty conditions and local social capital in one's own and neighboring areas, using tract-level data. Employment growth was a significant force for poverty reduction, with dramatic differences by initial poverty condition, and the largest effects in the poorest tracts. Other things being equal, the higher the initial poverty rate in a tract, the greater the decline in poverty over the 1990s. Being in a poverty pocket, however, slows the decline. The interaction between social capital and employment growth was not significant. The results suggest that job growth does have a poverty-reducing effect, and that this effect is larger in high-poverty tracts. Social capital appears to be most important in contributing to poverty decline in high-poverty areas. It also enhances the impact of job growth in medium poverty areas.

Policy PointsAn estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID‐19 persisting beyond three weeks.COVID‐19 and its long‐term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination.Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID.Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity. [ABSTRACT FROM AUTHOR]

The effectiveness of public assistance in reducing poverty in the U.S A. is reexamined by estimating the extent of public assistance among all families and of families officially defined in poverty. Also studied is the extent of public assistance among families not defined as in poverty. The findings are further analyzed for their changes during the decade 1970-80. It is found that errors of commission (assisting families not in poverty) and of omission (not assisting families in poverty) were quite widespread in 1980, although significantly reduced from their high prevalence in 1970. [ABSTRACT FROM AUTHOR]

Develops an operational definition of the underclass, highlighting some preliminary estimates of the size and composition of underclass areas and populations using the United States Census data in 1980. Existing literature on the underclass; Characteristics of population living in underclass areas in 1980; Comparison between the underclass and poverty areas.

Examines federal spending on poverty alleviation programs in the United States. Sufficiency of poverty-related transfers in filling the poverty gap; Level of participation in programs; Poverty gap estimates for certain periods.

In this article it is argued that among American families there are certain identifiable groups whose rate of poverty reduction was relatively unresponsive to the general rate of economic growth and progress. These groups were: farm families, families with a head 65 years and over, nonwhite families, and families with a female head. These groups were also labeled "minority" population groups as they comprise the smaller part of a given population category. "Majority" population groups comprised the larger part of a given population category and showed a significantly greater responsiveness to economic growth in their rates of poverty reduction. Because poor "minority" group families appear to be considerably less responsive to economic growth and progress in reducing their level of poverty incidence than are "majority" group families, it was argued that the former constitute a relative "backwash" among which poverty can be expected to become increasingly more concentrated if past relationships are allowed to prevail into the future.

The national economy of the United States is based on the family consumer unit with husband as the economic producer outside the home and woman the "economic administrator" in the home. Our social and economic policies do not provide adequate protection for women. This paper explores the older woman's place in our nation's economy, with special emphasis on the impact of employment levels, pension plans and Social Security benefits. It concludes that preservation of the family as an institution, and quite possibly our national economy, depends on making marriage and divorce more equitable relationships, and on providing greater economic security to the women of our society. [ABSTRACT FROM AUTHOR]

Objective: To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes.Data Sources/study Setting: Combined Department of Veterans Affairs (VA) administrative and Medicare claims data.Study Design: Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006-2010 were matched on period of military service to Veterans with no evidence of homelessness.Principal Findings: Experience of homelessness was associated with 1.37 (95 percent CI = 1.34-1.40) and 0.16 (95 percent CI = 0.14-0.17) more outpatient encounters per quarter in VA and non-VA settings, respectively, and 1.31 (95 percent CI = 1.30-1.32) and 0.49 (95 percent CI = 0.48-0.49) more inpatient days per quarter in VA and non-VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent-98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent-7.9 percent) fewer Medicare outpatient visits.Conclusions: Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services. [ABSTRACT FROM AUTHOR]

Objective: Cigarette smoking and smoking-related diseases disproportionately affect low-income populations. Health insurance coverage of smoking cessation treatments is increasingly used to encourage quitting. We assess the relationship between state Medicaid coverage of smoking cessation treatments and past-year quitting in adult Medicaid beneficiaries.Data Sources: 2009-2014 National Health Interview Survey (NHIS); 2008-2013 indicators of state Medicaid coverage of smoking cessation treatments.Study Design: A triple-differencing specification based on differences in Medicaid cessation coverage policies across states as well as within-state differences between Medicaid beneficiaries and a counterfactual group of low-income adults not covered by Medicaid.Data Collection/extraction Methods: Individual-level NHIS data with restricted geographical identifiers were merged with state-year Medicaid coverage indicators.Principal Findings: Combined coverage of both cessation counseling and medications in state Medicaid programs was associated with increased quitting, with an estimated mean increase in past-year quitting of 3.0 percentage points in covered Medicaid beneficiaries relative to persons without coverage.Conclusions: Combined coverage of both smoking cessation counseling and medication by state Medicaid programs could help reduce cigarette smoking among Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Objective: To evaluate impacts of state Medicaid expansions for low-income parents on the health insurance coverage, pregnancy intention, and use of prenatal care among mothers who became pregnant.Data Sources/study Setting: Person-level data for women with a live birth from the 1997-2012 Pregnancy Risk Assessment Monitoring System.Data Collection/extraction Methods: The sample was restricted to women who were already parents using information on previous live births and combined with information on state Medicaid policies for low-income parents.Study Design: I used a measure of expanded generosity of state Medicaid eligibility for low-income parents to estimate changes in health insurance, pregnancy intention, and prenatal care for pregnant mothers associated with Medicaid expansion.Principal Findings: I found an increase in prepregnancy health insurance coverage and coverage during pregnancy among pregnant mothers, as well as earlier initiation of prenatal care, associated with the expansions. Among pregnant mothers with less education, I found an increase in the adequacy of prenatal care utilization.Conclusions: Expanded Medicaid coverage for low-income adults has the potential to increase a woman's health insurance coverage prior to pregnancy, as well as her insurance coverage and medical care receipt during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality.Data Sources: Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey.Study Design: A cross-sectional study design of nursing homes within U.S. metropolitan areas.Data Collection/extraction Methods: Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau.Principal Findings: Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.Conclusions: Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. [ABSTRACT FROM AUTHOR]

Food insecurity is among the most significant, nutrition-related public health issues facing the United States. Unfortunately, little is known about the determinants of food insecurity except that it is not synonymous with poverty. Many households above the poverty line are food insecure; many below are not. We investigate a lack of financial capability as a potential salient determinant of household-level food security. Using original survey data collected among food pantry clients in North Texas, we assess the impact of financial capacity on food security relying on family background as an exclusion restriction. Our results indicate a strikingly significant effect, both economically and statistically, of financial capability in general and financial behaviors in particular. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty.Data Source: Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011-2015.Study Design: We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes.Principal Findings: Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in high-poverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5 pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove pre-ACA disparities in uninsured rates across these areas.Conclusion: Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished. [ABSTRACT FROM AUTHOR]

Abstract: Background: Interest in social determinants of health (SDOH) has expanded in recent years, driven by a recognition that such factors may influence health outcomes, services use, and health care costs. One subset of SDOH is material needs such as housing and food. We conducted a systematic review of the literature on material needs among emergency department (ED) patients in the United States. Methods: We followed PRISMA guidelines for systematic review methodology. With the assistance of a research librarian, four databases were searched for studies examining material needs among ED patients. Two reviewers independently screened titles, abstracts, and full text to identify eligible articles. Information was abstracted systematically from eligible articles. Results: Forty‐three articles were eligible for inclusion. There was heterogeneity in study methods; single‐center, cross‐sectional studies were most common. Specific material needs examined included homelessness, poverty, housing insecurity, housing quality, food insecurity, unemployment, difficulty paying for health care, and difficulty affording basic expenses. Studies overwhelmingly supported the notion that ED patients have a high prevalence of a number of material needs. Conclusions: Despite some limitations in the individual studies examined in this review, the plurality of prior research confirms that the ED serves a vulnerable population with high rates of material needs. Future research is needed to better understand the role these needs play for ED patients and how to best address them. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health.Data Sources: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases.Study Design: Empirical analyses and structured panel reviews.Methods: Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs).Principal Findings: ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated.Conclusions: The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research. [ABSTRACT FROM AUTHOR]

Objectives: To determine the magnitude and mechanisms of response to Medicare Part D cost sharing by low-income subsidy (LIS) recipients using oral hypoglycemic agents (OHAs) and statins.Data Sources: Medicare data for a 5 percent random sample of beneficiaries with diabetes enrolled in fee-for-service Part D drug plans in 2008.Study Design: We evaluated the impact of differences between generic and brand cost sharing rates among cohorts of LIS and non-LIS recipients to determine if wider price spreads increased the generic dispensing rate (GDR) and reduced total drug use and cost.Principal Findings: We found little association between cost sharing and aggregate OHA and statin use. In adjusted analyses, non-LIS beneficiaries who paid 46 percent of total OHA costs had 2.5 percent fewer OHA days supply than full benefit dual eligibles who paid just 5 percent of their therapy costs. For statins, the difference in days supply between those facing the lowest and highest cost sharing was 4.6 percent. Higher cost sharing was associated with filling fewer but larger prescriptions for both generics and brands.Conclusions: Higher generic and brand copays had little association with OHA and statin use among LIS recipients. This implies that modest changes in required cost sharing for these medicines would have very little substantive impact on generic dispensing or utilization patterns among LIS recipients and thus would have little effect on total program spending. At the same time, any increases in out-of-pocket costs would be expected to shift costs and place greater financial burden on low-income beneficiaries, particularly those in poor health. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.Data Sources: Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.Methods: Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.Principal Findings: A total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications.Conclusions: Race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the work and contribution of economist Mollie Orshansky in determining food expenditures and measuring poverty in the U.S. Orshansky creates the methodology known as Mollie's Measure (MM) which determines the extent of poverty in the country. According to the MM, there are 36.5 million Americans live in poverty and 15.4 million live in extreme poverty. The reliability of MM reflects the pragmatism of the inventor and the political difficulties related to replacing the measure with an alternative.

Objective: To assess the effects on hospitals of early California actions to expand insurance coverage for low-income uninsured adults after passage of the Affordable Care Act.Data Sources/study Setting: Data from the California Office of Statewide Health Planning and Development and the California Department of Health were merged with U.S. census data for 294 short-term general hospitals during the period 2009-2012.Study Design: A difference-in-difference analysis was conducted with hospitals in counties that did not implement insurance expansions used as a comparison group. Variables examined included payer mix, costs of unreimbursed care, and hospital operating margin. Sensitivity analyses were conducted as well as a triple difference analysis. Effects were estimated for hospitals overall and by ownership type.Principal Findings: California insurance expansions primarily benefited for-profit hospitals, with these facilities experiencing significant decreases in self-pay patients, increases in county-covered patients, and reductions in charity care. Most models yielded no significant change in payer mix and conflicting changes in unreimbursed care for nonprofit hospitals.Conclusions: California hospitals that treated the most uninsured prior to insurance expansions did not as a group experience substantial benefit in terms of reduced uninsured burden or better financial performance after program expansions occurred. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of past Medicaid eligibility expansions to parents on coverage, access to care, out-of-pocket (OOP) spending, and mental health outcomes, and consider implications for the Affordable Care Act (ACA) Medicaid expansion.Data Sources: Person-level data from the National Health Interview Survey (1998-2010) is used to measure insurance coverage and related outcomes for low-income parents. Using state identifiers available at the National Center for Health Statistics Research Data Center, we attach state Medicaid eligibility thresholds for parents collected from a variety of sources to NHIS observations.Study Design: We use changes in the Medicaid eligibility threshold for parents within states over time to identify the effects of changes in eligibility on low-income parents.Principal Findings: We find that expanding Medicaid eligibility increases insurance coverage, reduces unmet needs due to cost and OOP spending, and improves mental health status among low-income parents. Moreover, our findings suggest that uninsured populations in states not currently participating in the ACA Medicaid expansion would experience even larger improvements in coverage and related outcomes than those in participating states if they chose to expand eligibility.Conclusions: The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of the Oregon and New Mexico Health Insurance Flexibility and Accountability (HIFA) demonstrations. HIFA is an optional state Medicaid expansion targeted at adults and children with incomes below 200 percent of the federal poverty level (FPL). The study has five research questions: What type of health insurance do HIFA enrollees self report in surveys? What are the demographic characteristics of these enrollees? What type of health insurance coverage, if any, did HIFA enrollees have just prior to enrollment in the HIFA program? Among those with prior coverage, what prompted participation in the HIFA program? What type of health insurance, if any, would HIFA enrollees have in the absence of HIFA?Methods: Data were collected via telephone interviews with a total of 406 enrollees from Oregon and 409 enrollees from New Mexico. The survey was conducted between July 7 and September 20, 2009, for both states. The sample frame for the survey was based on administrative records of adults enrolled in June 2009. After completion of the survey, active enrollment status as of the date the telephone interview was confirmed. Respondents no longer enrolled at the time of the survey (7 cases in NM and 14 in OR) were excluded from the analysis. The final sample size was 794 verified HIFA enrollees.Results: HIFA enrollees tended to be middle-aged, male, and relatively unhealthy. Employment status varied tremendously from the self-employed to retired to unable to work. HIFA enrollees were reasonably well educated with 80 percent having at least a high school education. Most HIFA enrollees (90 percent) reported being uninsured just prior to participation in HIFA. Of those who were uninsured, most reported having been uninsured for an extended time-a year or more. Most enrollees joined HIFA because they lacked access to health insurance or could not afford insurance on the private market. The overwhelming majority (76 percent) of respondents believed that they would be uninsured in the absence of HIFA, with few considering either an employer plan or private purchase to be a viable option. Over 90 percent of enrollees correctly indicated they had insurance coverage. However, characterization of the type of coverage was problematic, particularly in the absence of the program-specific name.Conclusions: HIFA enrolled a relatively sick, male, middle-aged population that tended to have been long-term uninsured--the kind of enrollees for which the programs were designed--with little apparent crowd-out of private insurance. The reported health status coupled with low incomes suggests that individual purchase is unlikely, a sentiment echoed by the respondents. In the absence of HIFA, most enrollees believed they would rejoin the ranks of the uninsured from where they came. [ABSTRACT FROM AUTHOR]

This research evaluates the impacts on poverty rates of government funds for education, health and hospitals, and public welfare allocated to poverty reduction for counties with persistently high poverty in the Southern United States. Our analysis found that increases in education funding in a poverty hot-spot county reduce the poverty rates of that county and its neighbouring hot-spot counties. We also found that higher health and hospital funding in a hot-spot county is associated with higher poverty rates in neighbouring hot-spot counties and that public welfare funding is not effective in mitigating poverty either within or outside of poverty hot-spots. [ABSTRACT FROM AUTHOR]

This study explores the relationship between self-employment and income growth, employment growth, and change in poverty in metro and non-metro areas in the United States using county-level panel data. We investigate the impact of the relative size of the self-employment sector measured by the share of non-farm proprietorships (NFPs) in total full and part-time employment on three key economic performance indicators. We first estimate an income growth model to analyse the effects of self-employment on income growth. Then we investigate the independent effects of self-employment on employment growth and changes in family poverty rates. Our results indicate that higher self-employment rates are associated with statistically significant increases over time in income and employment growth, and reductions in poverty rates in non-metro counties. We find similar effects on metro county income and employment, but not on poverty dynamics. [ABSTRACT FROM AUTHOR]

The article focuses on the natural resources and dynamics of income and wealth inequality in Appalachian Region of the U.S. The Appalachian Regional Commission (ARC) which covers West Virginia and parts of 12 other states, has very high poverty rate. It investigates the reasons and causes of poverty rates in Appalachia with a special focus on the role of coal mining.

Food insecurity is experienced by millions of Americans and has increased dramatically in recent years. Due to its prevalence and many demonstrated negative health consequences, food insecurity is one of the most important nutrition-related public health issues in the U.S. In this article, we address three questions where economic insights and models have made important contributions: What are the determinants of food insecurity?; What are the causal effects of food insecurity on health outcomes?; and What is the impact of food assistance programs on food insecurity? We conclude with a discussion of the policy implications of the answers to these questions and future research opportunities in this research venue. [ABSTRACT FROM AUTHOR]

Concerns over rising college tuition and slow economic growth have brought renewed attention to the role of federal and state financial aid programs in opening access to education. Despite a large body of literature examining the effects of grant aid on four‐year and public two‐year college enrollment, for‐profit colleges—particularly the vast majority that offer two‐year degrees and certificates—have largely been ignored. Using panel data methods and a new administrative data set of for‐profit colleges operating in California between 1989 and 2003, I assess the impact of the federal Pell Grant program, the G.I. Bill, and California's Cal Grant program on the net number of for‐profit colleges per county. The results suggest that for both Pell and Cal Grants, increases in the per‐student maximum award encourage for‐profit entry. This relationship is particularly strong in counties with high adult poverty levels, where more students are eligible for aid. Further, these gains in the private sector do not appear to come at the expense of the public sector. Rather, public community colleges also experience enrollment gains as the generosity of Pell and Cal Grants increases, although this reaction appears to be weaker than the reaction of for‐profits. © 2010 by the Association for Public Policy Analysis and Management. [ABSTRACT FROM AUTHOR]

Because of dramatic levels of economic volatility and massive changes in welfare policies, scholars in this decade worried anew about whether our official poverty measure, adopted in the 1960s, is adequate. Poverty's causes continued to be debated, with demographic factors often pitted against policy and maternal employment changes. Some scholars focused on events that trigger spirals into poverty or poverty exits. The literature on consequences of poverty featured new techniques for identifying underlying processes and mechanisms. Researchers also explored “neighborhood effects” and focused on poverty deconcentration efforts. Finally, scholars produced a voluminous literature on the efforts to reform welfare and their subsequent effects. [ABSTRACT FROM AUTHOR]

The article discusses on the measure used to gauge poverty in the U.S., Europe and other developing countries. It discusses that the present official measure of poverty in the U.S. is flawed and both, the poverty threshold and measurement of available resources should be improved. It reports that European countries provided with sufficient social aid but they face a technical problem of relative poverty threshold. Also mentioned are the levels of economic development in developing and underdeveloped countries.

The article provides information on the effects of poverty measures implemented by the State of Connecticut. The poverty measures recommended by the National Academy of Sciences requires the State to assess the condition of families by measuring all its resources and also considering the taxes and expenses incurred by it. The antipoverty effects likely to change child care, adult education and child support policies are also discussed. The article also discusses the potential difficulties that a state might face in implementing a modern poverty measure and in generating policy alternatives.

The article provides information on the effects of implementation of the poverty measures by the New York City Center for Economic Opportunity to determine poverty in the country. The measures were suggested by the National Academy of Sciences in response to the U.S. state and local government's efforts to start antipoverty measures. The City Center faced obstacles in using the Census Bureau's American Community Survey as its source of data. The result of the survey revealed a high poverty rate. The demographic profile of the poor people generated by the City Center was found to be different from the profile produced by the official measure. The article also discusses the influence of poverty on policymaking in New York City.

We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates race, poverty, and gender disparities in taking advanced courses using 2 statewide data cohorts for public high school students in Florida. The results of the study show higher rates of advanced course-taking among whites, females, and non-poor students, and especially high rates of advanced course-taking for Asian students. It cites that when the pre-high school characteristics of the students are controlled, it substantially reduces poverty gaps, Asian-white gaps, and female-male gaps. Moreover, black and Hispanic students go to high schools that improve their probability of advanced course taking relative to white students.