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Background and Aims: Federal, state and local US governments have sought interventions to reduce deaths due to opioid overdoses by increasing the availability of naloxone. The Affordable Care Act (ACA) expanded Medicaid coverage to low‐income, childless adults, potentially giving this group financial access to naloxone. The aims of this paper are: (1) to describe the changes in the amount of Medicaid‐covered naloxone used between 2009 and 2016 and (2) to quantify the differential change in the amount of dispensed naloxone between states that expanded their Medicaid programs and states that did not. Design A quasi‐experimental approach based on states' ongoing choice to expand their Medicaid program to all adults with incomes between 100 and 138% of the federal poverty line (FPL), starting in 2014. As of 2018, 37 states had expanded and 14 states had not. Estimation of the policy impact relies on a difference‐in‐difference method. Setting: US state Medicaid programs. Participants and measurements: Data are from the Medicaid Drug Rebate Program and include all dispensed prescriptions of naloxone through the Medicaid program. State/quarters with fewer than 10 prescriptions are suppressed; n = 1632. Findings Prior to Medicaid expansion, the number of Medicaid‐covered naloxone prescriptions was very similar in expansion and non‐expansion states. On average, states that expanded Medicaid had 78.2 (95% confidence interval = 16.0–140.3, P = 0.02) more prescriptions per year for naloxone compared with states that did not expand Medicaid coverage, a nearly 10 increase over the pre‐expansion years. Medicaid expansion contributed to this growth in Medicaid‐covered naloxone more than other state‐level naloxone policies. Conclusions: Medicaid accounts for approximately a quarter of naloxone sales. Medicaid expansion generated 8.3% of the growth in naloxone units from 2009 to 2016, holding other factors constant. [ABSTRACT FROM AUTHOR]

Low‐income Latinas/os are exposed to widespread mental health disparities in the United States. Most recently, a resurgence of anti‐immigration narratives has led vulnerable Latina/o immigrants to experience considerable contextual stressors with multiple deleterious consequences for their overall well‐being, including significant disruptions to their parenting practices. Within this context of adversity and despite the multiple benefits associated with parent training (PT) prevention interventions, the availability of contextually and culturally relevant PT interventions remains limited in underserved Latina/o communities. This paper constitutes a contribution to this gap in knowledge by presenting a model of intervention delivery utilized in the dissemination of culturally adapted versions of the evidence‐based intervention known as GenerationPMTO.© The proposed model also describes a process of change that we have documented in empirical research with low‐income Latina/o immigrant parents who have been exposed to the adapted interventions. The manuscript is organized in four sections. First, an overview of the model is discussed, along with a brief summary of major theories. Next, the core components of the model are described, complemented by the presentation of a case study. Finally, implications for prevention and clinical intervention are discussed. [ABSTRACT FROM AUTHOR]

African‐Americans shoulder an excessive burden of unemployment, precarious employment, and low paying jobs in the United States, which may help explain why they experience some of the worst health outcomes among U.S. citizens. This paper presents a conceptual framework describing this phenomenon. The social determinants of health as described by this framework include racism, social and public policy formation, socioeconomic status, and conditions of employment. The intermediate determinants of health, which include the ability to afford health behavior, depression and addiction, environmental exposures, and access to primary care, are informed by conditions of employment, which leads to poor health outcomes for African‐Americans. This paper will explore in detail these relationships. [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]

Aim: This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP).Method: The 2005-2006 and 2009-2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services.Results: After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36-2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97-1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties.Interpretation: Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP.What This Paper Adds: Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children. [ABSTRACT FROM AUTHOR]

Although rural residents often expect resource extraction to lead to local prosperity, much of the recent research finds that resource extraction is associated with poverty. This paper tests these results by examining whether the findings may be due to methodological factors such as the tendency to focus on extreme cases, particular extracting sectors, and certain periods of time. By comparing two localities that have followed very different developmental trajectories--the state of Wisconsin and Hokkaido Prefecture in Japan--during the period from 1970 to 1990, this paper addresses these issues. The results do not clearly support either the expectation that resource extraction will lead to poverty or that it will lead to economic prosperity. Instead, like a handful of studies on resource dependency, the results indicate that the relationship be-tween extraction and poverty is unique to location. Despite the many differences between the United States and Japan, the strongest correlates of poverty in each country involve the proportion of land in an area that is forested. Particularly because these results mirror the findings from the one previous study that included this variable, future research must give greater attention to this explicitly environmental variable, as well as examining some of the possible reasons for the relationship.

Over the past decade, public funding for Couple and Relationship Education programs has expanded. As program administrators have been able to extend their reach to low-income individuals and couples using this support, it has become apparent that greater numbers of relationally distressed couples are attending classes than previously anticipated. Because psychoeducational programs for couples have traditionally served less distressed couples, this dynamic highlights the need to examine the policy and practice implications of more distressed couples accessing these services. This paper reviews some of the most immediate issues, including screening for domestic violence and couple needs, pedagogical considerations, and the potential integration of therapy and education services. We also make suggestions for future research that can inform policy and practice efforts. [ABSTRACT FROM AUTHOR]

In the early 1960s, the US federal government deemed poverty to be a national crisis, and actively intervened to solve this problem. My question for this article is how did preschool education become a key site to remedy this crisis? Government interventions were a combination of poverty research, racialized politics, and child development. I show how the discipline of early childhood education cohered around the term 'disadvantaged child', in turn influencing the War on Poverty policies, including the basis of Head Start preschool education. During this same decade proponents of Sesame Street-with private funding, along with extensive testing mechanisms by consultants-argued that the television could reach more children, therefore be more cost effective. This paper investigates how surplus populations became determined and demarcated, as early as three years old. I question how televised preschool taught 'affective skills' and proper social relations during times of political crisis. [ABSTRACT FROM AUTHOR]

Abstract: The Hill–Burton Act attempted to create a safety net for underprivileged Americans with the idea of “charity care.” This paper explores the efficacy with which eligible hospitals accomplish this goal by calculating a benefit‐to‐cost ratio (BCR) relative to the socio‐demographic characteristics (population density, rate of poverty, and diversity) of the hospital's county. Eight states (CA, FL, GA, MN, MT, RI, TX, and WI) and 893 hospitals were included using data from 2007. A BCR of the dollars of charity care provided versus the dollars of federal tax exemption received was performed and sociodemographic characteristics were compared covariately to examine potential disparities. The study illustrates that for every dollar of exemption, the public received $0.11 of charity care. There is a statistically significant association between a higher percentage of diversity and poverty and a decrease in BCR; county level rates of poverty and diversity are negatively correlated with BCR and only 1 percent of hospitals have a cost‐effective BCR. The investment in the charity care system is providing a very low rate of return and improvements or alternatives on the national scale should be considered. [ABSTRACT FROM AUTHOR]

ABSTRACT Most of the world's health problems afflict poor countries and their poorest inhabitants. There are many reasons why so many people die of poverty-related causes. One reason is that the poor cannot access many of the existing drugs and technologies they need. Another, is that little of the research and development (R&D) done on new drugs and technologies benefits the poor. There are several proposals on the table that might incentivize pharmaceutical companies to extend access to essential drugs and technologies to the global poor.1 Still, the problem remains - the poor are suffering and dying from lack of access to essential medicines. So, it is worth considering a new alternative. This paper suggests rating pharmaceutical and biotechnology companies based on how some of their policies impact poor people's health. It argues that it might be possible to leverage a rating system to encourage companies to extend access to essential drugs and technologies to the poor. [ABSTRACT FROM AUTHOR]

International labour migration is a multidimensional process and primarily a family mechanism intended to reduce vulnerabilities associated with underlying inequalities. However, for immigrants, the break-up of physical contact with family members is an enduring feature of vulnerability in their communication with origins (often in developing countries). On the whole, family relationships are transformed: the absence of physical contact is traded-off with remittances sent home to family members. Remittances create potential for resilience by increasing human development of children, while reducing extreme poverty at the local level. Remittance flows are also an important source of foreign exchange for countries of origin. However, labour markets' polarization, backlash, and economic downturns at destinations (often in developed countries), and governments' moral hazard, currency revaluation, and production inertia at origins recreate vulnerabilities and disrupt the potential build-up of resilience. In fact, the re-creation of vulnerabilities largely outweighs the generation of resilience threads. The paper develops a typology that highlights the dynamic interaction between vulnerabilities and resilience, revealing the multiple aspects of people and remittances flows, the potential for mainstreaming migration policies into economic development, and the scale of the policy task to reduce vulnerabilities associated to international labour migration. [ABSTRACT FROM AUTHOR]

In the USA, several nutrition-related issues confront the normal growth, maturation and development of children and adolescents including obesity and food insecurity. The purpose of this paper is to provide a review of the concept of food insecurity and a summary of studies that have examined the association between food insecurity and overweight/obesity in children and adolescents. Besides the initial case report, we review 21 studies (16 cross-sectional and five prospective studies) that have been published on this topic as of December 2009. As there is limited literature in this area, we review studies that sample children and adolescents in the USA. The results are mixed with positive, negative and null associations. The reasons for the mixed results are difficult to disentangle. Among earlier studies, small samples hampered definitive conclusions. More recent studies with larger samples have overcome these limitations and tend to find no associations between these constructs. Nonetheless, all of the studies to date have shown that food insecurity and overweight co-exist - that is, even though there may not be statistically significant differences in overweight between food-insecure and food-secure children, the prevalence of overweight remains relatively high in food-insecure children. [ABSTRACT FROM AUTHOR]

In the article the authors respond to an article that commented on their paper and attempt to more clearly express their position on the effectiveness of income transfers in combating poverty. The authors explore the impact that the 2008-2009 economic crisis has had on family incomes, unemployment and instances of poverty in the United States. They discuss some of the ways the U.S. government has attempted to alleviate the financial troubles felt by many citizens. They also examine the male-orientated nature of the recession, noting that nearly 75% of all job losses were among men.

This paper has two objectives. First, we examine state adoption and implementation of income support policies under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. We develop a composite measure of income support that includes welfare programs that scholars traditionally investigate and adds optional policies that encourage independence through work. Second, we engage a substantive focus on the administrative ability and willingness of states to adopt and implement sophisticated income support policies. We investigate the extent to which state government professionalism, ideology, economic resources, and racially based policies have shaped state policy. We find that the percentage of the state population is liberal; state racial demographics and governmental professionalism are critical determinants of state welfare and income support regimes. Significantly, we find no evidence that states are converging toward high-quality, effectively financed welfare policies or income regime policies to help the poor move into and economically survive in the job market. [ABSTRACT FROM AUTHOR]

Poverty affects a child's development and educational outcomes beginning in the earliest years of life, both directly and indirectly through mediated, moderated, and transactional processes. School readiness, or the child's ability to use and profit from school, has been recognized as playing a unique role in escape from poverty in the United States and increasingly in developing countries. It is a critical element but needs to be supported by many other components of a poverty-alleviation strategy, such as improved opportunity structures and empowerment of families. The paper reviews evidence from interventions to improve school readiness of children in poverty, both in the United States and in developing countries, and provides recommendations for future research and action. [ABSTRACT FROM AUTHOR]

The article focuses on the issue of attaining a global justice in the U.S. It examines some measures that would close the gap between the state of affairs and better enabling people to meet their basic needs. It explains that global poverty must be one of the most pressing obstacles to realizing global justice. The way in which people are depleting and destroying the global commons is another pressing and related issue. Moreover, the paper also explores how a concern individual can ground a case for more global taxation.

The mass devastation and suffering left in the wake of Hurricane Katrina in the US Gulf Coast brought the intersection of media and community into sharp focus. The news media played a pivotal role in almost every aspect of the disaster and its aftermath, and was harshly criticized for its depiction of minorities and for sensationalizing a human and environmental disaster. The literature suggests that media often represents minorities in a negative light, ultimately reinforcing existing social inequalities. This paper examines the portrayal of minority groups in the media during and after the storm. Data were coded from news media broadcasts to determine the nature of minority representation. Interviews were conducted with individuals from New Orleans who survived the disaster to understand issues related to media trust, the accuracy of media reports and perception of the media's portrayal of minorities. The results indicate that minorities are disproportionately shown in a passive or ‘victim’ role and are rarely shown in positions of expertize. Further, storm survivors indicated a misrepresentation of minorities in media coverage of the disaster, as well as reporting low levels of media trust and accuracy. The broader implications of these findings in relation to media reinforcement of social inequities and media responsibility are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The macroeconomy and social policies can have substantial influences on poverty in the United States. In this paper, I investigate whether these influences differ across metro and nonmetro areas. To do so, using a 16-year panel of state-level data, I estimate state and year fixed effects models separately for metro and nonmetro areas to see if the effects of the macroeconomy and social policies differ between these two areas. These models are estimated using two measures--the poverty rate and the squared poverty gap--and by family type. I find that cyclical forces have a much stronger effect on the poverty rate in nonmetro areas in comparison to metro areas, but the effects are similar for the squared poverty gap; wage growth has a pronounced effect on poverty in metro areas but no effect in nonmetro areas; and state-level social policies have slightly larger effects in nonmetro areas, but the effects are small. [ABSTRACT FROM AUTHOR]

Human capital models assume residential mobility is both voluntary and opportunity-driven. Residential mobility of low income households, however, often does not fit these assumptions. Often characterized by short-distance, high frequency movement, poverty-related mobility may only deepen the social and economic instability that precipitated the movement in the first place. Children may be particularly affected because of disrupted social and academic environments. Among community institutions, schools often experience significant student turnover as a consequence. This paper presents a case study of student transiency and residential instability within an impoverished rural New York school district, examining both enrollment change data and residential histories collected from economically disadvantaged parents of mobile students. It finds that poverty-related mobility is frequently not voluntary but the consequence of precipitating social and economic crises at the household level in combination with the inability to obtain adequate and affordable housing. Hence, poverty-related hypermobility may be interpreted as both a consequence and determinant of rural community disadvantage. [ABSTRACT FROM AUTHOR]

Despite the substantial body of research on the psychological and social effects of racial segregation in schools on African Americans, few studies have considered the possibility that more racially inclusive schools might reduce the risk of extremely negative adult life experiences such as incarceration. Yet such a connection is made plausible by research linking black racial isolation in schools to variables that are often associated with incarceration rates, including concentrated poverty, and low educational and occupational aspirations and attainment. In this paper, we apply methods first developed by labor economists to assess the impact of racial inclusiveness in schools on individual incarceration rates for 5-year cohorts of African Americans and whites born since 1930. We find strong support for the conclusion that blacks educated in states where a higher proportion of their classmates were white experienced significantly lower incarceration rates as adults. Moreover, our analysis suggests that the effects of racial inclusiveness on black incarceration rates have grown stronger over time. These longitudinal effects are consistent with the argument that the educational climate of predominantly black schools has deteriorated in more recent decades. [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]

Recurring efforts to reform welfare over the last twenty years have met with repeated failure. But on the last day of September 1988, the U.S. Congress passed what many proponents claim is a historic change in the nation's approach to dealing with dependent families. The new welfare reform legislation is thought to represent a new consensus for dealing with poverty and dependency among the able-bodied--a consensus that had previously been lacking. This paper reviews the approaches of past reform efforts which failed to unite competing views of the problems and appropriate interventions.

Two trends in the U.S. are absorbing the interest of researchers. One is the increasing proportion of women in the poor population, often termed the feminization of poverty. The other is the increasing proportion of women who have entered the labor force. This paper examines one group in which these two trends meet: women without husbands who head family households. Women who head families, along with their children, are among the poorest groups in the U.S., yet a large proportion of these women are working.

This article presents a paper which addresses the issue of rural poverty, as it has been treated through public policy in the U.S. It begins with a look at some of the causes of rural poverty and the evolution of public policy responses. The rural poor made especially great strides in the 1970's, unlike earlier decades. Primarily as a result of federal income transfer programs, rural poverty has lost much of its harsh personal impact. Nonetheless, the residual hard core of the poor still exist, being too costly and too difficult to reach.

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]

The changing relationship between work and poverty in non- metropolitan (nonmetro) America is documented using data from the 1980 and 1990 March supplements of the Current Population Survey. Specifically, this paper assesses changing differentials in the proportion of poor people who are working; documents the rapid rise in poverty among nonmetro and metropolitan (metro) workers during the 1979- 1989 period, especially among young adults and females; and provides evidence of growing inequality between metro and nonmetro workers, a pattern that cannot be explained by differences in work attachment, human capital, or job characteristics. The results imply that poverty is a persistent if not increasingly harsh reality for workers in rural America. [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]

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]

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]

American policy analysts have assumed that poverty is increasingly concentrating in the inner suburbs of large cities. This study demonstrates that that assumption is inaccurate. Using data on household income and poverty for suburban civil divisions from the 1970, 1980 and 1990 US Censuses, this article calculates values for two indicators of the change in the relative concentration of income and poverty, the coefficient of variation, and a regression of changes on initial values. Results indicate that poverty and income concentrations have not generally increased among suburbs over the last twenty years. There is evidence, however, that poverty has increasingly concentrated within some suburban municipalities of older metropolitan areas in the northeast and midwest. [ABSTRACT FROM AUTHOR]