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This article assesses the relative importance of several factors believed to reduce the likelihood of health insurance coverage among working Latinos in California, including cost, immigration history, availability of insurance, beliefs about insurance, and beliefs about health and health care. According to a survey of 1,000 randomly selected adults, the most prominent factors contributing to working Latinos' lack of health insurance include low income, absence of or ineligibility for a plan at work, birth outside the United States, and recent immigration. Although the availability of affordable plans plays a predominant role, the importance of potentially inaccurate perceptions of the cost of health insurance and unidentified factors associated with recent immigration may also be important in some segments of the population. Maintenance and redesign of employer-provided or public insurance programs seem essential for increasing health insurance among working Latinos, as may be encouragement of low-cost clinics in some Latino communities.

California's employed Latinos are less likely to have private health insurance than most other segments of the US population and face a variety of other barriers to obtaining health care. To better understand the availability and adequacy of health services for these individuals, researchers analyzed data from a telephone survey of 1,000 randomly-selected, employed adults. Among all survey respondents, a significant percentage obtained their health care from sources fully or partially dependent on government financing. Among the uninsured (30.7 percent of the sample), a majority of those who had a regular source of care received services from publicly-supported providers. Dissatisfaction with care was infrequent (less than 5 percent of the total sample) and apparently no greater among those receiving care from public sources than among those served by private doctors. These findings underscore the importance of the public sector in providing health cave for the underserved, the high quality of the services provided (or partially supported) by the public sector, and the seriousness of the consequences for the disadvantaged should public support for their healthcare diminish. [ABSTRACT FROM AUTHOR]

ABSTRACT Like many college-educated Americans, large numbers of scientists and engineers experienced economic insecurity in the form of unemployment, underemployment, or the fear of either for the first time in the early 1970s. Among 719 scientists and engineers in the San Francisco Bay Area, the economically insecure tended to support unionization of professionals and blame forces outside themselves for individual misfortune more often than the secure. These changes constitute important departures from the traditional individualism of technical professionals, and may signal increased politicization and egalitarianism among the college-educated under the influence of economic stress. [ABSTRACT FROM AUTHOR]

This article focuses on cost containment and initiation of care for cancer in a medicare-eligible population. Providing quality health care to the elderly while containing costs has become a key policy dilemma for the Social Security system. To contain costs, the federal government has often considered encouraging medicare beneficiaries to join Health Maintenance Organizations (HMOs) and requiring them to pay a higher percentage of the charges for their care. Supporters of HMOs argue that these organizations, free from the temptation in fee-for-service settings to provide more services than necessary, deliver care more economically. Investigations in both the United States and Canada indicate that copayment significantly reduces utilization of services, while a broad range of research studies suggests that lack of disposable income and inadequate insurance coverage cause at least some individuals to forego necessary care. These findings raise issues about possible impacts of recent cost-containment proposals on the quality of care received by Medicare beneficiaries with limited resources and progressive, life-threatening illnesses.

Background: The Robert Wood Johnson Foundation requested this utilization-focused evaluation of its Active Living Research (ALR) program. This evaluation reports on the trajectory of influence of past and future ALR outcomes on field-building and policy contributions as well as on possible users of completed and disseminated ALR products., Methods: In 2006 and 2007, key-informant interviews were conducted with 136 representatives of first-line potential users of ALR research products, including state physical activity and nutrition program coordinators, policymakers, scientists, and funders. Literature reviews, bibliometric analyses, and document reviews served to describe the context for ALR's work and the ways it could enhance its utility for field building and policymaking., Results: The contributions of ALR to the emerging transdisciplinary field included leadership in the development of measurement tools, epidemiologic studies, implementation research, the translation of research to practice, and the communication of learned lessons to diverse audiences. ALR's contributions to policy discussions were found across a spectrum of policy-development phases that included describing the problem, raising awareness of alternative strategies for increasing physical activity, convening nontraditional partners, and evaluating policy implementation., Conclusions: Policy-relevant research can make contributions to policymakers' thinking but almost never causes a change by itself. Five years after the original authorization of ALR, there is ample evidence of its recognition as a resource by key players, its field-building influence, and its contributions to policy discussions. All these bear promise for a broader contribution to obesity prevention. Recommendations for increasing ALR's impact on policy and practice are offered.

Widespread consumer suspicion about the quality of managed care indicates that marketers still have work to do Research shows that women identify personal relationships with physicians, medical expertise, speed of access, and comprehensiveness of service as important signs of quality when selecting a managed care plan for their families. Based on existing research findings and new focus group data, this article provides guidelines for promoting an association of quality with managed care, particularly among women.

While several investigators have reported relationships between ethnic background and expression of pain, such relationships are in fact highly problematical. Few studies of pain and ethnicity have used quantitative measures of pain combined with multivariate methods of data analysis. Most have focussed on populations which, unlike many in the United States today, are characterized by highly distinct ethnic groups. The study reported here interviewed 536 persons recently treated for forms of cancer known to cause significant pain. Pain was assessed using standard, well validated instruments, including Graphic Rating Scales anchored in several alternative time-frames and the McGill Pain Questionnaire. The study took place in an area with a low proportion of recent immigrants and only small concentrations of distinct ethnic minorities. No statistically significant relationships were observed between ethnic identity and measures of pain sensation. However, pain described in affective terms according to the McGill Pain Questionnaire did vary among ethnicities. This observation suggests that cultures associated with specific ethnic identities still condition individual expression of pain despite the high degree of assimilation that has occurred among ethnic groups in the United States.