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The National School Lunch Program (NSLP) is one of the most important food assistance programs in the United States to ensure children's food security and healthy development. Previous studies have offered mixed results and challenges in estimating the effects of program participation. This study assesses NSLP's effect on household food security using data from the Survey of Income and Program Participation (SIPP). SIPP collects information on food security that covers four reference months, including both summer (June, July, August) and nonsummer months. The number of summer months in these four reference months varies by SIPP rotation group. These unique features allow this study to address the potential selection bias in the research of NSLP and food security by examining a seasonal difference in program participation. The analysis found that one more summer month in the reference period increases the difference in low food security rates by about 1.5 percentage points between recipients and nonrecipients eligible for free or reduced-price lunch. Findings have important social work and health policy implications for increasing food security among low-income households with children. [ABSTRACT FROM AUTHOR]

Background: Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. Aim: To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Methods: Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Statistical analyses examined differences in post-acute healthcare utilization, adjusted for pre-stroke utilization, as a function of race (African-American vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver. Results: After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department services during the post-acute care period. These effects were maintained even after further adjustment for acute stroke severity. African-Americans had more home health care visits than Whites among patients who received some home health care. Having a co-residing caregiver was associated with reduced acute hospitalization length of stay and fewer post-acute emergency department and primary care physician visits. Conclusions: Underutilization of healthcare after stroke does not appear to explain poorer long-term stroke outcomes for women and African-Americans in this epidemiologically-derived sample. Caregiver availability may contribute to reduced formal care and cost during the post-acute period. [ABSTRACT FROM AUTHOR]

This study examined the association between household food insecurity (insufficient access to adequate and nutritious food) and trajectories of externalising and internalising behaviour problems in children from kindergarten to fifth grade using longitudinal data from the Early Childhood Longitudinal Study--Kindergarten Cohort (ECLS-K), a nationally representative study in the USA. Household food insecurity was assessed using the eighteen-item standard food security scale, and children's behaviour problems were reported by teachers. Latent growth curve analysis was conducted on 7,348 children in the ECLS-K, separately for boys and girls. Following adjustment for an extensive array of confounding variables, results suggest that food insecurity generally was not associated with developmental change in children's behaviour problems. The impact of food insecurity on behaviour problems may be episodic or interact with certain developmental stages. [ABSTRACT FROM AUTHOR]

Beginning in 2010 the Affordable Care Act (ACA) allowed young adults (ages 19-25) to remain on their parents' private health insurance plans, even if they were not full-time students. This study investigated the impact of the ACA on health insurance coverage for young adults with disabilities, comparing their experience with that of young adults without disabilities and that of a group of older adults (ages 26-34) with disabilities. We analyzed the periods 2006-09 and 2011-14, which were before and after implementation of the dependent coverage provision in the ACA, respectively. Coverage gains for older adults with disabilities were entirely attributable to changes in public insurance. Gains for young adults overall were driven by changes in private insurance. Both young adults with and without disabilities experienced a 4-percentage-point increase in private health insurance coverage between the two time periods, so the gap in private coverage between the two groups did not change significantly over time. Gains in coverage affected perhaps 2.9 million young adults overall and nearly 300,000 young adults with disabilities. [ABSTRACT FROM AUTHOR]

Background: Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people.Methods: A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained.Results: Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year.Conclusions: Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy. [ABSTRACT FROM AUTHOR]

Objectives. Due to increasing interest in the positive experiences associated with family caregiving, potential demographic group differences were examined on the Positive Aspects of Caregiving (PAC) scale at both the item and scale levels. Method. Family caregivers (N = 642) completed the PAC as part of their participation in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) clinical trial. Multiple indicators, multiple causes models were used to examine potential differential item functioning (DIF) across demographic subgroups. Results. Overall PAC scale scores indicated that both Hispanics and African Americans experienced more PAC than Whites. Two items with statistically significant (p < .004) and practically meaningful (odds ratio > 2.0) DIF were found for African American caregivers. After controlling for the underlying unidimensional construct, African Americans reported that caregiving gave them "a more positive attitude toward life" and enabled them to "appreciate life more" than either Whites or Hispanics. No instances of meaningful DIF were found between Hispanics and Whites, women and men, or spouses and nonspouses. Discussion. PAC scores differ significantly by race. In addition, 2 items with meaningful race DIF identify content areas that are particularly relevant to the cultural experiences of African American caregivers. [ABSTRACT FROM AUTHOR]

The article validates the Claims-Based Frailty Index (CFI) in a cohort of older adults to show that the CFI can identify phenotypically-frail individuals and predict outcomes. Topics mentioned include the National Health and Aging Trends Study (NHATS), calculation of hazard ratios or odds ratios for events using Cox proportional hazards models or logistic regression, and the test attributes of the CFI in the NHATS sample.

Objectives. We examined heterogeneous associations between job loss and unmet health care needs by family income level in the recent economic recession. Methods. We conducted logistic regression analyses with the sample from the 2008 Survey of Income and Program Participation (n = 12 658). Dependent variables were 2 dichotomous measures of unmet health care needs in medical and dental services. The primary independent variables were a dummy indicator of job loss during a 2-year period and the family income-to-needs ratio. We used an interaction term between job loss and the family income-to-needs ratio to test the proposed research question. Results. Job loss was significantly associated with the increased risk of unmet health care needs. The proportion with unmet needs was highest for the lowest-income unemployed, but the association between job loss and health hardship was stronger for the middle- and higher-income unemployed. Conclusions. The unemployed experience health hardship differently by income level. A comprehensive coordination of applications for unemployment and health insurance should be considered to protect the unemployed from health hardship. [ABSTRACT FROM AUTHOR]

Using two waves of data from the Child Development Supplement in the Panel Study of Income Dynamics, this study investigates whether parental characteristics (parenting stress, parental warmth, psychological distress, and parent's self-esteem) mediate household food insecurity's relations with child behavior problems. Fixed-effects analyses examine data from a low-income sample of 416 children from 249 households. This study finds that parenting stress mediates the effects of food insecurity on child behavior problems. However, two robustness tests produce different results from those of the fixed-effects models. This inconsistency suggests that household food insecurity's relations to the two types of child behavior problems need to be investigated further with a different methodology and other measures. [ABSTRACT FROM AUTHOR]

In this article, we report statistical properties of two classes of generalized Gini coefficients (G1 and G2). The theoretical results were assessed via Monte Carlo simulations. Further, we used G1 and G2 on life expectancy to measure health inequalities among the provinces of China and the states of the United States. For China, the results indicated that there was statistically significant health inequality by both G1 and G2. However, for the US, the results showed that there was significant health inequality by G1 but no statistical significance was found in health inequality by G2. Overall, from our study, China has higher health inequality than the United States. [ABSTRACT FROM AUTHOR]

The Coordinated Enhanced Observing Period (CEOP) is an international project that was first proposed by the Global Energy and Water Cycle Experiment (GEWEX) in 1997 and was formally launched in 2001. Since that time it has been adopted by the World Climate Research Programme (WCRP), which views it as an essential part of its strategy for developing global datasets to evaluate global climate models, and by the Integrated Global Observing Strategy Partnership (IGOS-P), which views it as the first element of its global water cycle theme. The United States has been an active partner in all phases of CEOP. In particular, the United States has taken the lead in contributing data from a number of reference sites, providing data processing, and archiving capabilities and related research activities through the GEWEX Americas Prediction Project (GAPP). Other U.S. programs and agencies are providing components including model and data assimilation output, satellite data, and other services. The U.S. science community has also been using the CEOP database in model evaluation and phenomenological studies. This article summarizes the U.S. contributions during the first phase of CEOP and outlines opportunities for readers to become involved in the data analysis phase of the project. [ABSTRACT FROM AUTHOR]