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Abstract Background Elderly minority patients are less likely to receive influenza vaccination and colorectal cancer screening than are other patients. Communication between primary care providers (PCPs) and patients may affect service receipt. Methods Encounters between 7 PCPs and 18 elderly patients were observed and audiotaped at 2 community health centers. Three investigators coded transcribed audiotapes and field notes. We used qualitative analysis to identify specific potential barriers to completion of preventive services and to highlight examples of how physicians used patient-centered communication and other facilitation strategies to overcome those barriers. Results Sharing of power and responsibility, the use of empathy, and treating the patient like a person were all important communication strategies which seemed to help address barriers to vaccination and colonoscopy. Other potential facilitators of receipt of influenza vaccine included (1) cultural competence, (2) PCP introduction of the discussion, (3) persistence of the PCP (revisiting the topic throughout the visit), (4) rapport and trust between the patient and PCP, and (5) PCP vaccination of the patient. PCP persistence as well as rapport and trust also appeared to facilitate receipt of colorectal cancer screening. Conclusion Several communications strategies appeared to facilitate PCP communications with older patients to promote acceptance of flu vaccination and colorectal cancer screening. These strategies should be studied with larger samples to determine which are most predictive of compliance with prevention recommendations.

Background: Elderly minority patients are less likely to receive influenza vaccination and colorectal cancer screening than are other patients. Communication between primary care providers (PCPs) and patients may affect service receipt.Methods: Encounters between 7 PCPs and 18 elderly patients were observed and audiotaped at 2 community health centers. Three investigators coded transcribed audiotapes and field notes. We used qualitative analysis to identify specific potential barriers to completion of preventive services and to highlight examples of how physicians used patient-centered communication and other facilitation strategies to overcome those barriers.Results: Sharing of power and responsibility, the use of empathy, and treating the patient like a person were all important communication strategies which seemed to help address barriers to vaccination and colonoscopy. Other potential facilitators of receipt of influenza vaccine included (1) cultural competence, (2) PCP introduction of the discussion, (3) persistence of the PCP (revisiting the topic throughout the visit), (4) rapport and trust between the patient and PCP, and (5) PCP vaccination of the patient. PCP persistence as well as rapport and trust also appeared to facilitate receipt of colorectal cancer screening.Conclusion: Several communications strategies appeared to facilitate PCP communications with older patients to promote acceptance of flu vaccination and colorectal cancer screening. These strategies should be studied with larger samples to determine which are most predictive of compliance with prevention recommendations. [ABSTRACT FROM AUTHOR]

The proportion of U.S. children living in doubled-up households, in which a child lives with a parent plus adult kin or nonkin, has increased in the last 40 years. Although shared living arrangements are often understood as a strategy to cope with crises, no research to date has examined changes in children's living arrangements during the first year of the COVID-19 pandemic. We use the American Community Survey and the Current Population Survey to examine children's doubled-up living arrangements during 2020 and the extent to which children may have experienced "excess" doubling up relative to earlier years. We consider trends by household type (multigenerational, extended with other relatives, and nonrelative households) and differences by demographic characteristics (marital status, race and ethnicity, work status, education, age, and number of coresident children). We find evidence that more than half a million (509,600) children experienced "excess" doubling up in 2020. Greater than expected increases in doubled-up arrangements were driven by increases in multigenerational households, in particular among Black and Hispanic children, young children (under age six), those whose mothers never married, and those whose mothers were not working. Correlates of coresidence remained largely unchanged over time, although having a mother who had never married became a stronger correlate in 2020. Our findings suggest that both economic and instrumental needs likely explained the rise in multigenerational coresidence in 2020., (Copyright © 2023 The Authors.)

A growing literature in family demography examines children's residence in doubled-up (shared) households with extended family members and nonkin. This research has largely overlooked the role of doubling up as a housing strategy, with "hosts" (householders) providing housing support for "guests" living in their home. Yet, understanding children's experiences in doubled-up households requires attention to host/guest status. Using the American Community Survey and Survey of Income and Program Participation, we identify the prevalence of children doubling up as hosts and guests in different household compositions (multigenerational, extended family, nonkin), show how this varies by demographic characteristics, and examine children's patterns of residence across these household types. We find large variation by demographic characteristics. More disadvantaged children have higher rates of doubling up as guests than hosts, whereas more advantaged children have higher rates of doubling up as hosts than guests. Additionally, compared with hosts, guests more often use doubling up as a longer-term strategy; a greater share of guests live consistently doubled up over a three-year period, but those who do transition between household types experience more transitions on average than do hosts. Our findings show the importance of attending to both housing status and household composition when studying children living in doubled-up households., (Copyright © 2021 The Authors.)

As rents have risen and wages have not kept pace, housing affordability in the United States has declined over the last 15 years, impacting the housing and living arrangements of low-income families. Housing subsidies improve the housing situations of low-income families, but less than one in four eligible families receive a voucher. In this article, we analyze whether one of the largest anti-poverty programs in the United States-the Earned Income Tax Credit (EITC)-affects the housing (eviction, homelessness, and affordability) and living arrangements (doubling up, number of people in the household, and crowding) of low-income families. Using the Current Population Survey, the American Community Survey/decennial census, and the Fragile Families and Child Wellbeing Study, we employ a parameterized difference-in-differences strategy to examine whether policy-induced expansions to the EITC affect the housing and living arrangements of single mothers. Results suggest that a $1,000 increase in the EITC improves housing by reducing housing cost burdens, but it has no effect on eviction or homelessness. Increases in the EITC also reduce doubling up (living with additional, nonnuclear family adults)-in particular, doubling up in someone else's home-and reduce three-generation/multigenerational coresidence, suggesting that mothers have a preference to live independently. We find weak evidence for a reduction in overall household size, yet the EITC does reduce household crowding. Although the EITC is not an explicit housing policy, expansions to the EITC are generally linked with improved housing outcomes for single mothers and their children.

Purpose: Studies have found considerable heterogeneity in the links between employment and mental health, finding that certain work conditions, such as nonstandard schedules and low job quality, are linked with poorer mental health. One largely overlooked facet of work is multiple job holding. In this article, we examine the link between multiple job holding and mental health among low-income mothers., Methods: We used data from the Fragile Families and Child Wellbeing Study (n = 7,844 person-wave observations), a longitudinal cohort study (1999-2016) of mostly low-income mothers in 20 large U.S. cities, to examine the link between multiple job holding and maternal depression and life dissatisfaction., Results: Across a number of different model specifications, we find that multiple job holding is associated with higher probabilities of depression (3-4 percentage points higher). We also find some weaker evidence that multiple job holding is associated with life dissatisfaction (2-4 percentage points higher). When we include measures of job quality and intensity, we continue to see an independent association between multiple job holding and mental health. We also find that the associations between multiple job holding and depression/life dissatisfaction are strongest for mothers who also work 45 hours or more per week, work nonstandard schedules, and have lower earnings., Conclusions: Our study suggests that multiple job holding is associated with a greater likelihood of experiencing depression and somewhat associated with greater life dissatisfaction and should be considered by mental health practitioners and researchers seeking to understand drivers of depression., (Copyright © 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Background: Maternal labor force participation has increased dramatically over the last 40 years, yet surprisingly little is known about longitudinal patterns of maternal labor force participation in the years after a birth, or how these patterns vary by education., Objective: We document variation by maternal education in mothers' labor force participation (timing, intensity, non-standard work, multiple job-holding) over the first nine years after the birth of a child., Methods: We use the Fragile Families and Child Wellbeing Study (N~3000) to predict longitudinal labor force participation in a recent longitudinal sample of mothers who gave birth in large US cities between 1998 and 2000. Families were followed until children were age 9, through 2010., Results: Labor force participation gradually increases in the years after birth for mothers with high school or less education, whereas for mothers with some college or more, participation increases between ages 1 and 3 and then remains mostly stable thereafter. Mothers with less than high school education have the highest rates of unemployment (actively seeking work), which remain high compared with all other education groups, whose unemployment declines over time. Compared with all other education groups, mothers with some college have the highest rates of labor force participation, but also high rates of part-time employment, non-standard work, and multiple job-holding., Contribution: Simple conceptualizations of labor force participation do not fully capture the dynamics of labor force attachment for mothers in terms of intensity, timing of entry, and type of work hours, as well as differences by maternal education.

Using longitudinal data from the Fragile Families and Child Wellbeing Study ( N = 4,701; 1998-2010), the authors studied whether the unemployment rate was associated with private financial transfers (PFTs) among urban families with young children and whether family income moderated these associations. They found that an increase in the unemployment rate was associated with greater PFT receipt and that family income moderated the association. Poor and near-poor mothers experienced increases in PFT receipt when unemployment rates were high, whereas mothers with incomes between 2 and 3 times the poverty threshold experienced decreases. Simulations estimating the impact of the Great Recession suggest that moving from 5% to 10% unemployment is associated with a 9-percentage-point increase in the predicted probability of receiving a PFT for the sample as a whole, with greater increases in predicted probabilities among poor and near poor mothers.