Journal of health & social policy最新文献

Using the National Education Longitudinal Study (NELS) data set from the 1988-1992 period, this study used longitudinal data to assess the effects of student religious commitment on the marijuana, cocaine, and alcohol consumption of those children. The results of this study support the notion that a high level of religious commitment among adolescents reduces their likelihood of consuming marijuana, cocaine, and alcohol. Religiously committed adolescents consumed marijuana, cocaine, and alcohol less frequently and were less likely to be under the influence of marijuana and alcohol at school than their less religious counterparts. There were, however, no differences in the likelihood of religious and less religious twelfth graders to be under the influence of cocaine while at school. The study also indicates that the use of marijuana, cocaine, and alcohol by adolescents was associated with lower levels of academic achievement than those students who did not use these substances.

As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand homeand community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2002) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: (1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental- income payments). This analysis estimates that when compared with Medicaid institutional care in 2002, HCBS waivers produced a national average public expenditure saving of $43,947 per participant. doi:10.1300/J045v22n02_03.

Nationwide, grandparents raising grandchildren is a growing phenomenon. In the District of Columbia, 19% of children under age 18 live in kincare-headed households. This compares to 8% nationally. This article reports on findings from an AARP focus group study of 40 grandparents raising grandchildren in the District of Columbia. It tells the stories of individuals who have traveled different pathways to arrive at their common destiny of being a grandparent caregiver. It primarily uses the voices of African American grandmothers and grandfathers to address the resources and challenges they face as they care for and care about their grandchildren. Through hearing their stories, AARP crafted nine recommendations aimed at improving the quality of life of District of Columbia grandparents raising grandchildren. The article reports on recommendations emerging from the research and reinforces the need for collaboration among various stakeholders to address the fragmented service delivery system. doi:10.1300/J045v22n03_13.

This study reports the outcomes associated with the use of formal respite care services among a sample of kinship, foster and adoptive caregivers of special needs children involved in the child welfare system. It uses pre-post survey research data collection methods to evaluate changes in caregivers' ratings of their quality of life, health, stress, support, objective and subjective burden, stress, and family relations. Caregivers reported reduced stress, improved quality of life, and significantly decreased feelings of objective burden as a result of respite. Suggestions for improving and evaluating respite care outcomes are provided. doi:10.1300/J045v22n03_06.

As technological advances in the United States continue to improve the effectiveness of medical interventions, expectations among Americans of both improved health and extended life expectancy have also increased. At the same time, many of the population continue to lack the insurance necessary to access even the most basic healthcare services (Institute of Medicine, 2004; Tunzi, 2004; Saha & Bindman, 2001). With approximately 18,000 avoidable deaths attributed annually to inadequate medical coverage and 43.6 million individuals currently without insurance benefits, the need to address the disparity in access to treatment and a means of social justice in the distribution of health care is all too clear (Crispen & Whalen, 2004). As a nation relying on market mechanisms to regulate the costs and quality of available health resources (Baldor, 2003; Saha&Bindman, 2001), the welfare of society as a whole may soon be threatened by the provision of marginal services to a select minority as increasing numbers of the uninsured continue to experience less favorable clinical outcomes and higher mortality rates (Tunzi, 2004; Litaker & Cebul, 2003; Jackson, 2001; Sox, Burstin, Edwards, O'Neil et al., 1998). The author will first examine the consequences of being among the growing number of uninsured individuals in the United States. Attention will then be given to exploring the social justice issues inherent in this critical problem and evaluating these issues through the perspective of both libertarian and feminist theory. Using these theories, innovative strategies for attaining distributive justice in the provision of health care will be offered with recommendations for utilizing these alternative approaches to develop and implement future health policy.

Kinship caregivers view spirituality and religion as integral and holistic in nature and an essential coping component to their survival as caregivers. This article examines the following eight spirituality and religious themes defined by a group of African American caregivers of children: spirituality and destiny; spirituality and drugs; faith and healing; spirituality and negotiation; surviving through faith; spirituality, religion, and community; religion; worship and the child; and the need for respite through worshiping and self-care. Historical and social aspects regarding the role of spirituality and religion within the African American community are discussed. Qualitative data from a focus group of 19 low income African American kinship caregivers aged 40-70 years are used to present spiritual and religious clinical tools, techniques, and concepts for intervening with kinship caregivers. doi:10.1300/J045v22n03_07.

The passage of the Personal Responsibility Work Opportunities Reconciliation Act (PRWORA) in 1996 changed the way America sought to help its most vulnerable citizens. The Temporary Assistance for Needy Families (TANF) legislation required families to work first. Many families with young children found the stringent requirements of TANF too restrictive for their needs. In this study a number of TANF customers were either physically ill or suffered mental health problems thus preventing them from finding suitable employment. Additionally they may have children who have health problems, which preclude the parent from work activity. Faced with time limits these families may rely on relatives or fictive kin to assume the responsibility of receiving TANF grants for the children so that they may avoid sanctions and possible loss of support for their children. These arrangements are called child-only cases. Given that poverty is related to neglect and neglect may result in out of home placement, these children are at risk for child welfare intervention. Child welfare systems look to kin to assume the responsibility of child rearing to reduce the number of children especially African American children who enter care. However, TANF and informal arrangements for kin to take care of children result in substantially less money for families. An evaluation of TANF is needed to determine if this legislation provides an adequate system for caring for needy families and children. doi:10.1300/J045v22n03_04.

This study used a framework of strategic behavior to further explore MCOs' physician contractual decision making. Using data from a cross-sectional mail survey of 1,215 physicians, we tested the assumption that a physician's patient profile is related to higher rates of contract denial or termination when adjusted and unadjusted for the level of managed care market competition. As minority physicians serve more minority patients who tend to have a poorer health status than white patients, we expected greater rates of contract denials and terminations for minority physicians when models are unadjusted for the level of market competition. In models adjusted for competition, we expected physician and patient race to be unrelated to MCO contractual decisions. We found physician ethnicity was not a predictor for contract denials or terminations, but patient ethnicity was a predictor for contract denials and terminations. When market competition is accounted for, the differences were almost unchanged.

This paper focuses on how potential race related salary inequity and racial discrimination patterns can be measured in health care organizations. Incorporating ethical principals to the measurement strategy helps conceptualize potential patterns of salary inequity. Convergent validity assessment through triangulation method allows for the measurement of parallelism, correspondence, and the affirmation of major findings. The most important benefit of the suggested strategies is the ability to assess and identify how discrimination may be occurring in organizations.

Although research suggests numerous interventions that can improve immunization coverage (Taskforce on Community Preventive Services, 2000), there is often a gap between policies supported by and public entities. The question for this study is whether the variation in childhood (19 to 35 months) immunization coverage rates across states is related to significant variations in state regulatory regimes that may optimize the benefits of state registries and systems that are designed to improve assessment of immunization practices. Utilizing 2002 data from the CDC and survey data collected from state immunization program officials, we find that financial support for state immunization programs, opt-out state registries, and state-mandated participation in provider quality improvement and assessment programs have positive associations with statewide coverage rates. We also suggest that more active state governmental support for interventions supported by rigorous scientific evaluation will not only improve early childhood immunization coverage, but may also support other public health objectives such as life-time full immunization and improve bioterrorism response planning.