Impact of Housing Instability and Social Risk Factors on Food Insecurity Among Vulnerable Residents in San Diego County.

To analyze the impact of housing instability and social risk facts on food insecurity using resource center client information. We utilized 2-1-1 San Diego's client database to analyze the association of food insecurity and housing instability among residents from August 2017 to March 2020. 3468 clients had food or housing needs assessed by a risk rating scale. A multiple logistic regression model analyzed the associations between food insecurity and social risk factors including housing, transportation, utility bills, criminal justice, and medical debt. Multiple logistic regression indicates that those with housing instability encounter significantly greater risk of food insecurity (AOR 1.2) for homeless-sheltered, (AOR 2.1) for homeless-unsheltered. Also, utility needs (AOR 1.2) is significantly associated with food insecurity. However, those with medical debt are 48% less likely to have food insecurity. Approximately 77% of clients experienced food insecurity. Those with food insecurity also experienced higher needs in housing and other social risk factors. By further researching the association of food insecurity, housing instability, and other social needs in a population, we can better inform public health strategies that focus on proactive community and resource planning.

Dental Service Utilization Among Children in the Child Welfare System.

OBJECTIVE: To examine predisposing, enabling, and need-related factors associated with dental utilization by children involved with the child welfare system (CWS). METHODS: Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW; Wave II), a national probability sample of children (2-17 years) following a welfare assessment during 2008-2009 (n = 2806). Caregiver-reported child receipt of dental services in the past year was the outcome in weighted logistic regression models. RESULTS: Two-thirds of children had a recent dental visit. Older children (OR 2.95, 95% CI 2.06,4.21 for ages 6-11; OR 2.47, CI 1.82, 3.37 for ages 12-17, compared to ages 2-5) were more likely to have visited the dentist, as were children of more educated caregivers (OR 1.68; CI 1.20, 2.36 for high school, OR 2.45; CI 1.71, 3.52 for more than high school). Children without a usual source of care (OR 0.50; CI 0.27, 0.94) and those living with non-biological parents had lower odds of a recent visit (OR 0.64; CI 0.43, 0.97). Children with dental problems were twice as likely to have a recent visit (OR 2.02; CI 1.21, 3.38), while children with unmet needs who could not afford care had lower odds of utilizing services (OR 0.28; CI 0.16, 0.46). CONCLUSIONS FOR PRACTICE: Many children in the CWS, especially younger children (ages 2-5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care.

Disparities between asthma management and insurance type among children.

Asthma is a chronic illness among children. Minority children may be vulnerable to asthma complications since more than half are from households that are poor or near poor, and some have no health insurance. Asthma management plans are important for the long-term treatment of asthma and beneficial for self-management. This study analyzed insurance type and the relationship between having an asthma management plan among children across all races with asthma. This study utilized the 2002 and 2003 National Health Interview Survey. Findings showed that whites were significantly more likely than Non-Hispanic blacks and Hispanics to have an asthma management plan (OR, 1.66; p = .0031). In this study, children who reported Children's Health insurance Program (CHIP) coverage were twice as likely to have an asthma management plan (OR, 2.67; p = .0004). Mandating all insurers to provide an asthma management plan to children with asthma may reduce the race-based inequities and differences in asthma management plan status.

Racial influences associated with asthma management among children in the United States.

OBJECTIVE: To examine the influence of race and having an asthma management plan on the impact of experiencing asthmatic episodes. METHODS: This study utilized the 2002 and 2003 National Health Interview Survey to conduct a retrospective study and secondary data analysis. Univariate, bivariate, and multivariate analysis was performed to examine physician asthma management plan recommendations among minority and non-minority children in the United States. RESULTS: Most of the study participants (59%) reported not having an asthma management plan. Children who experienced an asthma episode in the past 12 months were less likely to have an asthma management plan (OR .51, P<.0001). In the multivariate analysis, Whites were significantly more likely than were Blacks and Hispanics to have an asthma management plan (OR 1.66, P=.0031). CONCLUSIONS: Findings from this study indicate that Black and Hispanic children with asthma are less likely to have an asthma management plan, and children with an asthma management plan are less likely to have had asthma episodes in the past 12 months. Requiring all insurers to provide an asthma management plan to children with asthma may reduce these race-based inequities.

Utilization and Cost Analysis of a Chronically Ill, Newly Insured Indigent Population.

The Affordable Care Act expanded health insurance for low-income, uninsured individuals. Few longitudinal analyses have investigated how insurance expansion influences cost and utilization among adults with chronic conditions. This study conducted longitudinal analysis investigating time trends in utilization and cost among newly insured, chronically ill, low-income individuals using Generalized Estimating Equations models. For hospitalization, hospital outpatient services, emergency department (ED) visits, and primary care visits, two indicators were measured: the proportion of enrollees with services and the average number of visits among users. The average health expenditure per person was estimated using a gamma distribution. Results indicate that the number of individuals using inpatient or ED services was highest during the first six months following insurance coverage and decreased in subsequent periods, while primary care visits increased during the first year. Using six-month rather than annual measures of utilization and cost may be necessary to identify short-run changes following initial insurance coverage.

Physician-targeted financial incentives and primary care physicians' self-reported ability to provide high-quality primary care.

OBJECTIVE: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care-driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs' ability to provide high-quality care. METHODS: Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs' self-reported ability to provide quality care. RESULTS: After adjusting for patient-centered medical home (PCMH)-consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs' ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment. CONCLUSION: Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care-driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care.

The relationship between workplace environment and job satisfaction among nursing assistants: findings from a national survey.

OBJECTIVES: To identify supervisory factors related to job satisfaction among certified nursing assistants (CNAs). Although this topic has been studied at the facility and state levels, it has not previously been addressed in a nationally representative sample. DESIGN: Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey, conducted by the National Center for Health Statistics. SETTING: Nationally representative sample of nursing homes (n = 790). PARTICIPANTS: Eight randomly selected CNAs from each nursing home, 4 who had been at that job for less than 1 year and 4 at the job for a year or more (n = 3011). Analysis was limited to 2897 individuals working at the same facility when interviewed. MEASURES: Job satisfaction was measured by a 6-item score addressing workplace morale, challenging work, benefits, salary or wages, learning new skills, and overall satisfaction. Characteristics of the work environment included supervisor behavior, time pressures, organizational climate, perception that the CNA's work was valued, and whether the CNA principally cared for the same residents. RESULTS: In adjusted analysis, organizational climate, supervisor behavior, sufficient time for tasks, and being valued were positively associated with job satisfaction, as were hourly earnings. CONCLUSIONS: Clear communication from supervisors and evidence that the CNA function is valued were associated with job satisfaction. Specific strategies, such as merit raises and job design, may increase job satisfaction.

Disparities in access to care among asthmatic children in relation to race and socioeconomic status.

Asthma is one of the leading chronic illnesses among children in the United States. International epidemiological studies have also shown asthma prevalence is an increasing problem. The objective of this study was to examine the correlates of access to care among asthmatic children age 0-17 in the United States. This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses were performed to examine health care utilization among children with asthma in the United States. It was found that Black children were highly associated with not visiting a general doctor in the past 12 months (OR 0.47; 95% CI 0.30, 0.75). Uninsured asthmatic children were associated with the risk of not seeing a general doctor in the past 12 months (OR 0.40; 95% CI 0.23, 0.69). Our study findings indicate disparities among Black children with asthma and their ability to access appropriate health care services. Additional studies are required to identify factors that contribute to the temporal trends in asthma and country of origin.

Characteristics and recruitment paths of certified nursing assistants in rural and urban nursing homes.

CONTEXT: Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs. PURPOSE: To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job. METHODS: Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative survey of 3,017 CNAs; analysis was restricted to 2,897 currently working CNAs. Location was categorized as metropolitan, micropolitan, or neither (other rural county). Demographics included age, sex, race, education, income, and years at present job. Analyses were weighted to reflect the complex sampling design. FINDINGS: CNAs in micropolitan and other rural nursing homes were more likely to be white and US citizens than were urban CNAs. Rural or micropolitan CNAs were more likely to note "job close to home" as a reason for becoming a CNA than were urban CNAs (70.8%, 66.3%, and 43.6%, respectively; P < .001). Over half of CNAs (52.2%) entered the field from a different job category. CNAs in micropolitan and small rural counties were more likely than urban CNAs to report being trained at a nursing facility (61.4%, 65.4%, 52.5%; P < .001) rather than community college or other site. Informal means (family and friends) were the most common recruitment path. CONCLUSIONS: Career-changers (individuals entering the CNA role from another job) represent a major recruitment target. The prevalence of informal networks in CNA recruitment history suggests that nursing homes seeking to become "employers of choice" will be advantaged when recruiting.