Health Policy

Is Biology Destiny: Birth Weight and Life Chances

Is Biology Destiny: Birth Weight and Life Chances
American Sociological Review. 65:458-467,

Conley, D. & Bennett, N.
01/01/2000

Two key questions are addressed regarding the intersection of socioeconomic status, biology, and low birth weight over the life course. First, do the income and other socioeconomic conditions of a mother during her pregnancy affect her chances of having a low-birth-weight infant net of her own birth weight, that of the father, and other family-related, unobserved factors? Second, does an individual's birth weight status affect his or her adult life chances net of socioeconomic status? These questions have implications for the way we conceive of the relationship between socio- economic status and health over the life course, specifically in sorting out causal directionality. We use intergenerational data from the Panel Study of Income Dynamics, for the years 1968 through 1992. Results of sibling comparisons (family- fixed-effects models) demonstrate that maternal income does not appear to have a significant impact on birth weight. However, low birth weight results in lower educational attainment net of other factors. These findings suggest that, when considered across generations, causality may not be as straightforward as implied by cross-sectional or unigenerational longitudinal studies.

Medicare and Drug Coverage: A Women's Health Issue

Medicare and Drug Coverage: A Women's Health Issue
Women's Health Issues. 2000, Volume 10, pages 47-53.

Blustein, J.
01/01/2000

The lack of prescription drug coverage under the Medicare program translates into high out-of-pocket drug costs for seniors. This nationwide study of older Americans with hypertension (''high blood pressure'') demonstrates that women bear the disproportionate burden of this gap in Medicare coverage. Women form the majority of older people with hypertension, and are less likely to have supplemental policies to cover the cost of the prescription drugs that are needed to treat the disease. Moreover, women have substantially lower incomes. Despite their economic vulnerability, older women with hypertension spend substantially more on prescription drugs than men.

Project Report: Population Aging and Longevity in World Cities

Project Report: Population Aging and Longevity in World Cities
Japan Foundation Center for Global Partnership Newsletter, Vol. 26, fall

Rodwin, V.G.
01/01/2000

Improvements in health care and declining birth rates have combined to create rapidly aging populations throughout the industrialized world. By 2020, for example, nearly seventeen percent of the US population is expected to be over the age of sixty-five. In Japan that mark has already been passed, with more than one-quarter of the population expected to be over sixty-five by 2020. At the same time, the world's population is increasingly concentrated in urban areas: the United Nations estimates that by 2025, sixty-one percent of the world's population will live in cities. As both urbanization and population aging increase, we will need models of how to accommodate this population shift and examples to emulate in dealing with these phenomena.

Race and the Inheritance of Low Birth Weight

Race and the Inheritance of Low Birth Weight
Social Biology. 47:77-93,

Conley, D. & Bennett, N.
01/01/2000

This paper uses intergenerational data from the Panel Study of Income Dynamics (PSID) to address the black-white difference in propensities toward low birth weight (LBW). We determine that socioeconomic conditions account for some variation in low birth weight across race. Further, while race differences in the risk of low birth weight cannot be explained entirely, we find that the inheritance of parental birth weight status dramatically reduces the black-white gap in low birth weight. Intergenerational legacies of poor infant health explain the largest share of racial disparities in filial birth weight. We then try to assess whether this intergenerational transmission of low birth weight is indeed genetic by using grandparent-fixed effects models to factor out, to a great extent, family socioeconomic circumstances. We find that even within this framework, both father's and mother's birth weight status have an important impact on filial outcomes. However, the degree of inheritance is weaker for African Americans than for other races. Finally, we theorize that the importance of paternal birth weight status implies a genetic association that does not work through the uterine environment but rather through the fetus itself.

The WINGS Project: Modeling intervention effectiveness for high-risk women

The WINGS Project: Modeling intervention effectiveness for high-risk women
Evaluation & the Health Professions, Vol. 23, No. 2, 123-148

Greenberg, J., Hennessy, M., Celentano, D., Gonzales, V. & Van Devanter, N.
01/01/2000

This study evaluates the effectiveness of two strategies�communication and condom skills training�for increasing condom-protected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (2 difference = 23, df =3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.

Transforming Health Management: An Evidence Based Approach

Transforming Health Management: An Evidence Based Approach
Frontiers of Health Services Management, 16:4, Summer 2000, pp 3-24.

Kovner, A.R., Elton, J.J. & Billings, J.
01/01/2000

Explores the concept of evidence-based management, demonstrates how it can enhance health management practice, and introduces an organizational structure for promoting the evidence-based approach. Challenge of making better-informed strategic decisions; Management research in healthcare; Approaches related to evidence-based management; Evidence-based management decision making; Case vignettes.

Who is Enrolled in For-Profit vs. Nonprofit Medicare HMOs?

Who is Enrolled in For-Profit vs. Nonprofit Medicare HMOs?
Health Affairs. 2000;19:210-220.

Blustein, J., Hoy, E.C.
01/01/2000

We compare the characteristics of enrollees in for-profit and nonprofit Medicare health plans using nationwide data from the 1996 Medicare Current Beneficiary Survey. We find few differences in overall health status, limitations in activities of daily living (ADLs), or history of chronic disease. However, older Americans enrolled in for-profit plans are substantially poorer and less educated than those enrolled in nonprofit plans, are more likely to have joined their plan recently, and are more likely to have joined a plan with the expectation of reducing their out-of-pocket health care costs.

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