Abstracts

"Reducing Nursing Home Use Through Consumer-Directed Personal Care Services." Medical Care, August 2006, Stacy B. Dale and Randall Brown. This study tested whether consumer direction of personal care services under the Arkansas Cash and Counseling Demonstration reduced nursing home use and expenditures, compared with traditional Medicaid agency services, and how it affected total Medicaid costs. The authors found that nursing facility use was 18 percent lower for the treatment group than the control group for the three-year follow-up period. Although personal care costs were substantially higher for the treatment group than for controls, the savings in long-term care costs fully offset the higher personal care costs in the second and third years among consumers who were receiving personal care at the time they enrolled in the study. Reprints available while supply lasts; call 609-275-2350.

"Advancing the Use of Scientifically Based Research in Forming Policy: A Response to Mahoney and Zigler." Journal of Applied Developmental Psychology, vol. 27, issue 4, July/August 2006, Mark Dynarski. Reviews the tenets of the scientific process as they relate to using evaluation research to inform the policymaking process. Based on recent experiences with the 21st Century Community Learning Centers program, the author notes that federal budget and appropriations decisions have considered scientifically based evidence, as well as opinions about that evidence, to allocate finite resources and demonstrate public accountability, but developing a better conceptual and empirical understanding of how research findings can inform budget decisions is a worthwhile topic for further study.

"Mother-Child Bookreading in Low-Income Families: Correlates and Outcomes During the First Three Years of Life." Child Development, July/August 2006, Helen Raikes, Gayle Luze, Jeanne Brooks-Gunn, H. Abigail Raikes, Barbara Alexander Pan, Catherine S. Tamis-LeMonda, Jill Constantine, Louisa Banks Tarullo, and Eileen T. Rodriguez. Although reading to preschoolers has been shown to influence their later language and cognitive development, few studies have examined these relationships for children under age 3. Researchers studied over 2,500 low-income English- and Spanish-speaking families across the country who were participating in the Early Head Start evaluation. About half of the mothers reported reading daily to their children, and frequency was higher among white mothers than other ethnic groups, as well as among mothers of girls, firstborn children, and children in the Early Head Start program. English-speaking mothers who read to their children at a very early age had 2-year-olds with greater language comprehension; larger, more expressive vocabularies; and higher cognitive scores. Spanish-speaking mothers who read to very young children every day had 3-year-olds with greater language and cognitive development. The researchers note that language-oriented interventions for vulnerable children should begin earlier than has been generally proposed.

“Disease Management: Promising, But Not Yet Proven.” Expert Review of Pharmacoeconomics & Outcomes Research, June 2006, Debbie Peikes. Some studies have shown that people with chronic health conditions may experience fewer hospitalizations and have better quality of life if they receive medical care consistent with recommended standards; adhere to medication, diet, exercise, and self-care regimens; have access to transportation and social support services; and experience better communication among their health care providers. These findings have led to the development of disease management programs to help change patient and provider behavior, with the goal of saving money and improving patient quality of life. This article notes that implementation of disease management has outpaced evidence proving its worth, but that new evidence from a number of rigorous demonstration projects for Medicare beneficiaries will become available over the coming year. Early results provide some evidence that disease management may improve the quality of care but show limited effects on a patient’s diet, exercise, and adherence to medication. Furthermore, disease management programs vary widely in quality and scope, as well as in the diseases they target. The author recommends waiting for more evidence before wholesale adoption of disease management. Reprints available while supply lasts; call 609-275-2350.

“Gender Differences in Adolescents’ Attitudes About IT Careers.” Encyclopedia of Gender and Information Technology, June 2006, Martha M. Bleeker. Though the popularity of technology continues to flourish and drive the American economy, recent studies suggest that the revolution may be leaving females behind, with the number of U.S. women earning computer science degrees plummeting over the past two decades. This article analyzes gender differences in adolescents’ attitudes about IT careers—computer scientist, computer systems analyst, database administrator, webmaster, web developer/designer, computer support services, and computer teacher. The author found that regardless of gender, interest in the IT jobs included in the study was very low, with boys reporting higher interest than girls. Overall, girls were most interested in web development. Boys reported higher expectations for success than girls for all of the careers, with the sole exception of web development.

"Obesity Among U.S. Urban Preschool Children: Relationships to Race, Ethnicity, and Socioeconomic Status." Archives of Pediatric and Adolescent Medicine, vol. 160, no. 6, June 2006, Robert C. Whitaker and Sean Orzol. In the United States, a disparity among racial/ethnic groups in the prevalence of obesity is one of the great concerns and enigmas in the obesity epidemic. This article seeks to determine whether there are racial/ethnic differences in the prevalence of obesity among preschool children and determine whether these differences are explained by socioeconomic factors. Using data Mathematica collected for the Fragile Families and Child Well-Being Study in 20 large U.S. cities, the researchers found that the prevalence of obesity was 25.8 percent among Hispanics, 16.2 percent among blacks, and 14.8 percent among whites. The high prevalence of obesity among Hispanics relative to blacks or whites was not explained by racial/ethnic differences in maternal education, household income, or food security.

"The Early Head Start Father Studies: Design, Data Collection, and Summary of Father Presence in the Lives of Infants and Toddlers.” Parenting: Science and Practice, April-September 2006, vol. 6, no. 2 and 3, Kimberly Boller, Robert Bradley, Natasha Cabrera, Helen Raikes, Barbara Pan, Jeffrey Shears, and Lori Roggman. This introduction provides an overview of the research and policy context for the Early Head Start Father Studies, which began in 1997. The studies addressed key questions about low-income fathers and their children (all under 3 years old), using a variety of data collection approaches. The article describes methods and response rates, father demographics, and father-child relationship status. Reprints available while supply lasts; call 609-275-2350.

“The Meaning of ‘Good Fatherhood’: Low-Income Fathers’ Social Constructions of Their Roles.” Parenting: Science and Practice, April-September 2006, vol. 6, no. 2 and 3, Jean Ann Summers, Kimberly Boller, Rachel F. Schiffman, and Helen H. Raikes. To gain a better understanding of how low-income fathers of young children think about their role, researchers asked fathers of 24-month-old children what “good fatherhood” means to them. Fathers identified four broad responsibilities: (1) providing a stable environment, (2) teaching their children, (3) fostering physical interaction, and (4) giving emotional support. Overall, fathers articulated a strong sense of commitment and intentionality in their plans for interactions with their children. The findings provide opportunities for service providers and policymakers to develop strategies to support fathers’ abilities to carry out their intentions. Reprints available while supply lasts; call 609-275-2350.

“Relation Between Father Connectedness and Child Outcomes.” Parenting: Science and Practice, April-September 2006, vol. 6, no. 2 and 3, Cheri A. Vogel, Robert H. Bradley, Helen Raikes, Kimberly Boller, and Jeffrey Shears. This article examines the relation between low-income fathers’ presence in their children’s lives and children’s early developmental outcomes. Children with resident or involved nonresident biological fathers showed higher levels of self-regulation and lower levels of aggression than children with unstable father connections. Children with involved nonresident biological fathers were better off than children who had transient relationships with their fathers. However, relations appear to differ by race and ethnicity, with the most straightforward relations for European Americans and Latin Americans. Reprints available while supply lasts; call 609-275-2350.

“Two Studies of Father Involvement in Early Head Start Programs: A National Survey and a Demonstration Program Evaluation.” Parenting: Science and Practice, April-September 2006, vol. 6, no. 2 and 3, Helen Raikes and Jeanne Bellotti. Using data from a population survey of 261 Early Head Start programs and a father involvement demonstration of 21 programs, the authors examine the extent to which fathers participate in Early Head Start intervention programs for infants and toddlers. Fathers were present in the lives of a majority of Early Head Start children--70 percent in the national study and 76 percent in the demonstration study. Fifty-nine percent of resident fathers and 30 percent of nonresident fathers reported participating in the Early Head Start program. Nearly a quarter of the fathers had high levels of participation (attended three or more events a month). Reprints available while supply lasts; call 609-275-2350.

“Maternal Feeding Style During Infancy and Children’s Adiposity at 5 Years of Age.” Archives of Pediatrics and Adolescent Medicine, May 2006, Hillary L. Burdette, Robert C. Whitaker, Waynitra C. Hall, and Stephen R. Daniels. This article examines the relationship between maternal infant-feeding style and adiposity in childhood to determine whether feeding style explains any of the association between maternal obesity and childhood obesity. Researchers found little relationship between maternal feeding style during infancy—for example, awareness of infant’s hunger and satiety cues, feeding on a schedule, and using food to calm infant’s fussiness—and fatness at age 5. They also found that mothers who were more concerned about their infants overeating or eventually being overweight were more likely to have fatter children by age 5. They suggest that inquiring during infancy about these concerns opens the window to early, constructive dialogue with parents about obesity prevention.

“Maternal Mental Health, Substance Abuse, and Domestic Violence in the Year after Delivery and Subsequent Behavior Problems in Children at Age 3 Years.” Archives of General Psychiatry, May 2006, Robert C. Whitaker, Sean M. Orzol, and Robert S. Kahn. By 3 years of age, children are at significantly higher risk for behavior problems if their mothers experience mental health problems, substance use, or domestic violence in the year after delivery. These maternal conditions often occur together, and as the number of maternal conditions increases, so does the risk of children’s behavior problems. This article takes the first-ever look at the cumulative effects of these maternal conditions on behavior problems in young children. Reprints available while supply lasts; call 609-275-2350.

"National Estimates of Mental Health Insurance Benefits." Journal of Behavioral Health Services & Research, May 2006, Myles Maxfield, Lori Achman, Jeffrey Buck, and Judith Teich. This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, the extent of their coverage, and the proportion enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Over three-quarters (76 percent) had mental health benefits as part of their health insurance. Approximately 18 percent had no such benefits; for the remaining 6 percent, mental health benefits could not be determined. Of the 18 percent with no mental health benefits, 84 percent also had no health insurance; the remainder (16 percent) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that for 44 percent of the population, benefits included prescription drugs as well as at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12 percent of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42 percent of the U.S. population. Reprints available while supply lasts; call 609-275-2350.

"Charge of the Right Brigade? Communities, Coverage, and Care for the Uninsured." Health Affairs Web Exclusive, April 2006, Lawrence D. Brown and Beth Stevens. Local communities tend to find it easier to expand care than to extend coverage. To study this issue, the Robert Wood Johnson Foundation funded projects in 14 communities to expand health coverage and improve care for their uninsured residents. This study of seven Communities in Charge sites suggests that, despite solid community leadership and carefully crafted plans, coverage expansions were constrained by political, economic, and organizational obstacles. Redistribution of financial and organizational resources among both mainstream and safety-net institutions in these communities was hard to achieve. The findings suggest that communities are no better equipped than other sectors of U.S. society to solve the problems of uninsurance.

“Community Approaches to Providing Care for the Uninsured.” Health Affairs Web Exclusive, April 2006, Erin Fries Taylor, Peter Cunningham, and Kelly McKenzie. Faced with rising uninsurance rates and little response at state or federal levels in recent years, communities have developed many different types of strategies to provide care for uninsured persons. This article profiles local strategies in the Community Tracking Study sites, focusing on efforts that go beyond traditional safety net access. The findings suggest that more recent community efforts, which tend to be privately sponsored, are relatively modest in scope compared to more mature programs with public financing. While local strategies can fill some holes, communities often do not have the necessary resources to fully address the problem.

"Who Enrolls in Community-Based Programs for the Uninsured and Why Do They Stay?" Health Affairs Web Exclusive, April 2006, Erin Fries Taylor, Catherine McLaughlin, Anne Warren, and Paula Song. Faced with growing numbers of uninsured, many communities are developing local programs to provide coverage or improved access. While some would predict that only those with health problems would participate, little is known about who enrolls. This article examines participation and retention in three community programs aimed at low-income uninsured adults. In two of the three programs, the typical participant had no health problems. Improved access to preventive and routine physician care, and increased security about accessing care should the need arise, appeared to be the primary benefits of both initial and continued enrollment.

“Neighborhood Safety, Collective Efficacy, and Obesity in Women with Young Children.” Obesity, March 2006, Hillary L. Burdette, Thomas A. Wadden, and Robert C. Whitaker. The characteristics of neighborhoods can influence how and where people spend their time, and unsafe neighborhoods are often thought to contribute to the obesity epidemic by decreasing outdoor activity. Despite a hypothesized link between neighborhood safety and obesity, this was the first study to evaluate this association among adults. Using data collected in 20 large U.S. cities for the Fragile Families and Child Wellbeing Study, researchers found that mothers who perceived their neighborhoods to be safer had a lower body mass index and were less likely to be obese, even after controlling for multiple measures of socioeconomic status.

"Breastfeeding, Introduction of Complementary Foods, and Adiposity at Five Years of Age." American Journal of Clinical Nutrition, March 2006, Hillary L. Burdette, Robert C. Whitaker, Waynitra C. Hall, and Stephen R. Daniels. Does breastfeeding or the age at which other foods are introduced to infants affect the risk of obesity in early childhood? Research on this question has produced mixed results. Among the studies examining the association between infant feeding and fatness during early childhood, this is the first to use dual-energy X-ray absorptiometry (DXA), which is a direct measure of body fatness. In this study of 313 African American and Caucasian children, the authors find that a child's fatness at age five is not related to being breastfed or the age in infancy when other foods are introduced. Reprints available while supply lasts; call 609-275-2350.

"Surveillance Programs for Chronic Viral Hepatitis in Three Health Departments." Public Health Reports, January-February 2006, Douglas T. Fleming, Amy Zambrowski, Felicia Fong, Andrea Lombard, Lynne Mercedes, Claudia Miller, Jan Poujade, Aaron Roome, Amy Sullivan, and Lyn Finelli. Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have these diseases under surveillance.

"Identifying Best Practices for WISEWOMAN Programs Using a Mixed-Methods Evaluation." Preventing Chronic Disease, January 2006, Melanie Besculides, Heather Zaveri, Rosanne Farris, and Julie Will. Because recommendations on best practices for public health programs typically are drawn from unique settings, they can be challenging to implement in programs already in operation. The authors describe a mixed-methods evaluation that integrated quantitative and qualitative inquiry to identify best practices in implementing lifestyle interventions in the Center for Disease Control and Prevention's WISEWOMAN program. The program involves screening for risk factors associated with cardiovascular disease and lifestyle interventions for participants, who must be uninsured and ineligible for Medicaid, and discusses lessons learned in using the approach.

"An Examination of Firms' Employment Costs." Applied Economics, vol. 38, 2006, Sarah Dolfin. The existence of quasi-fixed costs of work may affect firms' desired employee hours and number of workers, which has important implications for the estimation of labor supply parameters. Firm-level data from the 1982 U.S. Employment Opportunity Pilot Project are used to estimate the importance to firms of employee quasi-fixed costs related to searching, hiring, training, and firing. Specifically, this paper examines how these costs affect number of workers and hours per worker, turnover, and vacancies, to the extent that the costs are determined by a firm's presumably exogenous industrial classification. Results show that higher costs are associated with lower turnover, fewer vacancies, and longer hours as predicted by a model of labor demand.

“Welfare-to-Work Transitions for Parents of Infants: Employment and Child-Care Policy Implementation in Eight Communities.” In From Welfare to Child Care: What Happens to Young Children When Mothers Exchange Welfare for Work, 2006, Christine Ross and Gretchen Kirby. Nearly half the states have used the flexibility provided under federal welfare reform law to require parents of infants to work as a condition of receiving benefits, and nearly all states require teenage parents to return to school soon after the birth of a child. Mathematica’s implementation study examined the policy environment (work and school requirements) and practical considerations (child-care and supportive services) that influence the timing and ease of the transition from welfare to work or school for parents of infants. The study was based on staff interviews and focus groups with key informants in eight communities. Researchers found that case managers and program administrators did not view parents of infants as a group that had categorical needs substantially different from those of the broader TANF population and that TANF policies regarding work requirements, sanctions, and time limits were applied in the same way. In contrast, teenage parents were viewed as a subgroup with special needs requiring comprehensive services and support.

“Measuring Physical Environments of Parks and Playgrounds: EAPRS Instrument Development and Inter-Rater Reliability.” Journal of Physical Activity and Health, 2006, Brian E. Saelens, Lawrence D. Frank, Christopher Auffrey, Robert C. Whitaker, Hillary L. Burdette, and Natalie Colabianchi. A better understanding of environments in which physical activity occurs is critical to increasing physical activity. Research on the relationship between levels of physical activity and the availability of park/playground areas is limited because there are no instruments to assess the quality of these public recreation spaces. Little is known about what dimensions of quality enhance use, for example, because these physical activity environments can’t be characterized. This article discusses the first step, based on a qualitative survey of park and recreational professionals and frequent park users, in the process of creating an instrument to assess parks and playgrounds.

“The Struggle to Provide Community-Based Care to Low-Income People With Serious Mental Illnesses.” Health Affairs, vol. 25, no. 3, 2006, Peter Cunningham, Kelly McKenzie, and Erin Fries Taylor. This paper describes gaps in services for low-income people with serious mental illness, as reported by mental health professionals and other observers in 12 communities in the U.S. According to respondents, service gaps have grown in recent years—especially for the uninsured—because of state budget pressures and Medicaid cost-containment policies. Growing service gaps contribute to high prevalence of serious mental illness among the homeless and prison populations, as well as emergency department crowding. Some states and communities are aggressively addressing these gaps, although funding for new programs remains scarce. Reprints available while supply lasts; call 609-275-2350.

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