Abstracts

“Vocational Rehabilitation Services for Individuals with Spinal Cord Injury.” Journal of Vocational Rehabilitation, vol. 25, no.1, 2006, Michelle A. Meade, Amy J. Armstrong, Kirsten Barrett, Phyllis S. Ellenbogen, and M. Njeri Jackson. Employment brings many benefits but is often unavailable, inaccessible to, or underutilized by individuals with SCI and other significant physical disabilities. Vocational rehabilitation services can provide assistance in obtaining employment; however, the extent that these services are accessed, desired, or valued by individuals with SCI is unknown. This article reports on a survey of individuals with SCI in Virginia. Approximately 32 percent of respondents reported receiving at least one job-related service, the most frequent of which was vocational counseling (20 percent). No gender differences were found between individuals who did and did not receive services. Racial differences were found, with nonwhites more likely to have received services. Respondents most frequently reported an interest in receiving assistance with developing a new job skill (24 percent), assistance with finding a job (21 percent), and retirement planning (19 percent).

“Work Intensity and Variations in Health and Personal Characteristics of Individuals with Spinal Cord Injury.” Journal of Vocational Rehabilitation, vol. 25, no.1, 2006, Michelle A. Meade, Kirsten Barrett, Phyllis S. Ellenbogen, and M. Njeri Jackson. This article describes the relationship between work intensity, personal and injury-related factors, and the resources typically associated with employment, including insurance, access to health care, and salary. No significant differences were found with regard to gender or pre-injury employment status between individuals with SCI who were not working, those employed part-time, and those employed full-time. Significant differences were noted between groups with regard to race, marital status, total number of medical problems, receipt of vocational services, and severity of injury. Individuals working full-time were significantly more likely to have dental insurance, less likely to have been unable to get needed medical care, and less likely to have problems with either uncontrolled spasticity or chronic pain in the past 12 months, as compared with the other two groups. Results support the value of employment in providing access to health care and a range of other benefits for persons with SCI. The findings also suggest that secondary conditions may influence the level/intensity of employment for individuals with SCI and that working part-time still provides advantages over unemployment.

“Perspectives on Networking, Cultural Values, and Skills Among African American Men with Spinal Cord Injury: A Reconsideration of Social Capital Theory.” Journal of Vocational Rehabilitation, vol. 25, no.1, 2006, M. Njeri Jackson, Michelle A. Meade, Phyllis Ellenbogen, and Kirsten Barrett. Unemployment among African Americans with SCI poses a serious challenge to successful recovery and community reintegration. Recent research about documented racial disparities in employment following injury is often laden with assumptions about the absence of "social capital," including networks of support, appropriate skills, work ethic, or viable work history profile. Such assumptions inform social policy aimed at assisting the unemployed, including African Americans with SCI, and are embedded in explanations for reducing the role of government in addressing poverty and related social issues. Social capital theory has also been used to justify an increased reliance on nongovernmental networks and institutions (particularly faith-based) to address concerns of individuals and families struggling with employment, health care, or other issues traditionally addressed by the state. This article discusses the attitudes of African American men with SCI toward work and their perceptions of obstacles and supports in their attempts to seek and secure employment in comparison and contrast to explanations presented in social capital theories. The results raise questions about assumptions and policies based in social capital theories and suggest a need to reconsider and reframe explanations for unemployment and those social reintegration strategies embodied in related policies.

“The Impact of Spinal Cord Injury on the Employment of Family Caregivers.” Journal of Vocational Rehabilitation, vol. 25, no.1, 2006, Phyllis S. Ellenbogen, Michelle A. Meade, M. Njeri Jackson, and Kirsten Barrett. This article describes and explores the impact of SCI on the employment of family members, especially those who act as primary caregivers, of individuals with SCI. Four primary themes emerged: (1) caregivers had to create flexibility in their employment situation in order to successfully maintain employment, especially immediately after the injury; (2) while many caregivers felt that they needed to work for financial reasons, there were times when the responsibilities of work and caregiving conflicted; (3) responsibilities left little time for the caregivers to engage in leisure, maintain social connections, spend time with their spouse, or care for their own personal needs; and (4) caregivers' employment was affected by the lack of available certified nursing aides.

“Evaluating Early Childhood Assessments: A Differential Analysis.” In Blackwell Handbook of Early Childhood Development, 2006, Samuel J. Meisels and Sally Atkins-Burnett. Assessment is fundamentally a positive process that holds the potential for enhancing teaching and improving learning. This chapter provides an analytical discussion of the field by adhering to the National Education Goals Panel typology that categorizes four uses or roles for assessment in the preschool years: (1) identification, (2) instructional improvement, (3) program evaluation, and (4) accountability. The chapter also describes a number of achievable challenges: identifying children at risk for developmental delay or school failure; obtaining evaluative information from classroom settings that can be used to inform instruction and improve learning; and designing evaluations that reflect the wide range of influences that affect child growth and development.

“Head Start: What Do We Know About Its Effectiveness? What Do We Need to Know?” In Blackwell Handbook of Early Childhood Development, 2006, John M. Love, Louisa Banks Tarullo, Helen Raikes, and Rachel Chazan-Cohen. Head Start has been the setting and source of a great deal of research over the four decades since its inception. The authors summarize previous reviews of Head Start research and examine more recent outcome and impact studies that have not been systematically summarized. The authors conclude that Head Start research has come far since the last major synthesis in the mid-1980s. There continues to be clear evidence that the program provides immediate benefits for the children it enrolls and long-term gains persist into elementary school, although evidence for the latter is weaker. The authors also talk about the next steps for Head Start research.

"Nutrition Monitoring in the United States." In Present Knowledge in Nutrition, 2006, Ronette Briefel. Nutrition monitoring is defined as “an ongoing description of nutrition conditions in the population, with particular attention to subgroups defined in socioeconomic terms, for purposes of planning, analyzing the effects of policies and programs on nutrition problems, and predicting future trends.” This chapter provides a brief history of the National Nutrition Monitoring and Related Research Program. It also describes national nutrition surveys and other monitoring activities conducted since the mid-1990s, uses and policy applications of the data, and the need for methodological research to meet future challenges.

“Social Status, Stress, and Adolescent Smoking.” Journal of Adolescent Health, November 2006, Daniel M. Finkelstein, Laura D. Kubzansky, and Elizabeth Goodman Lower social status and greater stress have been linked to increased risk of smoking among youth, but previous studies have not fully explored the relations among social status, stress, and smoking risk. This article reports on a study that examined whether perceived stress accounts for the observed association between social status and smoking. Findings indicate that both higher stress and lower social status increase risk of smoking among youth, but that stress does not account for the association between lower social status and smoking. This suggests that stress reduction interventions may not alleviate social inequalities in teen smoking, but they still hold promise for youth smoking prevention.

“Poor Preventive Care Achievement and Program Retention Among Low Birth Weight Infant Medicaid Enrollees.” Pediatrics, October 2006, Shanna Shulman. This article reports on a study that examined the relative odds of achieving preventive care goals during the first year of life and retaining Medicaid coverage at the end of the first year among Medicaid-enrolled low birth weight infants in Florida. Association with maternal prenatal health promotion was also considered. Findings show that low birth weight infants had lower relative odds of achieving preventive care goals during the first year and of retaining Medicaid coverage after the first year, compared with infants of normal birth weight. Maternal health promotion was positively associated with achievement of preventive goals and program retention for all infants regardless of birth weight. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.

“School Vending Machine Use and Fast-Food Restaurant Use Are Associated with Sugar-Sweetened Beverage Intake in Youth.” Journal of the American Dietetic Association, October 2006, Jean L. Wiecha, Daniel Finkelstein, Philip J. Troped, Maren Fragala, and Karen E. Peterson. This article examines associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages. The authors analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks. Findings show that among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. The authors suggest that reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.

"Implementing the Institute of Medicine Definition of Disparities: An Application to Mental Health Care." Health Services Research, October 2006, Thomas G. McGuire, Margarita Alegria, Benjamin L. Cook, Kenneth B. Wells, and Alan M. Zaslavsky. In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition and applies it to disparities in outpatient mental health care. The authors found significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. They conclude that a rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

“Parental Interactions with Latino Infants: Variation by Country of Origin and English Proficiency.” Child Development, September/October 2006, Natasha J. Cabrera, Jacqueline D. Shannon, Jerry West, and Jeanne Brooks-Gunn. In 2001, Latino children represented 18 percent of the U.S. population 18 years of age and younger, with this percentage expected to rise during this century. This study examined variation in mother-infant interactions, father engagement, and infant cognition as a function of country of origin, socioeconomic status, and English language proficiency in a national sample of Latino infants born in the United States and living with both biological parents. Differences between Mexican-American infants, who had lower mother-infant interactions and less father physical play than did the other Latino infants, were associated with differences in acculturation (both parents’ English proficiency). Indicators of acculturation and paternal reports of happiness with partner were associated with paternal engagement. Indicators of acculturation were also related to mother-infant interactions. Infant cognitive scores were associated with maternal interaction but not father engagement, and maternal but not paternal mental health.

"The Impact of Quality-Reporting Programs on Hospital Operations." Health Affairs, September/October 2006, Hoangmai H. Pham, Jennifer Coughlan, and Ann S. O’Malley. This article uses data from the 2005-2006 Community Tracking Study site visits to examine the impact of quality reporting on hospitals’ data collection and review processes, feedback and accountability mechanisms, quality improvement activities, and resource allocation. Individual hospitals participate in multiple, varied reporting programs with distinct effects on hospital operations. Reporting programs play complementary roles in encouraging quality improvement but are poorly coordinated and command sizable resources, in large part because of inadequate information technology. Policy should be directed at encouraging formal assessments of how individual and combinations of programs affect quality outcomes, and the development of adaptable information systems.

"The Effect of New Insurance Coverage on the Health Status of Low-Income Children in Santa Clara County." Health Services Research, September 2006, Embry M. Howell and Christopher Trenholm. The Santa Clara County Children’s Health Initiative seeks to provide coverage through the Healthy Kids initiative to all children in the county whose family incomes are below 300 percent of the federal poverty level. This paper provides new evidence on the effects of insurance coverage on children’s health by looking at how Healthy Kids affects the health of the low-income, undocumented children it serves. The authors found that children in the study group continuously insured for one year were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children. The study group also had fewer missed school days, but the difference was significant only among children who did not enroll for a medical reason. The authors conclude that Healthy Kids had a favorable impact on children’s health.

"Health Plan Pay-for-Performance Strategies." American Journal of Managed Care, September 2006, Sally Trude, Melanie Au, and Jon B. Christianson. This article examines health plan strategies, planning development, and implementation of pay-for-performance programs (financial incentives for hospitals and physicians tied to quality and efficiency) at the community level, focusing on differences across the 12 Community Tracking Study site visit areas. Most health plans are committed to pay-for-performance programs. Although providers would prefer health plans in their communities to use a single standardized set of measures and methods, this is unlikely given local market environments. A national effort directed at standardization might significantly reduce the extent of customization but also may limit the opportunities for local collaboration with providers.

"The Effect of Urinary Incontinence on Quality of Life in Older Nursing Home Residents." Journal of the American Geriatrics Society, September 2006, Catherine E. DuBeau, Samuel E. Simon, and John N. Morris. Researchers sought to determine whether nursing home residents with urinary incontinence have worse quality of life than continent residents, whether the relationship between continence and quality of life differs across strata of cognitive and functional impairment, and whether change in continence status is associated with change in quality of life. This is the first study to demonstrate quantitatively that prevalent and new or worsening incontinence decreases quality of life even in frail functionally and cognitively impaired nursing home residents. These results provide a crucial incentive to improve continence care and quality in nursing homes and a rationale for targeting interventions to those residents most likely to benefit.

"Reliability of a Structured Assessment for Nonclinicians to Detect Delirium Among New Admissions to Postacute Care." Journal of the American Medical Directors Association, September 2006, Samuel E. Simon, Margaret A. Bergman, Richard N. Jones, Katherine M. Murphy, E. John Orav, and Edward R. Marcantonio. Researchers evaluated the interrater reliability of a structured delirium assessment method for nonclinician interviews with elderly patients newly admitted to postacute care. The structured delirium assessment process produced very high interobserver agreement. Nonclinician interviewers using a structured assessment achieved reliability that rivaled or exceeded that of trained clinical assessors in other studies. The authors note that nonclinicians may offer an effective alternative for the assessment of delirium among postacute patients in skilled nursing facilities.

“Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their Preschool-Aged Children.” Pediatrics, September 2006, Robert C. Whitaker, Shannon M. Phillips, and Sean M. Orzol. Stressful social circumstances, particularly constrained economic resources, have been linked to behavioral problems in young children and to symptoms of depression and anxiety in mothers. Using data Mathematica collected for the Fragile Families and Child Wellbeing Study, researchers sought to determine if the prevalence of depression and anxiety in mothers and the prevalence of behavior problems in preschool-aged children are more common when mothers report being food insecure. They found that 71 percent of respondents were fully food secure, 17 percent were marginally secure, and 12 percent were insecure. Mental health problems in mothers and behavior problems in their children were twice as likely in food-insecure households, after controlling for multiple factors, including income and other forms of material hardship. Alleviating food insecurity might be one way to enhance the mental and emotional well-being of mothers and their young children.

"Enduring Links: Parents' Expectations and Their Young Adult Children's Gender-Typed Occupational Choices." Educational Research and Evaluation, August 2006, Janis E. Jacobs, Christina S. Chhin, and Martha M. Bleeker. Educational Research and Evaluation, August 2006. This study examined (1) the relation between parents' gender-typed occupational expectations for their children at age 15 and their children's own reports of occupational expectations at age 17; (2) the long-term relations between parents' gender-typed occupational expectations for their children at age 17 and their children's actual occupation at age 28; and (3) the relation between job satisfaction and having a gender-traditional or nontraditional job. The results indicate that parents' gender-typed occupational expectations were significantly related to children's own expectations and to their actual career choices, and job satisfaction was significantly related to having a gender-typed career. The findings suggest that parents' early gender-typed expectations for their children's occupational achievements were highly related to the actual occupational decisions made by the adult children.

"Unemployment Insurance: Strengthening the Relationship Between Theory and Policy." Journal of Economic Perspectives, summer 2006, Walter Nicholson and Karen Needels. Ever since the U.S. federal-state system of unemployment insurance was founded in the 1930s, it has provided partial, temporary replacement of wages to eligible workers who lose jobs “through no fault of their own” (as determined by state-level regulations). Unemployment insurance is one of the largest social insurance programs in the United States, with benefits paid totaling about $34 billion in 2004. Economic theory can help us understand the challenges this complex program is likely to face over the next few years. The authors summarize the salient characteristics of the unemployment insurance program and then examine the theoretical and econometric research. In addition, they address key issues that the unemployment insurance system is likely to face in upcoming years and ways policymakers may be able to use economic analysis to adjust the program so that it remains effective in addressing the needs of unemployed workers.

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