Showing papers in "Journal of Health Care for the Poor and Underserved in 2003"

Health issues of migrant and seasonal farmworkers.

Abstract: This paper describes the socioeconomic conditions under which the 3 to 5 million migrant and seasonal farmworkers in the United States live. Health consequences resulting from occupational hazards and from poverty, substandard living conditions, migrancy, language and cultural barriers, and impaired access to health care are described. Specific problems include infectious diseases, chemical- and pesticide-related ill- nesses, dermatitis, heat stress, respiratory conditions, musculoskeletal disorders and traumatic injuries, reproductive health problems, dental diseases, cancer, poor child health, inadequate preventive care, and social and mental health problems. By increasing awareness among health care professionals of the plight of migrant and seasonal farmworkers, the authors hope to encourage development of a stronger public health infra- structure and to improve the health status of these individuals.

African Americans' Beliefs and Attitudes Regarding Hypertension and Its Treatment: A Qualitative Study

Abstract: Since low adherence rates contribute to morbidity and mortality among hypertensive African Americans, health beliefs known to influence nonadherence must be explored. Hypertensive African Americans were recruited from an urban, public hospital and divided into two categories: adherent, well-controlled versus nonadherent, poorly controlled participants. Separate focus group sessions were held for each category. Participants proved similar with respect to sociodemographic variables but varied in the duration of hypertension. Some beliefs were mentioned more often among nonadherent participants than among adherent participants when describing medical treatments and physicians' encounters. Some participants perceived medication to be harmful and noneffective, and some expressed distrust of pharmaceutical companies and physicians, believing them to use patients for experimentation to test medications. Their descriptions of dialogues with physicians suggested authoritarian and ethnicity-inappropriate communication patterns. To reduce the nonadherence rate among African Americans, it may be necessary to integrate health beliefs into educational interventions and physician-patient communication.

Racial/Ethnic Disparities in Adult Preventive Dental Care Use

Abstract: Using the Behavioral Model of Health Services Utilization, this study examines whether adult preventive dental care utilization differs by ethnicity/race. Logistic regression results find that controlling only for predisposing characteristics (gender, age, education, and health status), African Americans, Mexican Americans, and Other race/ethnicity are less likely than whites to utilize dental services. However, the effects are no longer significant when enabling resource variables are included in the model (income level, insurance, census region, and metropolitan statistical area). Interactions between race/ethnicity and insurance status show that privately insured racial/ethnic minority groups do not differ from privately insured whites in their utilization of dental services. Similarly, the preventive dental care utilization of publicly insured African Americans and Other Hispanics does not differ significantly from privately insured whites. However, publicly insured whites, Mexican Americans, and individuals of Other race/ethnicity have significantly lower odds of utilizing dental services relative to whites with private insurance.

Variation in preventive service use among the insured and uninsured: does length of time without coverage matter?

Abstract: Lacking health insurance has consequences for the ways in which individuals seek care. In this research, the authors use data from the first panel (1996) of the Medical Expenditure Panel Survey to assess the relationship between preventive services and the length of time with insurance during a 12-month period. Regression analyses show that indi- viduals with continuous coverage during the entire period have dramati- cally higher rates of preventive service use than individuals who lack cov- erage for all 22 months. For most services, the authors also find modest differences in preventive service use between the continually insured and those individuals with coverage for lto6 months. Rates of preventive ser- vice use for individuals with 7 to Tl months of coverage are statistically indistinguishable from the continually insured. The authors' findings highlight the importance of considering the length of time without cover- age when evaluating preventive service use of the uninsured population.

Maternal drug use and the timing of prenatal care.

Abstract: This paper explores the role of maternal drug use and the timing of prenatal care. The study data were collected from women delivering live births at eight participating hospitals in the Washington, D.C., Metropolitan Area Drug Study. An estimated 16.9 percent of the women in this sample initiated prenatal care in their third trimester or received no prenatal care. After adjusting for age, race/ethnicity, education, parity, and attitude toward pregnancy, cocaine use was strongly associated with the timing of prenatal care. Using multivariable ordinal logistic regression, the data suggest significant barriers to prenatal care for substance abusers, especially cocaine users. Increasing access to prenatal care continues to be an important public health policy objective, particularly in urban areas where substance abuse is prevalent. Health services research must test strategies that address the timing of prenatal care among drug-dependent, urban women.

Hospital Resource Utilization Among Patients with Sickle Cell Disease

Abstract: In the United States, sickle cell disease primarily affects African Americans and carries a high risk of disability, making its sufferers particularly vulnerable. Sickle cell patients often experience unexpected, intermittent, and life-threatening complications leading to high levels of emergency room use and frequent hospitalizations. Using national discharge data from not-for-profit hospitals, this study explores the relationship between patient and hospital characteristics and hospital resource use by sickle cell patients. A random-effects least squares regression analysis was used to examine relationships between patient and hospital characteristics and hospital charges and length of stay. Patient characteristics, especially severity measures, related significantly to total hospital charges, length of stay, and average daily charges, but few hospital characteristics were associated significantly with these outcomes.

Discontinuation From HIV Medical Care: Squandering Treatment Opportunities

Abstract: The purpose of this study was to assess HIV-infected patients'discontinuation of their primary care. Onehundred ninety-eight consecutive outpatients were interviewed on initial HIV primary care presentation, assessed after six months about their discontinuation from primary care, and had characteristics associated with discontinuation determined. Primary care was not continued in 20 percent (40/198) of the cases. Cohort characteristics included 25 percent women; 44 percent black, 28 percent white, 25 percent Hispanic; 69 percent with highest yearly income < $16,000; 47 percent injection drug users; and median CD4 count 285/\iL. Characteristics significantly associated (p < 0.05) with discontinuation were higher CD4 count, less education, no history of victimization, previous jail time, and site of medical care. One-fifth of HIV-infected patients did not remain engaged in primary care after estab- lishing this essential link to treatment.

Caring for the underserved: current practice of alumni of the National Health Service Corps.

Abstract: The objective of this study was to examine the number and characteristics of National Health Service Corps (NHSC) alumni who currently practice with an underserved population. The study design was a cross-sectional survey mailed in 1998 to a sample of 2,160 alumni. The response rate was 58.9 percent; overall, 52.5 percent of respondents reported currently working with the underserved. In bivariate analyses, retention in practice with the underserved was associated with several clinician and service experience variables. In a logistic regression model, higher initial desire to work with the underserved, older age, job satisfaction, and higher salary were associated with current service. The authors conclude that more than half of the NHSC alumni responding to the survey reported working with an underserved population in 1998. Associations between clinician and service experience characteristics and retention in practice with the underserved can inform policy and research to improve retention.

Varieties of health services utilization by underserved Mexican American women.

Abstract: Varieties of health services utilization by medically underserved patients were examined in 250 Mexican American women attending a primary care clinic in San Diego, California. Less than half (48.4 percent) of these medically underserved women had obtained clinical preventive services conforming to recommended guidelines, 34.4 percent reported having obtained an annual physical examination in the past year, and 66.0 percent reported visiting a doctor only when they were sick. Lack of any form of health insurance, including Medi-Cal, was associated with underutilization of primary care services to a greater degree than the other variables examined. However, other factors such as full-time employment, low education, dissatisfaction with primary care delivery, and cultural preference for traditional ethnomedical alternative forms of health care, constitute important barriers to utilization of primary care services. Efforts to provide health care to the medically underserved must take these barriers into consideration if they are to be successful.

Correlates of late stage breast cancer and death in a Medicaid-insured population.

Abstract: The authors examine how patient and insurance characteristics influence breast cancer stage at diagnosis and survival in women insured by Medicaid (N = 1,159). Two risk factors were identified for women under 65: absence of Medicaid enrollment prior to diagnosis and residency in a nursing home. Women who were not Medicaid insured prior to diagnosis were nearly 2 times more likely to have late stage disease relative to women enrolled during the month of diagnosis, and women receiving nursing home benefits had 2.47 higher odds of late stage disease relative to women who did not receive this type of care. These two variables also influenced the likelihood of death. Additional investigation is needed to evaluate breast cancer care in nursing homes and to understand what, if any, care women receive prior to Medicaid enrollment.

Broadening perspectives on mobile medical outreach to homeless people.

Abstract: Using data collected by Project Renewal's mobile medical services to homeless people in New York City, this paper discusses a tension between an emergency medicine model of outreach and that of primary care. In the former model, clinicians evaluate clients on the basis of presenting complaints and refer them, as necessary, for specialized treatment. The latter is a broader model of comprehensive outreach and/or treatment, where clinicians screen clients and assess them for various conditions offering ongoing evaluation and treatment on site. The model of outreach is applicable for some homeless clients, but the prevalence and overlap of physical complaints, infectious diseases, substance abuse, and psychiatric symptoms among homeless people in New York City has resulted in an evolution toward broader approaches to outreach in this population. Improvements in diagnostic testing and increasingly portable medical technology may make the mobile delivery of medical care to homeless persons increasingly feasible.

Prenatal care and infant birth outcomes among Medicaid recipients.

Abstract: Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.

Prenatal Psychosocial Needs: Differences Between a TennCare Group and a Privately Insured Group in Appalachia

Abstract: The purpose of this study was to determine the prenatal psychosocial needs of a group of women enrolled in TennCare, a Medicaid managed care program designed to cover all otherwise uninsured people in Tennessee, and compare them with privately insured women. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between 14 and 44 years of age and 16 to 28 weeks gestation at three prenatal clinics in East Tennessee. Chi-square analysis revealed that the TennCare enrollees in East Tennessee were significantly more likely to report higher psychosocial needs in pregnancy than the privately insured group. Women enrolled in TennCare had a significantly higher incidence of physical abuse, depressive symptoms, and smoking than the privately insured group. Pregnancy provides a window of opportunity for assessing and intervening with vulnerable women enrolled in Medicaid managed care who report psychosocial problems.

Factors Associated with Health-Compromising Behavior Among the Homeless

Abstract: This exploratory study examined a set of sociodemographic, risk, and protective factors associated with health-compromising behavior among the homeless. One hundred and sixty-one homeless adults living in a midsize, southern metropolitan area were surveyed. Information was collected using structured in-depth interviews that assessed residential and event histories, life circumstances, mental and physical health symptoms, and health-related risk behaviors (drug and alcohol use, risky sexual practices, sleeping outdoors, aggressive behavior, and weapon possession). Descriptive results showed differences in health-compromising behavior for ascribed characteristics such as age, race, and gender. Younger people, nonwhites, and men took more risks. Multivariate results indicated that while sociodemographic risk factors were important predictors of health-compromising behavior for people who are homeless, other variables, including childhood memories, victimization, and local nativism, were also significant. The implications of these findings are explored in the larger context of a social policy framework.

Use of the Health Care for the Homeless Program services and other health care services by homeless adults.

Abstract: This study examined factors associated with the use of the Health Care for the Homeless Program and other health care services by homeless adults. A total of 941 homeless adults were identified in 52 soup kitchens in U.S. communities. Descriptive statistics and logistic regres- sion models were applied. Among homeless adults, having dental prob- lems was the most robust factor associated with their use of Health Care for the Homeless Program services (odds ratio (OR) = 2.50, 95 percent confidence interval (CI) = 1.44-4.32). Among homeless adults who did not visit Health Care for the Homeless Program services during last six months, the number of emergency room visits was the most powerful fac- tor associated with their use of other health care services (OR = 1.15,95 percent CI = 1.05-1.26). The results of the study can help health care pro- viders better serve homeless adults to meet their health needs.

Medicaid Managed Care and Racial Differences in Satisfaction and Access

Abstract: Many researchers have suggested that the implementation of managed care may lower access to, and quality of, health care services for minorities. However, very little empirical data examining this issue exists. To examine it, the authors used a study design that was both cross-sectional and longitudinal in that they surveyed Medicaid recipients in two counties at two points in time; one of the counties began delivering services through managed care between the two survey periods. Their results indicate that, overall, managed care had neither a positive nor a negative effect on African Americans' access to health care services in either absolute terms or relative to whites'. In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems.

Improving the detection of drug abuse, alcohol abuse, and depression in community health centers.

Abstract: Up to 35 percent of primary care patients suffer from sub- stance abuse or mental disorders, and most of these patients receive care from general medical professionals rather than mental health specialists. Accumulating evidence suggests that primary care physicians often fail to recognize, diagnose, and treat their patients with mental and substance use disorders; only about 5 percent of primary care visits result in a men- tal or substance use diagnosis. The goals of this project were to evaluate the feasibility of screening for drug abuse, alcohol abuse, and major depression at two federally funded urban Community/Migrant Health Centers (C/MHCs), in Newark, New Jersey, and Bronx, New York, and to examine the effects of a clinical tool designed to guide primary care clini- cians in the identification and treatment of substance use and depression, assess provider perceptions of the screening form, and determine the con- cordance between provider and patient reports of assessment and management.

Case Management and Access to Services for Homeless Women

Abstract: Previous research on case management for homeless persons has not sufficiently addressed access to services for women of reproductive age. This cross-sectional study estimates the proportion of homeless women with case managers and the associations of case management with access to shelter; food stamps; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and general medical care. Nine hundred seventy-four homeless women were sampled in Los Angeles County in 1997 and asked about their use of services and whether they had case managers. Approximately 56 percent of respondents had case managers. Having a case manager was associated with greater odds of using food stamps and of finding shelter without difficulty in the previous 30 days, but not with use of WIC or with unmet needs for medical care. More assertive forms of outreach may be necessary to link this population to case managers and a broader range of services.

Community Care for People Who Are Homeless and Mentally Ill

Abstract: This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.

Access to care among vulnerable populations enrolled in commercial HMOs.

Abstract: This cross-sectional study compares self-reported access to care among a representative sample of 13,952 HMO enrollees in New Jer- sey. Using multivariate logistic regression, this study found that com- pared with college graduates, those with less than a high school education reported more difficulty obtaining tests or treatment. Compared with whites, Hispanics were more likely to report difficulty seeing their pri- mary care provider, and African Americans reported greater difficulty seeing a specialist and obtaining tests and treatment. Enrollees in poor health were more likely to report problems seeing a specialist and obtain- ing tests and treatment than enrollees in excellent health. Income was not a consistent predictor of access. Nonfinancial barriers appear to be more influential than financial barriers for predicting access problems in com- mercial HMOs. More work is needed to identify the source of nonfinancial barriers to care among vulnerable populations.

HIV risk among a sample of Mexican and Puerto Rican men and women.

Abstract: HIV/AIDS has disproportionately affected the Hispanic communities in the United States. Consequently, Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education efforts. Although such efforts ideally consider variations across subpopulations, including differences in high-risk behaviors and routes of transmission by national origin, gender, and acculturation levels, relatively few studies of risk behavior have considered such differences. This paper reports on an interview-based study of HIV knowledge, risk behavior, and protective behaviors among a sample of 143 men and women of Mexican ethnicity in San Diego County, California and 189 men and women of Puerto Rican ethnicity in Cuyahoga County, Ohio. The authors' findings indicate that individuals who have been in the United States for longer periods of time and who are younger in age are at increased risk of HIV infection. Increased perceived risk may also be predictive of increased actual risk.

Evaluating behavioral health services in Minnesota's Medicaid population using the Experience of Care and Health Outcomes (ECHO) Survey.

Abstract: Performance data on Medicaid managed behavioral health care are for the most part unavailable. The purpose of the current study is to provide a benchmark of Medicaid enrollees' evaluations of access to, and quality of, behavioral health services and to examine the factors that influ- ence these ratings. Eight hundred eighty-five Minnesota Medicaid man- aged care enrollees who received behavioral health services in 2000 com- pleted the Experience of Care and Health Outcomes Survey, a multi- dimensional satisfaction survey that included measures of access to ser- vices, communication with clinicians, functional improvement, and the effect of treatment. Between 29 and 59 percent of the respondents gave the highest possible ratings to the behavioral health services they received. Access to services and functional improvements were rated less favorably than communication with clinicians and the effects of treatment. Ratings within certain domains varied by age, race, education, and region.

Immunization Predictors in Rural Adults Under 65 Years of Age

Abstract: The specific study goal was to identify predictors of influenza and pneumonia immunizations in rural adults 18 to 64 years of age in Appalachia. The survey data used were collected from 931 adults from eight rural counties as part of a larger study. Information collected included influenza and pneumonia vaccination status, demographic and insurance coverage information, and immunization-related knowledge and beliefs. Immunization rates were 41.3 percent for influenza and 19.9 percent for pneumonia. Logistic regression analysis indicated that perceived disease susceptibility, perceived benefit, perceived harm, and insurance coverage for immunizations were significant predictors of both types of immunization, with insurance coverage being the strongest predictor. The findings can be used in development of promotional campaigns for increasing immunizations in this underserved rural population.

Barriers to enrollment and successful outreach strategies in CHIP: reflections on the Arizona experience.

Abstract: This paper presents a case study of the efforts by one state (Arizona) to increase Children's Health Insurance Program enrollment through outreach projects funded by private foundations. Barriers to enrollment include the organization of the Children's Health Insurance Program and perceptions of parents. The most successful outreach either involves intensive personal contact or is connected with a health care pro- vider agency. The paper concludes by discussing how the barriers and successful outreach strategies in Arizona can be generalized to other states and can inform Children's Health Insurance Program outreach broadly.

Organ donation among Asians and Pacific Islanders: preliminary research findings.

Abstract: The waiting time for organs for transplantation increased dramatically during the last decade, but the increase was greater for some ethnic groups than for others. The median waiting time for people who entered the waiting list for kidneys in the United States in 1996 was significantly longer for Asians and Pacific Islanders (API) (44 months), African Americans (44 months), and Hispanics (40 months) than for whites (24 months).1 (The United Network for Organ Sharing [UNOS] does not report statistics for American Indians.) Increasing organ donation among nonwhite ethnic groups would increase opportunities to receive donated organs for nonwhite patients on waiting lists for organs. Research regarding organ donation among African Americans began more than two decades ago2 and similar research about Hispanics more than a decade ago.3 There is a growing literature analyzing organ donation among African Americans and Hispanics\" and proposing interventions.7\"9 As the API population grows, organ donation among API in the United States is emerging as a major health issue. The Bureau of the Census reported that between 10.6 and 12.8 million people (or between 3.7 and 4.5 percent of the population) in the United States were API in 200010 and projected that API would make up 9.3 percent of the population by 2050.11 The literature on organ donation among API in the United States is relatively recent,1213 and efforts to increase organ donation among API in the United States are just being developed.8 Three things underlie the fact that health care issues of API in the United States have generally been overlooked: (1) the stereotype of API as a uniformly successful ethnic minority group, (2) the relative recency of immigration of API to the United States and resulting rapid growth of that population, and (3) inadequate data on the health status of API.14\"17 In this paper, we present background information on organ donation among API in the United States and report on our preliminary research with a public education campaign about organ donation among API in Seattle. The preliminary public education campaign included surveys on knowledge about organ donation. In previous qualitative research about organ donation with five Asian ethnic groups, Shiu-Thornton (personal communication) identified several themes that were common across the ethnic groups. Two of these themes were respect for elders and the tendency for decisions about

Social, prognostic, and therapeutic factors associated with cancer survival: a population-based study in metropolitan Detroit, Michigan.

Abstract: Previously, we studied the effect of socioeconomic status (SES) on cancer survival among adults of Toronto, Ontario and Detroit, Michigan.1 Detroiters’ survival was significantly worse among people from lower SES areas for 12 of 15 relatively common types of cancer. In contrast, no such SES-survival associations were found for 12 of 15 cancer types in Toronto Between-country analysis, which compared cases arising from Toronto and Detroit’s low-income areas, revealed a significant Toronto survival advantage for 13 of 15 most prevalent cancers. Other studies demonstrated that such Canadian advantage was maintained even with a conservative comparison of Toronto’s poor with Detroit’s near poor,2 as well as in other Canada-U.S. comparative locales.3–5 Furthermore, SES acted as an effect modifier, that is, significant country-by-SES interactions were observed. Canadian survival advantages were observed only among the ecologically defined poor (residents of low-income neighborhoods). The present study aims to advance understanding of the factors associated with such disadvantaged survival among people with cancer in the United States. Nine of 10 U.S. studies on cancer survival during the past 10 years have found a significant disadvantage with low SES.1,3,6 Survival among those of relatively high SES was found to be 49 percent greater than that of their lower status counterparts. A similar SES-cancer survival association, although of attenuated magnitude (13 percent differential), has also been observed in other developed continental European and Nordic countries, as well as Australia.7–10 Interestingly, the aggregate SES-cancer survival differential among Canadian cohorts has been found to be only 3 percent.1–5,11,12 Health care systems differences, such as the greater representation of universally accessible single-payer systems in Nordic and other European countries, and Canada, may parsimoniously account for the greatly diminished SES-cancer survival associations found in these countries compared with the United States. Studies of race and cancer survival have provided further evidence for an SES-survival association in the United States.13–16 Cumulative cancer survival among blacks was found to be approximately 43 percent less than that of whites, but this difference diminished to only 8 percent in studies that provided any adjustment for socioeconomic factors or health care access.17 This analytic picture seems straightforward, but its valid policy interpretation is complicated by a number of other known relationships. For example, in the United States, such social factors as SES and race are both highly associated with cancer prognostic and treatment factors,18–25 which themselves are highly associated with cancer survival in the United States and other countries.26–28 Moreover, the associations of social factors with tumor biology in the United States29–32 and the associations of social factors with prognosis and treatment in other countries, including Canada,33–36 have all been observed to be extremely small or nonsignificant. Separately, each of these meta-estimates seems to be most consistent with a systemic, rather than an individual biological-behavioral, account. This study aims to measure the relative weight of all these factors—social, biological, standard prognostic, and therapeutic—in predicting cancer survival among a well-defined U.S. population.

Working with African American Small Businesses to Implement an On-Site Cardiovascular Health Program

Abstract: During the past 50 years, the United States has experienced a substantial decline in mortality due to cardiovascular disease.1 This improvement in cardiovascular health has been attributed to changes in major risk factors, including primary identification and treatment of hypertension, high cholesterol, and tobacco use;1 secondary prevention with assorted pharmacological agents;2 as well as angioplasty and bypass surgery.3 While the African American population has experienced a decrease in heart disease, the rate of decline has been slower than that in the white population.3 Historically, cardiovascular mortality rates for African American men and women were lower than rates for white men and women in the United States, but since the mid-1980s, the rate of decline for white men has accelerated compared with African American men, such that now the rates approximate each other. The rates for African American women now exceed those for white women.3 In areas surrounding the Atherosclerosis Risk in Communities study (ARIC), Williams et al. reported higher prevalence of elevated blood pressure, diabetes, and obesity among African Americans.4 Black men were more likely to smoke but smoked fewer cigarettes per day than their white counterparts. High-density lipoprotein levels were similar in white and black women, although they were slightly lower in white men compared with African American men. While population-based strategies to reduce the burden of cardiovascular disease are effective and important, they cannot replace access to individual medical care as a means of primary and secondary prevention of heart disease, not to mention tertiary treatment and rehabilitation.3 Disparate rates of cardiovascular disease also may be caused by differences in access to medical care.5 Primary care physicians can help in reducing tobacco use, monitoring and treating high blood pressure, screening for diabetes, and screening for and treating hypercholesterolemia.3 Individuals without insurance are less likely to have a usual source of care and to have met minimum standards of physician visits; African Americans are more likely than whites to be without health insurance.5 Differences in medical care by race/ethnicity such as those described in the ARIC study are another possible cause of disparities.4 Since employment is the major route to health insurance in the United States, attention to employment-related health benefits may be one

Childhood injuries in Connecticut's Medicaid managed care program.

Abstract: This study describes childhood injuries and injury-related care using encounter data from a Medicaid managed care program. Enrollment and encounter data for federal fiscal year 2000 were used to identify children who received treatment for an injury, to identify risk factors, and to describe injury-related care. Twenty percent of children were treated for an injury. Preschool-age children and adolescents, males, whites, and residents of nonurban areas were at greatest risk. Sixty percent of injured children received emergency care or were hospitalized. Length of hospital stay for treatment of injuries was 33 percent longer than admissions for other conditions. E-codes were rarely reported. One of five children in Connecticut's Medicaid managed care program was treated for an injury in a one-year period. Medicaid managed care data can be used to determine the percentage of children who experience injuries, to identify risk factors, and to describe injury-related care.