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Annual Review of Public Health Apr 2021Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been... (Review)
Review
Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been implemented around the world to increase financial resources. We refer to these as cash transfers. In this article, we discuss theory and evidence on whether, how, for whom, and to what extent purposeful cash transfers improve health. Evidence suggests that cash transfers produce positive health effects, but there are many complexities and variations in the outcomes. Continuing research and policy innovation-for example, universal basic income and universal Child Development Accounts-are likely to be productive.
Topics: Health; Humans; Public Assistance; Randomized Controlled Trials as Topic
PubMed: 33395543
DOI: 10.1146/annurev-publhealth-090419-102442 -
Primary Care Mar 2021Immigrants enrich the United States through economic contributions and unique perspectives. Immigrants find themselves navigating a new culture, a complicated health... (Review)
Review
Immigrants enrich the United States through economic contributions and unique perspectives. Immigrants find themselves navigating a new culture, a complicated health care system, unfamiliar social programs, and an ever-changing policy environment. They may be discouraged by unmet expectations of life in the United States, changing family dynamics, and discrimination. Screening for the social determinants of health is crucial, as not all patients will proactively seek the advice of their health care provider for these issues. Health care providers can assist and empower immigrants to navigate these challenges, as well as serve as advocates on a broader scale.
Topics: Communication; Delivery of Health Care; Emigrants and Immigrants; Employment; Health Literacy; Health Services Accessibility; Housing; Humans; Patient Navigation; Professional-Patient Relations; Public Assistance; Refugees; Schools; Undocumented Immigrants; United States
PubMed: 33516419
DOI: 10.1016/j.pop.2020.09.010 -
JAMA Network Open Sep 2023Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for...
IMPORTANCE
Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.
OBJECTIVE
To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.
EXPOSURE
Differential state-level public assistance spending.
MAIN OUTCOME AND MEASURE
The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.
RESULTS
A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects).
CONCLUSIONS AND RELEVANCE
This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.
Topics: Adult; Aged; Female; Humans; Male; Cohort Studies; Ethnicity; Neoplasms; Public Assistance; Survival Rate; United States; Black or African American
PubMed: 37669050
DOI: 10.1001/jamanetworkopen.2023.32353 -
Neurology Feb 2023
Topics: Humans; Food Assistance; Retirement; Cognition; Food Security; Memory Disorders
PubMed: 36351815
DOI: 10.1212/WNL.0000000000201649 -
JAMA Network Open May 2023Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer,...
IMPORTANCE
Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable.
OBJECTIVE
To examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023.
EXPOSURE
Cancer history.
MAIN OUTCOMES AND MEASURES
The main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending.
RESULTS
Of 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.
Topics: Humans; Adult; Female; Male; Health Expenditures; Cross-Sectional Studies; Income; Public Assistance; Unemployment; Neoplasms
PubMed: 37234005
DOI: 10.1001/jamanetworkopen.2023.15823 -
BMC Geriatrics Mar 2022Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have...
BACKGROUND
Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have higher risks of morbidity than non-recipients, and mental health is strongly related to frailty. We aimed to examine whether older recipients of public assistance were more likely to have depressive symptoms compared to non-recipients.
METHODS
Data were obtained from the Japan Gerontological Evaluation Study, a 2016 community-based study of older adults. Poisson regression analyses with a robust error variance using fixed effects were conducted to examine the relationship between receiving public assistance and depressive symptoms controlling for sociodemographic factors. Depressive symptoms were assessed by the Geriatric Depression Scale 15.
RESULTS
We found that the older recipients of public assistance were 1.57 times (95% confidence interval [CI]: 1.47, 1.67) more likely to have depressive symptoms compared to non-recipients. We also found that, when additionally adjusting for indicators of social participation, this relationship was slightly attenuated; however, the recipients still had worse mental health issues (Prevalence ratio: 1.33; 95% CI: 1.25, 1.42).
CONCLUSIONS
Even after controlling for sociodemographic factors, older recipients of public assistance tended to be more depressed than non-recipients. However, our findings also indicated that social participation could slightly attenuate the negative relationship between receiving public assistance and depressive symptoms. Therefore, the public assistance program needs to consider the inclusion of mental healthcare support in addition to financial support.
Topics: Aged; Cross-Sectional Studies; Depression; Humans; Japan; Public Assistance; Social Participation
PubMed: 35236284
DOI: 10.1186/s12877-022-02868-0 -
Journal of Health Care For the Poor and... 2020Rental assistance, in the form of vouchers and project-based subsidized housing, is a primary source of affordable housing for low-income Americans, given a growing and...
Rental assistance, in the form of vouchers and project-based subsidized housing, is a primary source of affordable housing for low-income Americans, given a growing and severe shortage of private-market rental units. However, due to supply constraints, fewer than one in four eligible households receive this kind of assistance. In this paper, we examine associations between receipt of rental assistance and self-rated health among a sample of 400 low-income adults in one U.S. city. We find that individuals who currently receive rental assistance have lower odds of reporting poor or fair self-rated health than individuals who are currently on rental assistance waiting lists. These relationships persist after adjusting for factors that affect access to rental assistance and are not significantly modified by criminal justice history. Our findings suggest that the current unmet need for rental assistance may contribute to poor health among low-income Americans.
Topics: Adult; Connecticut; Female; Health Status; Health Surveys; Humans; Male; Middle Aged; Public Assistance; Public Housing; Self-Assessment; Social Determinants of Health; Waiting Lists
PubMed: 32037334
DOI: 10.1353/hpu.2020.0025 -
BMC Pediatrics May 2021Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social...
BACKGROUND
Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children's health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.
METHODS
We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients' sociodemographic factors from January 2016 and identified the incidence of childhood diseases' diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.
RESULTS
Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16-2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07-1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21-2.70), and dental diseases (IR = 1.79; 95% CI, 1.33-2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children's acute health conditions.
CONCLUSIONS
Among public assistance recipients, living in single-parent households may be a risk factor for children's chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children's health conditions, contents of medical treatments, and broader socioeconomic factors.
Topics: Adolescent; Child; Cohort Studies; Dental Caries; Humans; Japan; Public Assistance; Retrospective Studies
PubMed: 33941113
DOI: 10.1186/s12887-021-02682-4 -
Social Science & Medicine (1982) Dec 2022The consequences of environmental disasters and other ecologic and communal crises are frequently worst in racially/ethnically minoritized and low-income populations...
The consequences of environmental disasters and other ecologic and communal crises are frequently worst in racially/ethnically minoritized and low-income populations relative to other groups. This disproportionality may create or deepen patterns of governmental distrust and stoke health promotion disengagement in these groups. To date, there has been limited contextualization of how historically disenfranchised populations utilize government-administered or facilitated resources following such disasters. Focusing on the water crisis in Flint, Michigan, we examine and theorize on the usage of neo public assistance, free risk reduction resources that are provided to disaster survivors as a liminal means of redressing ills created and/or insufficiently mitigated by the state. We surveyed 331 Flint residents, evaluating their usage of four neo public assistance resources following the FWC, finding low to moderate uptake: 131 residents (39.6%) indicated that they obtained blood lead level (BLL) screenings, 216 (65.3%) had their tap water tested for lead (Pb) and other contaminants, 137 (41.4%) had their home water infrastructure replaced, and 293 (88.5%) had acquired bottled water at community distribution sites. Unemployment, receiving public benefits, and lacking reliable transportation and stable housing were associated with lower uptake of some resources. Compared to White and "Other" race individuals, Black residents were generally more likely to acquire/utilize these resources, suggesting heightened concerns and health promotion proclivities even in the face of observed macro and individual-level challenges. Potential reasons and implications are discussed.
Topics: Humans; Lead; Public Assistance; Disasters; Risk Reduction Behavior; Water
PubMed: 36327635
DOI: 10.1016/j.socscimed.2022.115464 -
Disaster Medicine and Public Health... Oct 2021Modern digital strategies, including Internet of Things, machine learning, and mobile applications, have revolutionized situational awareness during disaster management.... (Review)
Review
OBJECTIVE
Modern digital strategies, including Internet of Things, machine learning, and mobile applications, have revolutionized situational awareness during disaster management. Despite their importance, no review of digital strategies to support emergency food security efforts has been conducted. This scoping review fills that gap.
METHODS
Keywords were defined within the concepts of food assistance, digital technology, and disasters. After the database searches, PRISMA guidelines were followed to perform a partnered, 2-round scoping literature review.
RESULTS
The search identified 3201 articles, and 26 articles met criteria and were included in the analysis. The data types used to describe the tools were text/opinion (42.3%), qualitative (23.1%), system architecture (19.2%), quantitative and qualitative (11.5 %), and quantitative (3.8%). The tools' main functions were Resource Allocation (41.7%), Data Collection and Management (33%), Interagency Communications (15.4 %), Beneficiary Communications (11.5%), and Fundraising (7.7%). The platforms used to achieve these goals were Mobile Application (36%), Internet of Things (20%), Website (20%), and Mobile Survey (8%); 92% covered the disaster response phase.
CONCLUSIONS
Digital tools for planning, situational awareness, client choice, and recovery are needed to support emergency food assistance, but there is a lack of these tools and research on their effectiveness across all disaster phases.
Topics: Humans; Disaster Planning; Disasters; Food Assistance; Resource Allocation; Text Messaging
PubMed: 34632974
DOI: 10.1017/dmp.2021.281