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American Journal of Preventive Medicine Sep 2015Under the current version of the Supplemental Nutrition Assistance Program (SNAP), participants can purchase virtually any food or beverage (collectively, food).... (Review)
Review
Under the current version of the Supplemental Nutrition Assistance Program (SNAP), participants can purchase virtually any food or beverage (collectively, food). Research indicates that SNAP recipients may have worse dietary quality than income-eligible nonparticipants. Policymakers have urged the U.S. Department of Agriculture (USDA) to pilot SNAP purchasing restrictions intended to support a healthier diet, and state legislators have proposed similar bills. The USDA rejected these invitations, stating that it would be administratively and logistically difficult to differentiate among products, amid other concerns. However, the USDA's Dietary Guidelines for Americans and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) do just that. Further, state governments define and differentiate among foods and beverages for tax purposes. This paper reviews several factors intended to inform future policy decisions: the science indicating that SNAP recipients have poorer diet quality than income-eligible nonparticipants; the public's support for revising the SNAP program; federal, state, and city legislators' formal proposals to amend SNAP based on nutrition criteria and the USDA's public position in opposition to these proposals; state bills to amend eligible foods purchasable with SNAP benefits; state retail food tax laws; and the retail administration and program requirements for both WIC and SNAP. The paper finds that the government has a clear ability to align SNAP benefits with nutrition science and operationalize this into law.
Topics: Beverages; Child; Commerce; Female; Food; Food Assistance; Humans; Infant; Legislation, Food; Nutrition Policy; Poverty; United States; United States Department of Agriculture
PubMed: 26091926
DOI: 10.1016/j.amepre.2015.02.027 -
International Journal For Equity in... Aug 2020Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in...
BACKGROUND
Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in these individuals' lives". Greater understanding is required concerning the types of access actually used by families in poverty in attempts to meet their basic needs. Poverty must be addressed based on the question: "Inequality of what?" It is in reflecting on the realities of such groups when their basic needs are not met that public policies can be improved and implemented with legitimate priorities.
OBJECTIVE
Describe coverage and access to public health, education and social assistance services and the related effects on the quality of life of families in extreme poverty.
METHODS
An exploratory mixed methods study was conducted applying Amartya Sen's "Basic Capability Equality" framework, with: 1) 27 interviews with managers and professionals from public services serving territories with extreme poverty; 2) Survey with a systematic proportionate stratified sample of 336 heads of households in extreme poverty from a total 2605 families. The resulting data was analyzed with thematic content analysis and descriptive statistics, respectively.
RESULTS
The managers and professionals described the lives of families in extreme poverty with phrases such as, "These people suffer. Sadness weighs on their lives!" and "Depression is the most common illness". Their precarious circumstances and inadequate access were cited as causes. Quality of life was considered bad or very bad by 41.4% of heads of households. A total income of less than one-third of the minimum wage was received by 56.9% of the sample. One or more people were unemployed in the family in 55.8% of cases. For 53.3% of heads of households, public services "did not meet any or few of their needs". The main social determinants of health were described as: alcohol and drugs (68.8%); lack of good health care (60.7%); and absence of income/work (37.5%). The following were identified as solutions to improve their quality of life: (1) health (40.5%); (2) education (37.8%); and (3) employment (44.6%).
CONCLUSIONS
The social determinants of poverty and health must be addressed jointly through intersectoral public policies and egalitarian mechanisms that promote investment in social protection.
Topics: Adult; Brazil; Cities; Educational Status; Employment; Family Characteristics; Female; Health Equity; Humans; Income; Male; Poverty; Public Assistance; Public Policy; Quality of Life; Social Conditions; Social Determinants of Health; Social Welfare; Socioeconomic Factors; Substance-Related Disorders; Urban Population
PubMed: 32762684
DOI: 10.1186/s12939-020-01243-y -
The Journal of Medical Humanities Jun 2023Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians' opinions on the service are nuanced, particularly as the legislation changes over time. In... (Review)
Review
Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians' opinions on the service are nuanced, particularly as the legislation changes over time. In this paper, we outline findings from our review of representations of MAiD in Canadian news media texts since its legalization. These stories reflect the concerns, priorities, and experiences of key stakeholders and function pedagogically, shaping public opinion about MAiD. We discuss this review of Canadian news media on MAiD, provide examples of four key themes we identified (vulnerability, autonomy, dignity, and human rights), and discuss their implications for health policy and equity. Though key stakeholders share the values of autonomy, dignity, and human rights, they appeal to them in diverse ways, sometimes with conflicting policy demands. These representations offer a useful gauge of how views about MAiD continue to shift alongside changes in federal legislation. These stories can influence related policies, respond to the powerful voices that shape MAiD legislation, and have the potential to change national conversations. Our analysis adds to the existing body of scholarship on MAiD by examining post-Bill C-7 news media, identifying related health equity issues and tensions, and discussing potential impacts of MAiD's representations in news media.
Topics: Humans; Canada; Suicide, Assisted; Medical Assistance; Communication
PubMed: 36454353
DOI: 10.1007/s10912-022-09764-z -
Journal of Nutrition Education and... Jun 2022To examine food access, dietary intake, and perceptions about diet and associations with health among adults on probation.
OBJECTIVE
To examine food access, dietary intake, and perceptions about diet and associations with health among adults on probation.
DESIGN
Using a mixed-methods approach, interviews were used to understand food access, dietary intake, and diet and associations with health. A survey measured self-assessed diet quality and diet and associations with health.
SETTING
One probation office in Rhode Island.
PARTICIPANTS
English-speaking adults on probation in 2016 (n = 22 interviews, n = 304 surveys).
MAIN OUTCOME MEASURE(S)
Food access, dietary intake, knowledge about diet and health, and perceptions about healthy food.
ANALYSIS
We used a thematic analytic approach to analyze the interviews. Descriptive statistics were performed for the survey.
RESULTS
Many interviewees had inadequate food access, although most participated in the Supplemental Nutrition Assistance Program, and some received food from food banks. Interviewees primarily shopped at grocery stores and prepared food at home, and dietary intakes did not meet the 2020-2025 Dietary Guidelines for Americans. Almost two-thirds (64.2%) of survey participants reported good or fair diet quality. Based on the survey results, the majority of participants strongly agreed and agreed with the statements, "The types of foods I eat affect my health" and "The types of food I eat affect my weight."
CONCLUSIONS AND IMPLICATIONS
This study identified low-quality dietary intake and food acquisition strategies, such as shopping sales, buying bulk, and going to multiple stores, by US adults on probation to access food with limited resources. Participants reported interest in eating healthier foods and knew there was a connection between dietary intake and health. These data support addressing ways to improve food access and dietary quality, focusing on future programs and policies for this population.
Topics: Adult; Diet; Eating; Food; Food Assistance; Food Supply; Humans; United States
PubMed: 35618404
DOI: 10.1016/j.jneb.2021.12.004 -
JAMA Network Open Jul 2021Socioeconomic factors in the disparities in COVID-19 outcomes have been reported in studies from the US and other Western countries. However, no studies have documented...
IMPORTANCE
Socioeconomic factors in the disparities in COVID-19 outcomes have been reported in studies from the US and other Western countries. However, no studies have documented national- or subnational-level outcome disparities in Asian countries.
OBJECTIVE
To assess the association between regional COVID-19 outcome disparities and socioeconomic characteristics in Japan.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study collected and analyzed confirmed COVID-19 cases and deaths (through February 13, 2021) as well as population and socioeconomic data in all 47 prefectures in Japan. The data sources were government surveys for which prefecture-level data were available.
EXPOSURES
Prefectural socioeconomic characteristics included mean annual household income, Gini coefficient, proportion of the population receiving public assistance, educational attainment, unemployment rate, employment in industries with frequent close contacts with the public, household crowding, smoking rate, and obesity rate.
MAIN OUTCOMES AND MEASURES
Rate ratios (RRs) of COVID-19 incidence and mortality by prefecture-level socioeconomic characteristics.
RESULTS
All 47 prefectures in Japan (with a total population of 126.2 million) were included in this analysis. A total of 412 126 confirmed COVID-19 cases (326.7 per 100 000 people) and 6910 deaths (5.5 per 100 000 people) were reported as of February 13, 2021. Elevated adjusted incidence and mortality RRs of COVID-19 were observed in prefectures with the lowest household income (incidence RR: 1.45 [95% CI, 1.43-1.48] and mortality RR: 1.81 [95% CI, 1.59-2.07]); highest proportion of the population receiving public assistance (1.55 [95% CI, 1.52-1.58] and 1.51 [95% CI, 1.35-1.69]); highest unemployment rate (1.56 [95% CI, 1.53-1.59] and 1.85 [95% CI, 1.65-2.09]); highest percentage of workers in retail industry (1.36 [95% CI, 1.34-1.38] and 1.45 [95% CI, 1.31-1.61]), transportation and postal industries (1.61 [95% CI, 1.57-1.64] and 2.55 [95% CI, 2.21-2.94]), and restaurant industry (2.61 [95% CI, 2.54-2.68] and 4.17 [95% CI, 3.48-5.03]); most household crowding (1.35 [95% CI, 1.31-1.38] and 1.04 [95% CI, 0.87-1.24]); highest smoking rate (1.63 [95% CI, 1.60-1.66] and 1.54 [95% CI, 1.33-1.78]); and highest obesity rate (0.93 [95% CI, 0.91-0.95] and 1.17 [95% CI, 1.01-1.34]) compared with prefectures with the most social advantages. Among potential mediating variables, higher smoking rate (RR, 1.54; 95% CI, 1.33-1.78) and obesity rate (RR, 1.17; 95% CI, 1.01-1.34) were associated with higher mortality RRs, even after adjusting for prefecture-level covariates and other socioeconomic variables.
CONCLUSIONS AND RELEVANCE
This cross-sectional study found a pattern of socioeconomic disparities in COVID-19 outcomes in Japan that was similar to that observed in the US and Europe. National policy in Japan could consider prioritizing populations in socially disadvantaged regions in the COVID-19 response, such as vaccination planning, to address this pattern.
Topics: Adult; Aged; COVID-19; Cross-Sectional Studies; Crowding; Educational Status; Employment; Family Characteristics; Female; Health Status Disparities; Humans; Income; Japan; Male; Middle Aged; Obesity; Occupations; Pandemics; Public Assistance; SARS-CoV-2; Smoking; Social Class; Socioeconomic Factors; Young Adult
PubMed: 34259847
DOI: 10.1001/jamanetworkopen.2021.17060 -
Journal of Nutrition Education and... Apr 2022To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM).
OBJECTIVE
To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM).
DESIGN
Semi-structured in-depth interviews conducted with food bank clients.
SETTING
Arizona regional food bank.
PARTICIPANTS
Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, aged 45-83 years, majority female, Hispanic, and food insecure.
PHENOMENON OF INTEREST
Food bank use and preferences, and how these related to T2DM management.
ANALYSIS
A hybrid thematic analysis combining inductive and deductive reasoning.
RESULTS
Three organizing themes emerged from the analysis. First, food assistance was influenced by food preferences and the ability to pair with existing household foods. Second, desired support included fresh fruits and vegetables, meat, oats, oil, and herbs; recipes; cooking demonstrations; and social support. Third, factors influencing T2DM management were lack of financial resources, low motivation, insufficient nutrition knowledge, low medication adherence, and multiple comorbidities. Participants also expressed resilience and interest in improving T2DM management.
CONCLUSIONS AND IMPLICATIONS
Among a predominantly Hispanic food bank sample, produce and protein-rich foods, nutrition and culinary education, and social support were components of a supportive food bank experience and should be considered when designing food-based interventions for T2DM management for food insecure persons.
Topics: Diabetes Mellitus, Type 2; Female; Food Assistance; Food Insecurity; Food Supply; Humans; Vegetables
PubMed: 35034840
DOI: 10.1016/j.jneb.2021.11.001 -
American Journal of Public Health Dec 2017
Topics: Food Assistance; Humans; Income Tax; Politics; Poverty; Public Health; Socioeconomic Factors; United States
PubMed: 29116841
DOI: 10.2105/AJPH.2017.304109 -
Journal of Managed Care & Specialty... Mar 2023Disparities in prescription abandonment may exacerbate health inequities. Whether copay assistance is associated with changes in prescription abandonment across...
Disparities in prescription abandonment may exacerbate health inequities. Whether copay assistance is associated with changes in prescription abandonment across different patient groups is unknown. To assess disparities in copay assistance use; prescription abandonment across race, ethnicity, or income; and association of copay use with prescription abandonment and whether it differs across race, ethnicity, or household income. This pooled, cross-sectional study assessed claims-level prescription data linked to a consumer database containing information on race, ethnicity, and household income for commercially insured patients. The first prescription for rheumatoid arthritis (RA) or oral oncolytic medicines from 2016 to 2020 was included. Logistic regression models measured odds of copay assistance use (copay/discount cards or free-trial voucher) and prescription abandonment (prescription not filled within 30 days of health plan approval). Interaction terms for copay assistance use by race, ethnicity, and income were tested. The sample included 67,674 patients prescribed RA medications and 9,560 prescribed oral oncolytic medications. Copay assistance use across race, ethnicity, and income ranged from 28.2% to 31.1% (RA medicines) and 27.2% to 36.7% (oral oncolytic medicines). Among those prescribed RA medicines and not using copay assistance, Black/African American, Hispanic patients, and those with household incomes less than $50,000 were more likely to abandon prescriptions than White patients and patients with household incomes more than $200,000 (odds ratio [OR] [95% CI], value: Black/African American: 1.17 [1.06-1.29], < 0.01; Hispanic: 1.11 [1.01-1.22], = 0.03; income <$50,000: 1.24 [1.11-1.37], < 0.01). Among patients using oral oncolytic medicines and not using copay assistance, there was no racial or ethnic difference in prescription abandonment. Patients using oral oncolytics with household incomes less than $50,000 were more likely to use copay assistance (1.34 [1.12-1.61], < 0.01), but also more likely to abandon their prescriptions if not using copay assistance (1.44 [1.12-1.85], < 0.01). Copay assistance was associated with a 79% (RA) and 71% (oral oncolytics) lower odds of prescription abandonment (0.21 [0.19-0.24], < 0.01; 0.29 [0.24-0.36], < 0.01), which did not differ across race, ethnicity, or income levels ( > 0.05). Copay assistance has potential to narrow disparities in prescription abandonment for commercially insured Black/African American or Hispanic patients taking RA medicines and patients with household incomes less than $50,000; however, efforts to improve access to copay assistance are needed. Copay assistance, as a factor facilitating equal access to medicines, is an important consideration when evaluating policies that impact access to copay assistance programs. Genentech, Inc., provided funding and support for this study. Dr Wong is an employee of Genentech, Inc., and shareholder of Roche, Inc. Ms Donahue, Mr Thiesen, and Mr Yeaw are employees of IQVIA.
Topics: Humans; Arthritis, Rheumatoid; Cross-Sectional Studies; Ethnicity; Hispanic or Latino; United States; Black or African American; White; Income; Health Expenditures; Prescription Fees; Medication Adherence; Public Assistance
PubMed: 36692908
DOI: 10.18553/jmcp.2023.22288 -
Inquiry : a Journal of Medical Care... 2021This article presents an exploratory model to classify public attitudes towards health systems financing and organization. It comprises 5 factors (pay-as-you-use,...
This article presents an exploratory model to classify public attitudes towards health systems financing and organization. It comprises 5 factors (pay-as-you-use, solidarity, willingness to contribute, mixed financing, and public provision) measured by 17 indicators, selected through Exploratory Structural Equation Modeling (ESEM) applied to a sample of Chilean adults. Based on this model, cluster analysis proposed 2 groups: "Taxes-public" and "Insurance-choice," representing 47% and 53% of interviewees, respectively. The results show differences between groups concerning the evaluation of both health care providers and insurers. The second cluster tends to evaluate them more harshly, showing less willingness to contribute further, less solidarity, more agreement with the current financing arrangement in terms of the mixture and its insurance (as opposed to purchasing of service based on health problems), and more support for choice of provider. These results highlight the need to consider people's attitudes in the public discussion of health systems financing.
Topics: Adult; Attitude; Chile; Government Programs; Humans; Insurance Carriers; Medical Assistance
PubMed: 34166144
DOI: 10.1177/00469580211020187 -
Social Science & Medicine (1982) Jan 2022Public assistance recipients in Japan are financially empowered by social welfare but are also exposed to social stigma. Therefore, when their status of receiving public...
Public assistance recipients in Japan are financially empowered by social welfare but are also exposed to social stigma. Therefore, when their status of receiving public assistance changes, the conditions of their social life likely change. We examined whether the social relationships of older adults receiving public welfare are influenced by either starting or terminating their use of public assistance. This study used the Japan Gerontological Evaluation Study panel data from 2013 to 2016. To measure social relationships, we used four indicators: the frequency of meeting with friends, the number of friends whom the participants had met with in the past month, their frequency of participating in sports clubs, and their frequency of participating in hobby clubs. In the analyses, changes in social relationships between 2013 and 2016 were used as the study outcomes. Linear regression analyses were conducted to examine if their social relationships changed before and after starting or terminating public assistance while adjusting for confounders. We found that people who stopped receiving public assistance experienced an increase in their frequency of meeting with friends (coefficient: 0.56; 95% CI: 0.06, 1.07), the number of friends (coefficient: 0.60; 95% CI: 0.20, 0.99), participation in sports clubs (coefficient: 0.91; 95% CI: 0.46, 1.39), and participation in hobby clubs (coefficient: 0.70; 95% CI: 0.26, 1.13) compared to those who continued to receive public assistance. Contrarily, the measured social relationships did not change after the participants started receiving public assistance. Our main findings were that terminating one's reception of public assistance increases informal socializing and social participation while starting public assistance does not interrupt pre-existing relationships. These findings contribute to the literature by adding that social relationships are not negatively influenced by either terminating or starting public assistance. Targeted promotions of social connections would effectively maintain the health statuses of low-income older adults.
Topics: Aged; Health Status; Humans; Interpersonal Relations; Japan; Public Assistance; Social Participation
PubMed: 34942580
DOI: 10.1016/j.socscimed.2021.114661