-
International Journal For Equity in... Aug 2023Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the...
BACKGROUND
Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively.
METHODS
We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment.
RESULTS
A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments.
CONCLUSIONS
A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.
Topics: Male; Humans; Female; Aged; Public Assistance; Social Support; Cluster Analysis; Latent Class Analysis; Mental Disorders
PubMed: 37537561
DOI: 10.1186/s12939-023-01959-7 -
Pediatrics Jan 2021Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated...
BACKGROUND
Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated maltreatment, long-term outcomes of physical abuse in US community samples are unknown. We hypothesized that early childhood physical abuse would prospectively predict adult outcomes in education and economic stability, physical health, mental health, substance use, and criminal behavior.
METHODS
Researchers in two multisite studies recruited children at kindergarten entry and followed them into adulthood. Parents completed interviews about responses to the child's problem behaviors during the kindergarten interview. Interviewers rated the probability that the child was physically abused in the first 5 years of life. Adult outcomes were measured by using 23 indicators of education and economic stability, physical health, mental health, substance use, and criminal convictions reported by participants and their peers and in school and court records.
RESULTS
Controlling for potential confounds, relative to participants who were not physically abused, adults who had been abused were more likely to have received special education services, repeated a grade, be receiving government assistance, score in the clinical range on externalizing or internalizing disorders, and have been convicted of a crime in the past year (3.20, 2.14, 2.00, 2.42, 2.10, and 2.61 times more likely, respectively) and reported levels of physical health that were 0.10 SDs lower. No differences were found in substance use.
CONCLUSIONS
Unreported physical abuse in community samples has long-term detrimental effects into adulthood. Pediatricians should talk with parents about using only nonviolent discipline and support early interventions to prevent child abuse.
Topics: Adult Survivors of Child Abuse; Child; Child Abuse; Criminal Behavior; Education, Special; Female; Health Status; Humans; Internal-External Control; Longitudinal Studies; Male; Physical Abuse; Prospective Studies; Public Assistance; Substance-Related Disorders; Young Adult
PubMed: 33318226
DOI: 10.1542/peds.2020-0873 -
Canadian Journal of Public Health =... 2005
Topics: Canada; Humans; Organizational Innovation; Public Assistance; Public Policy; Social Welfare
PubMed: 15682686
DOI: 10.1007/BF03404005 -
American Journal of Public Health Feb 2014We examined the impact of Arizona's "Supporting Our Law Enforcement and Safe Neighborhoods Act" (SB 1070, enacted July 29, 2010) on the utilization of preventive health...
OBJECTIVES
We examined the impact of Arizona's "Supporting Our Law Enforcement and Safe Neighborhoods Act" (SB 1070, enacted July 29, 2010) on the utilization of preventive health care and public assistance among Mexican-origin families.
METHODS
Data came from 142 adolescent mothers and 137 mother figures who participated in a quasi-experimental, ongoing longitudinal study of the health and development of Mexican-origin adolescent mothers and their infants (4 waves; March 2007-December 2011). We used general estimating equations to determine whether utilization of preventive health care and public assistance differed before versus after SB 1070's enactment.
RESULTS
Adolescents reported declines in use of public assistance and were less likely to take their baby to the doctor; compared with older adolescents, younger adolescents were less likely to use preventive health care after SB 1070. Mother figures were less likely to use public assistance after SB 1070 if they were born in the United States and if their post-SB 1070 interview was closer to the law's enactment.
CONCLUSIONS
Findings suggest that immigration policies such as SB 1070 may contribute to decreases in use of preventive health care and public assistance among high-risk populations.
Topics: Adolescent; Arizona; Child, Preschool; Emigration and Immigration; Female; Humans; Infant; Interviews as Topic; Longitudinal Studies; Mexican Americans; Pregnancy; Pregnancy in Adolescence; Preventive Health Services; Public Assistance
PubMed: 24354823
DOI: 10.2105/AJPH.2013.301655 -
ESC Heart Failure Jun 2022There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to... (Observational Study)
Observational Study
AIMS
There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance.
METHODS AND RESULTS
The Kyoto Congestive Heart Failure registry was a physician-initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow-up of 470 days, the cumulative 1 year incidences of all-cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all-cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69-1.32; P = 0.84]. Even after taking into account the competing risk of all-cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64-1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07-2.29; P = 0.02).
CONCLUSIONS
The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all-cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
Topics: Aftercare; Cohort Studies; Heart Failure; Humans; Patient Discharge; Prospective Studies; Public Assistance; Registries; Stroke Volume; Ventricular Function, Left
PubMed: 35289117
DOI: 10.1002/ehf2.13898 -
BMJ Open May 2022Although several individual risk factors of frequent outpatient attendance (FOA) have previously been reported, identifying a specific risk profile is needed to provide...
OBJECTIVES
Although several individual risk factors of frequent outpatient attendance (FOA) have previously been reported, identifying a specific risk profile is needed to provide effective intervention for impoverished citizens with complex biopsychosocial needs. We aimed to identify potential risk profiles of FOA among public assistance recipients in Japan by using classification and regression trees (CART) and discussed the possibilities of applying the CART to policypractice as compared with the results of conventional regression analyses.
DESIGN
We conducted a retrospective cohort study.
SETTING
We used secondary data from the public assistance databases of six municipalities in Japan.
PARTICIPANTS
The study population included all adults on public assistance in April 2016, observed until March 2017. We obtained the data of 15 739 people on public assistance. During the observational period, 435 recipients (2.7%) experienced FOA.
OUTCOME MEASURE
We dichotomised a cumulative incidence of FOA during the study period into a binary variable of exhibiting FOA or not. We adopted the definition of FOA by the Ministry of Health, Labour, and Welfare: visiting the same medical institution more than 15 days a month.
RESULTS
The results of the CART showed that an employed subpopulation with mental disabilities exhibited the highest risk of FOA (incidence proportion: 16.7%). Meanwhile, multiple Poisson regression showed that the adjusted incidence ratio of being unemployed (vs employed) was 1.71 (95% CI 1.13 to 2.59).
CONCLUSIONS
Using the CART model, we could identify specific risk profiles that could have been overlooked when considering only the risk factors obtained from regression analysis. Public health activities can be provided effectively by focusing on risk factors and the risk profiles.
Topics: Adult; Algorithms; Humans; Japan; Outpatients; Public Assistance; Retrospective Studies
PubMed: 35618333
DOI: 10.1136/bmjopen-2021-054035 -
Pediatrics Jun 2018Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in...
CONTEXT
Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in promoting the health of disadvantaged children.
OBJECTIVE
To summarize and evaluate research in which authors examine housing assistance and child health.
DATA SOURCES
PubMed, Web of Science, PsycInfo, and PAIS (1990-2017).
STUDY SELECTION
Eligible studies were required to contain assessments of public housing, multifamily housing, or vouchers in relation to a health outcome in children (ages 0-21); we excluded neighborhood mobility interventions.
DATA EXTRACTION
Study design, sample size, age, location, health outcomes, measurement, program comparisons, analytic approach, covariates, and results.
RESULTS
We identified 14 studies, including 4 quasi-experimental studies, in which authors examined a range of health outcomes. Across studies, the relationship between housing assistance and child health remains unclear, with ∼40% of examined outcomes revealing no association between housing assistance and health. A sizable proportion of observed relationships within the quasi-experimental and association studies were in favor of housing assistance (50.0% and 37.5%, respectively), and negative outcomes were less common and only present among association studies.
LIMITATIONS
Potential publication bias, majority of studies were cross-sectional, and substantial variation in outcomes, measurement quality, and methods to address confounding.
CONCLUSIONS
The results underscore a need for rigorous studies in which authors evaluate specific housing assistance programs in relation to child outcomes to establish what types of housing assistance, if any, serve as an effective strategy to reduce disparities and advance equity across the lifespan.
Topics: Child; Child Health; Humans; Public Assistance; Public Housing
PubMed: 29765008
DOI: 10.1542/peds.2017-2742 -
BMC Public Health Mar 2020Children's habitual physical activity, including active travel and catching public transit (walking and cycling to and from destinations), and independent mobility... (Comparative Study)
Comparative Study
Does free public transit increase physical activity and independent mobility in children? Study protocol for comparing children's activity between two Finnish towns with and without free public transit.
BACKGROUND
Children's habitual physical activity, including active travel and catching public transit (walking and cycling to and from destinations), and independent mobility (mobility without an adult) have decreased. Public transit trips are physically active and can provide access to hobbies independent of parents, but there is no device-measured data about children's total physical activity time following the introduction of free public transit. Our aim is to compare physical activity and independent mobility between children living in two Finnish towns, one with a recently introduced free public transit system, and the other without free public transit.
METHODS
The city of Mikkeli has provided free public transit for all comprehensive school children since 2017. Various districts from Mikkeli, and the reference town of Kouvola (towns from South-Eastern Finland with a comparative population size and geographical structure), are selected based on their accessibility and the availability of public transit services. Samples of 10-12-year-old children will be recruited through primary schools. We will compare moderate-to-vigorous physical activity time, sitting time (a thigh-worn Fibion® device) and independent mobility (a participatory mapping method, PPGIS) of children: 1) who live in towns with and without free public transit, 2) who live and go to school in districts with high vs. low perceived and objective access to free public transit, and 3) who report using vs. not using free public transit. In addition, ethnography will be used to get insights on the social and cultural effects of the free public transit on children's and parent's everyday life.
DISCUSSION
There is a need for scalable solutions that can increase children's physical activity independent of their socioeconomic background or place of residence. This project will give information on how a political action to provide free public transit for children is associated with their total physical activity time and independent mobility patterns, therefore providing highly relevant information for political decision-making and for promoting independent physical activity in children.
Topics: Child; Cities; Evaluation Studies as Topic; Exercise; Female; Finland; Housing; Humans; Male; Parents; Public Assistance; Research Design; Residence Characteristics; Schools; Students; Transportation; Travel; Walking
PubMed: 32183761
DOI: 10.1186/s12889-020-8385-6 -
American Journal of Public Health Dec 2019This commentary introduces a special section of on the Supplemental Nutrition Assistance Program (SNAP), the US government's largest antihunger program and...
This commentary introduces a special section of on the Supplemental Nutrition Assistance Program (SNAP), the US government's largest antihunger program and third-largest antipoverty program. SNAP demonstrably lifts adults, children, and families out of poverty, thereby constituting a vital component of this nation's public health safety net.Despite its well-documented benefits, SNAP is under political and budgetary siege, mainly from congressional representatives and lobbying groups opposed to a federal role in welfare. In part, SNAP is protected from total annihilation by its unusual authorizing legislation-the Farm Bill.This commentary provides a brief overview of the political history of SNAP and its Farm Bill location as background to the deeper analyses provided in this series of articles.
Topics: Attitude; Food Assistance; Food Supply; History, 20th Century; History, 21st Century; Humans; Hunger; Malnutrition; Politics; Poverty; Public Health; United States; United States Department of Agriculture
PubMed: 31693415
DOI: 10.2105/AJPH.2019.305361 -
[Nihon Koshu Eisei Zasshi] Japanese... Jan 2022Objectives In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been...
Objectives In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been implemented for them. This study aimed to investigate the expectations and problems of welfare offices, as well as their requests to the central government and prefectures about the healthcare management support program for public assistance recipients, which has been mandated since 2021.Methods In November 2019, snowball sampling was used to select 23 welfare offices for sending self-administered questionnaires about the healthcare management support program. Respondents were asked open-ended questions about their expectations and problems regarding the program, as well as their requests to the central government and prefectures. A subsequent interview survey was conducted from November 2019 to February 2020, gathering additional information on the questionnaire survey.Results We received consent for the questionnaire survey and interview survey from 16 welfare offices (response rate 69.6%). It was revealed that the staff in charge of the healthcare management support program at the welfare office expected the program to improve recipients' health awareness and condition and for it to be applied to other residents in the community. They reported difficulty in developing the implementation system, setting up the indicators and target population, and retaining health professionals. They requested the central government and prefectures to clarify the indicators and the criteria for evaluation, provide reference materials, introduce precedents, communicate and coordinate with welfare offices and related organizations in the community, hold meetings to share information, and secure financial resources.Conclusion Findings from our study suggest a need to strengthen the cooperation between the central government, prefectures, and local governments and to establish a multilayered system to implement the healthcare management support program effectively in welfare offices.
Topics: Health Services Needs and Demand; Humans; Local Government; Motivation; Public Assistance; Social Welfare
PubMed: 34719539
DOI: 10.11236/jph.21-070