Deborah Viola

The High Cost of the International Aging Prisoner Crisis: Well-Being as the Common Denominator for Action

The aging prisoner crisis continues to gain international attention as the high human, social, and economic costs of warehousing older adults with complex physical, mental health, and social care needs in prison continues to rise. According to the United Nations, older adults and the serious and terminally ill are considered special needs populations subject to special international health and social practice and policy considerations. We argue that older adults in prison have unique individual and social developmental needs that result from life course exposure to cumulative risk factors compounded by prison conditions that accelerate their aging. We position these factors in a social context model of human development and well-being and present a review of international human rights guidelines that pertain to promoting health and well-being to those aging in custody. The study concludes with promising practices and recommendations of their potential to reduce the high direct and indirect economic costs associated with mass confinement of older adults, many of whom need specialized long-term care that global correctional systems are inadequately equipped to provide.

Neighbourhood food environments and body mass index among New York City adults

Background Studies evaluating the impact of the neighbourhood food environment on obesity have summarised the density or proximity of individual food outlets. Though informative, there is a need to consider the role of the entire food environment; however, few measures of whole system attributes have been developed. New variables measuring the food environment were derived and used to study the association with body mass index (BMI). Methods Individual data on BMI and sociodemographic characteristics were collected from 48 482 respondents of the 2002–2006 community health survey in New York City and linked to residential zip code-level characteristics. The food environment of each zip code was described in terms of the diversity of outlets (number of types of outlets present in a zip code), the density of outlets (outlets/km2) and the proportion of outlets classified as BMI-unhealthy (eg, fast food, bodegas). Results Results of the cross-sectional, multilevel analyses revealed an inverse association between BMI and food outlet density (−0.32 BMI units across the IQR, 95% CI −0.45 to −0.20), a positive association between BMI and the proportion of BMI-unhealthy food outlets (0.26 BMI units per IQR, 95% CI 0.09 to 0.43) and no association with outlet diversity. The association between BMI and the proportion of BMI-unhealthy food outlets was stronger in lower (<median for % poverty) poverty zip codes than in high-poverty zip codes. Conclusions These results support a more nuanced assessment of the impact of the food environment and its association with obesity.

Socio-economic status, neighbourhood food environments and consumption of fruits and vegetables in New York City.

OBJECTIVE Recommendations for fruit and vegetable consumption are largely unmet. Lower socio-economic status (SES), neighbourhood poverty and poor access to retail outlets selling healthy foods are thought to predict lower consumption. The objective of the present study was to assess the interrelationships between these risk factors as predictors of fruit and vegetable consumption. DESIGN Cross-sectional multilevel analyses of data on fruit and vegetable consumption, socio-demographic characteristics, neighbourhood poverty and access to healthy retail food outlets. SETTING Survey data from the 2002 and 2004 New York City Community Health Survey, linked by residential zip code to neighbourhood data. SUBJECTS Adult survey respondents (n 15 634). RESULTS Overall 9?9% of respondents reported eating

Preconception Health of Low Socioeconomic Status Women: Assessing Knowledge and Behaviors

5 servings of fruits or vegetables in the day prior to the survey. The odds of eating

The Effects of the Palliative Medicine Consultation on the DNR Status of African Americans in a Safety-Net Hospital

5 servings increased with higher income among women and with higher educational attainment among men and women. Compared with women having less than a high-school education, the OR was 1?12 (95% CI 0?82, 1?55) for high-school graduates, 1?95 (95% CI 1?43, 2?66) for those with some college education and 2?13 (95% CI 1?56, 2?91) for college graduates. The association between education and fruit and vegetable consumption was significantly stronger for women living in lower- v. higher-poverty zip codes (P for interaction,0?05). The density of healthy food outlets did not predict consumption of fruits or vegetables. CONCLUSIONS Higher SES is associated with higher consumption of produce, an association that, in women, is stronger for those residing in lower-poverty neighbourhoods.

Relationship Between Pain and Chronic Illness Among Seriously Ill Older Adults: Expanding Role for Palliative Social Work

INTRODUCTION The stalled U.S. infant mortality rate and persistent disparities in adverse pregnancy outcomes may be addressed by optimizing a womans health throughout her childbearing years. This study examines womens knowledge and behaviors related to preconception risk factors in two community health centers serving lower income, racially diverse populations. METHODS A survey was administered among a convenience sample of women ages 18 to 44 years (n = 340). Questions focused on health behaviors and conditions, knowledge of risk factors, and recommendations of health care providers. Outcomes include the prevalence of risk factors and correlations between the presence of a risk factor and either a respondents knowledge or a health care providers recommendation. Data were analyzed for total respondents and two subgroups: Black, non-Hispanic and Hispanic. RESULTS Despite strong knowledge of risk factors in the preconception period, high-risk behaviors and conditions existed: 63% of women overweight or obese, 20% drinking alcohol, and 42% taking a multivitamin. Significant differences in risk factors were noted between Black, non-Hispanic and Hispanic respondents. Overweight/obesity (t = 3.0; p < .05) and alcohol use (χ² = 9.2; p < .05) were higher among Black, non-Hispanics, whereas Hispanic women had lower rates of multivitamin use (χ² = 11.1; p < .05). The majority of respondents recall being spoken to by a health care provider about pregnancy-related risks. Most risk factors were not influenced by providers recommendations, including multivitamin use, drinking alcohol, and smoking. However, birth control use was correlated with a providers recommendation (χ² = 7.6; p < .05). Correlations between the presence of risk factors and respondents knowledge existed for immunizations (χ² = 9.6; p < .05), but not for multivitamin use, drinking alcohol, or smoking. CONCLUSION Our study identified behaviors amenable to change. Knowledge alone or a doctors recommendation are not enough to change those behaviors. Innovative programs and support systems are required to encourage women to adopt healthy behaviors throughout the childbearing years.

Bringing health and social policy together: The case of the earned income tax credit

Objective: To examine the effectiveness of palliative medicine consultation on completion of advance directives/do-not-resuscitate (DNR) orders by racial/ethnic minorities. Method: A sample of 1999 seriously ill African American and Hispanic inpatients was obtained from the Palliative Medicine Consultation database (n = 2972). Associations between race/ethnicity and diagnosis and documentation of DNR status on admission and discharge were examined. Results: Cancer was the primary diagnosis, 34.5%. Among patients with a consultation, 98% agreed to discuss advance directives; 65% of African Americans and 70% of Hispanics elected DNR status. Inpatient deaths were 46%; 74% of decedents agreed to DNR orders. Discharged patients referred to hospice were 29%. Conclusion: Palliative medicine consultations resulted in timely completion of DNR orders and were positively associated with DNR election and hospice enrollment.

Waiting for a liver—Hidden costs of the organ shortage

Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.

Unraveling Trauma and Stress, Coping Resources, and Mental Well-Being Among Older Adults in Prison: Empirical Evidence Linking Theory and Practice

The principal objective of our research is to examine whether the earned income tax credit (EITC), a broad-based income support program that has been shown to increase employment and income among poor working families, also improves their health and access to care. A finding that the EITC has a positive impact on the health of the American public may help guide deliberations about its future at the federal, state, and local levels. The authors contend that a better understanding of the relationship between major socioeconomic policies such as the EITC and the publics health will inform the fields of health and social policy in the pursuit of improving population health.

Group drumming and well-being: A promising self-care strategy for social workers

Discussion about the economics of end‐stage liver disease has typically focused on the high cost of liver transplantation, but the management of complications in patients waiting for an organ can also be very expensive. Our research considered the hypothesis that an increase in the number of organ grafts would decrease health care costs in patients with liver disease by eliminating the cost of waiting for an organ. We examined treatment costs for a consecutive series of liver transplant candidates listed at our institution between November 1, 1996 and December 31, 1997. Costs were estimated for inpatient stays, outpatient visits, and posttransplant medications for 2 1/2 years from the date of listing. Of the 58 study patients, 26 (45%) received transplants, 7 of whom died within 2 1/2 years. A total of 11 patients (19%) died while waiting for an organ, and another 21 patients (36%) were still waiting after 2 1/2 years. Pretransplantation costs accounted for 41% of the total cost. Transplanting all 58 candidates without delay through a hypothetical increase in the supply of organs to meet demand would have more than doubled the number of transplantations while increasing costs in this cohort by only 37% (from