Jane E. Miller

Long-term poverty and child development in the United States: Results from the NLSY.

Abstract We describe developmental deficits in early childhood associated with longterm poverty in the National Longitudinal Survey of Youth (NLSY). We compare estimates of the effects of long-term poverty (based on a 13-year average of income) to estimates of the effects of poverty based on a single year of income (at the time of developmental assessment). There are substantial developmental deficits among children who, on average, are poor over a number of years relative to those who are not. These deficits are approximately twice as large according to the long-term income measure as compared to those based on the single-year measure, and are not explained by differences in maternal education, family structure, maternal behaviors during pregnancy, infant health, nutritional status, or age of mother at first birth. However, an index of the home environment accounts for one third to one half of the developmental disadvantages (net of other factors) of children who experience long-term poverty.

Racial differences in colorectal cancer mortality : The importance of stage and socioeconomic status

This investigation studies racial and socioeconomic differences in mortality from colorectal cancer, and how they vary by stage and age at diagnosis. Cox proportional hazards models were used to estimate the hazard ratio of dying from colorectal cancer, controlling for tumor characteristics and sociodemographic factors. Black adults had a greater risk of death from colorectal cancer, especially in early stages. The gender gap in mortality is wider among blacks than whites. Differences in tumor characteristics and socioeconomic factors each accounted for approximately one third of the excess risk of death among blacks. Effects of socioeconomic factors and race varied significantly by age. Higher stage-specific mortality rates and more advanced stage at diagnosis both contribute to the higher case-fatality rates from colorectal cancer among black adults, only some of which is due to socioeconomic differences. Socioeconomic and racial factors have their most significant effects in different age groups.

Birth Intervals and Perinatal Health: An Investigation of Three Hypotheses

This analysis uses data from Hungary, Sweden and the United States to investigate the factors contributing to the high health risks observed among infants born within 12 months of the preceding birth. Three hypotheses for poor perinatal health are explored: confounding by prematurity, selection of high-risk mothers into short birth intervals and maternal depletion. Results show that prematurity accounts for the greatest share of the excess risks associated with closely spaced births, and for virtually all of the excess risk of late fetal death. After the confounding effects of prematurity are controlled for, the study finds that infants conceived within a few months of the preceding birth remain at higher-than-average risk of low birth weight, preterm birth and neonatal death. The results suggest that avoidance of birth intervals of less than two years could be expected to effect a 5-10 percent decreased risk of low birth weight and neonatal death.

Trends and Differentials in Infant Mortality in the Soviet Union, 1970–90: How Much Is Due to Misreporting?

We use recently released data on perinatal mortality and cause of death to assess how much of the spatial and temporal variation in infant mortality in the former Soviet Union is attributable to differences in the extent of misreporting. We demonstrate that the dramatic rise in infant mortality that occurred in the mid-1970s was accounted for in large part by an increase in death rates from causes which predominate after the first month of life, particularly in the Central Asian republics, but also in the more developed Baltic and European republics. Improvements in the classification of perinatal deaths do not appear to have played a significant role in explaining trends in reported infant mortality in the 1970s, but may have been responsible for some of the rise (or lack of decline) during the late 1980s. Despite the apparent improvements in the recording of deaths that occurred shortly after birth, there is evidence in several republics of substantial misclassification of early infant deaths as late fe...

Lactation, seasonality, and mother's postpartum weight change in Bangladesh: An analysis of maternal depletion

Longitudinally collected data from rural Bangladesh was used to investigate the effects of lactation, reproductive patterns, and seasonality on maternal weight and postpartum weight change. Results of multivariate analyses demonstrate that weight change exhibits a strong seasonal pattern, with losses in winter (December through March) and the rainy season (July through November) and gains in other months. The rate of weight loss peaks between 5 and 9 months postpartum, declines to near zero by 16 months postpartum, and becomes positive thereafter. However, season and duration interact, so that women who reach the stage of most intensive nutritional demand at a time of low food supply relative to energy output lose considerably more weight than women who reach that stage when food supplies are more adequate. Currently lactating women lose weight more rapidly than nonlactating women. Weight loss is slower among women with low initial weight. Prior reproductive patterns are associated with both weight at the time of conception and weight gain during pregnancy, which together determine weight at the beginning of the lactation interval. Each additional birth is associated with a decrease of 280 g in weight at conception, whereas interpregnancy intervals of < 18 months are associated with an 800‐g deficit at the time of that conception compared to longer intervals. Weight gain during pregnancy is greater among women with high parity, short interpregnancy intervals, and lower weight at conception, but not enough to compensate for the prepregnancy deficit.

Developmental screening scores among preschoolaged children: The roles of poverty and child health

ObjectivesTo investigate, using a nationally representative sample of preschool-aged children, the relationship among poverty history, child health, and risk of an abnormal developmental screening score.MethodsData were derived from the 1988 National Maternal and Infant Health Survey and 1991 Longitudinal Follow-up. Family income in the child’s prenatal year and at 2 years old defined a poverty history for each child. Multivariate logistic regression was used to estimate the effects of poverty history on risk of an abnormal screening score or delays in large-motor, personal-social, or language subscales.ResultsPoor and near-poor children were 1.6 to 2.0 times as likely as nonpoor children to be classified as abnormal, even when maternal and household characteristics and the child’s health history were taken into account. Preterm birth, chronic illness, dearth of reading materials in the home, and maternal depression were also associated with elevated risks of abnormal scores.ConclusionsPoverty is the largest single predictor of an abnormal developmental screening score. The implications of inadequate medical care among poor children for the interpretation of individual screening scores and for amelioration of problems are also discussed.

Economic importance and statistical significance: Guidelines for communicating empirical research

Abstract A critical objective for many empirical studies is a thorough evaluation of both substantive importance and statistical significance. Feminist economists have critiqued neoclassical economics studies for an excessive focus on statistical machinery at the expense of substantive issues. Drawing from the ongoing debate about the rhetoric of economic inquiry and significance tests, this paper examines approaches for presenting empirical results effectively to ensure that the analysis is accurate, meaningful, and relevant for the conceptual and empirical context. To that end, it demonstrates several measurement issues that affect the interpretation of economic significance and are commonly overlooked in empirical studies. This paper provides guidelines for clearly communicating two distinct aspects of “significance” in empirical research, using prose, tables, and charts based on OLS, logit, and probit regression results. These guidelines are illustrated with samples of ineffective writing annotated to show weaknesses, followed by concrete examples and explanations of improved presentation.

Biomedical risk factors for hospital admission in older adults.

OBJECTIVES This study examines the influence of risk factors such as cigarette smoking, blood pressure, serum cholesterol, or chronic illness on frequency of hospital admission in a population-based sample. METHODS Data from the National Health and Nutrition Examination Survey I Epidemiologic Followup Study for 6,461 adults aged 45 years and older were used to assess the influence of risk factors measured by interview, physical examination, and laboratory tests on frequency of hospital admission over a 12- to 16-year follow-up period. Cox proportional hazard regressions were estimated separately for men and women and for ages 45 to 64 years and 65 years and older. SUDAAN software was used to correct for clustering, stratification, unequal weighting, and multiple observations per respondent. RESULTS Risk of hospitalization was higher for current but not former smokers (relative risk [RR] = 1.17-1.34 for different age-sex groups; P < 0.01), higher blood pressure (RR = 1.25-1.28 for ages 45-64; RR = 1.07-1.15 for ages 65 and older; P < 0.01), and lower serum albumin (RR = 1.08-1.14; P < 0.01). Diabetes, lung conditions, heart attack, and ulcer each were associated with higher risk in at least three of the four age-sex groups, as was arthritis among the middle-aged (45-64 years). Serum cholesterol was not associated with hospitalization. CONCLUSIONS Chronic conditions with high morbidity as well as many factors associated with mortality are associated with a higher frequency of hospitalization.

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Objectives Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. Methods Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. Results Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). Conclusions CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

Which Components of Medical Homes Reduce the Time Burden on Families of Children with Special Health Care Needs

OBJECTIVES To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 CSHCNs. STUDY DESIGN NS-CSHCN is a cross-sectional, observational study. We used generalized ordered logistic regression, testing for nonproportional odds in the associations between each of five medical home components and time burden, controlling for insurance, child health, and sociodemographics. DATA COLLECTION/EXTRACTION METHODS Medical home components were collected using Child and Adolescent Health Measurement Initiative definitions. PRINCIPAL FINDINGS Family-centered care, care coordination, and obtaining needed referrals were associated with 15-32 percent lower odds of time burdens arranging/coordinating and 16-19 percent lower odds providing health care. All five components together were associated with lower odds of time burdens, with greater reductions for higher burdens providing care. CONCLUSIONS Three of the five medical home components were associated with lower family time burdens arranging/coordinating and providing health care for children with chronic conditions. If the 55 percent of CSHCNs lacking medical homes had one, the share of families with time burdens arranging care could be reduced by 13 percent.