Stuart Henderson

Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.

The objective of this study was to understand the attitudes and preferences of risk‐eligible women regarding use of tamoxifen for breast cancer risk reduction.

Public Reporting and Pay-for-Performance: Safety-Net Hospital Executives' Concerns and Policy Suggestions

Safety-net hospitals (SNHs) may gain little financial benefit from the rapidly spreading adoption of public reporting and pay-for-performance, but may feel compelled to participate (and bear the costs of data collection) to meet public expectations of transparency and accountability. To better understand the concerns that SNH administrators have regarding public reporting and pay-for-performance, we interviewed 37 executives at randomly selected California SNHs. The main concerns noted by SNH executives were that human and financial resource constraints made it difficult for SNHs to accurately measure their performance. Additionally, some executives felt that market-driven public reporting and pay-for-performance may focus on clinical areas and incentive structures that may not be high-priority clinical areas for SNHs. Executives at SNHs suggested several policy responses to these concerns—such as offering training programs for SNH data collectors—that could be relatively inexpensive and might improve the cost-benefit ratio of public reporting and pay-for-performance programs.

Social Stigma and the Dilemmas of Providing Care to Substance Users in a Safety-Net Emergency Department

There has been increasing interest in how social stigma affects health care delivery to vulnerable patients but few examples of the dilemmas that may arise for providers who care for stigma-vulnerable populations. Using qualitative data, the authors examine care delivery in a safety-net emergency department where many patients were socially disadvantaged and vulnerable to stigma because of substance use problems. Analysis of our data revealed five themes related to the dilemmas of providing care for this patient population: 1) providers valued assisting vulnerable and underserved patients; 2) providers’ interactions with patients could be challenging; 3) providers did not know if substance involved patients provided accurate medical histories; 4) providers were concerned about drug-seeking behavior; and 5) providers had to balance substance-involved patients’ needs with the necessity of managing limited resources. We discuss how these themes relate to care dynamics and social stigma in the safety-net setting.

Barriers to Identifying Substance Abuse in the Reformed Welfare System

Substance abuse has been identified as a potential barrier to employment in the reformed welfare system. This article uses interviews with frontline welfare workers and policy makers to examine the process of identifying welfare clients for substance abuse services. Workers’ accounts reveal that official welfare policy, day‐to‐day work conditions, relationships with clients, and the unstated stigma surrounding substance abuse create an environment that interferes with their identification efforts. The lack of identification contrasts with the policy focus on clients’ alcohol and drug problems under welfare reform.

On the Declining Health Status of Welfare Caseloads: Emerging Dilemmas for Serving the Poor

An emerging concern for public policy is welfare reforms potential to inadvertently affect caseload composition by increasing the proportion of recipients with health-related barriers to employment. The authors examine this using data from the Welfare Client Longitudinal Study, an in-depth case study of a large California county. Through quantitative analyses, they examine the extent of change in health-related problems since welfare reform and their potential to progressively impact overall composition of the caseload. They augment this with qualitative data on how local welfare providers are responding to the health-related needs of aid recipients. Results suggest that the burden of health-related problems is growing and that welfare providers may be poorly equipped to respond effectively on their own. The changing composition of welfare caseloads may foster several new policy dilemmas that demand broader attention: states and localities may face difficulties meeting federal workforce participation requirements, may need to restructure welfare-to-work programs to serve a more functionally impaired population, and may need to take steps to better integrate health and welfare services at the local level.