Teague Ruder

Children on the Homefront: The Experience of Children From Military Families

OBJECTIVE: Although studies have begun to explore the impact of the current wars on child well-being, none have examined how children are doing across social, emotional, and academic domains. In this study, we describe the health and well-being of children from military families from the perspectives of the child and nondeployed parent. We also assessed the experience of deployment for children and how it varies according to deployment length and military service component. PARTICIPANTS AND METHODS. Data from a computer-assisted telephone interview with military children, aged 11 to 17 years, and nondeployed caregivers (n = 1507) were used to assess child well-being and difficulties with deployment. Multivariate regression analyses assessed the association between family characteristics, deployment histories, and child outcomes. RESULTS: After controlling for family and service-member characteristics, children in this study had more emotional difficulties compared with national samples. Older youth and girls of all ages reported significantly more school-, family-, and peer-related difficulties with parental deployment (P < .01). Length of parental deployment and poorer nondeployed caregiver mental health were significantly associated with a greater number of challenges for children both during deployment and deployed-parent reintegration (P < .01). Family characteristics (eg, living in rented housing) were also associated with difficulties with deployment. CONCLUSIONS: Families that experienced more total months of parental deployment may benefit from targeted support to deal with stressors that emerge over time. Also, families in which caregivers experience poorer mental health may benefit from programs that support the caregiver and child.

Developing predictive models of health literacy.

INTRODUCTIONLow health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is largely unaddressed in public health and clinical practice. To help overcome these limitations, we developed two models to estimate health literacy.METHODSWe analyzed data from the 2003 National Assessment of Adult Literacy (NAAL), using linear regression to predict mean health literacy scores and probit regression to predict the probability of an individual having ‘above basic’ proficiency. Predictors included gender, age, race/ethnicity, educational attainment, poverty status, marital status, language spoken in the home, metropolitan statistical area (MSA) and length of time in U.S.RESULTSAll variables except MSA were statistically significant, with lower educational attainment being the strongest predictor. Our linear regression model and the probit model accounted for about 30% and 21% of the variance in health literacy scores, respectively, nearly twice as much as the variance accounted for by either education or poverty alone.CONCLUSIONSMultivariable models permit a more accurate estimation of health literacy than single predictors. Further, such models can be applied to readily available administrative or census data to produce estimates of average health literacy and identify communities that would benefit most from appropriate, targeted interventions in the clinical setting to address poor quality care and outcomes related to LHL.

A Mixed-Method Approach to Understanding the Experiences of Non-Deployed Military Caregivers

Given the unprecedented operational tempo of the Afghanistan and Iraq wars and the heavy involvement of the Reserve and National Guard, the stress that military families are exposed to is distinct from stress in earlier conflicts, with little empirical data to inform the impact on non-deployed military caregivers or “home caregivers.” The study seeks to examine the experiences of home caregivers during deployments, with a focus on the impact of deployment on the caregiver’s well-being. We conducted 50 qualitative interviews and 1,337 survey interviews with home caregivers who experienced at least one deployment. The structured qualitative interview focused on caregiver experiences during deployment. The quantitative data centered on caregiver well-being and household and relationship hassles. The qualitative interview notes were the unit of analysis and traditional methods were used to analyze the data. The quantitative data were analyzed using regression models. The qualitative data revealed key deployment-related household challenges that caregivers experience and the effect of those challenges on caregivers. Multivariate analyses of the quantitative data explored differences in caregivers’ emotional well-being, household and relationship hassles. The results showed important component and deployment experience differences. Caregivers affiliated with the National Guard and those with more months of deployment reported significantly poorer emotional well-being, and more household and relationship hassles. Given the important role that maternal well-being has on child and family functioning, it is critical to understand how the stress of deployment is affecting mothers in their daily routines, especially during potentially high stress periods.

What kinds of injuries do OSHA inspections prevent

OBJECTIVE OSHAs enforcement program is one of the major public efforts to protect American workers. We examine both the scope of injury prevention that inspections can contribute and the types of standards that contribute the most. METHODS We linked Pennsylvania Department of Labor and Industry files for lost-time injuries and employment to calculate injury rates for 1998-2005 for all single-establishment manufacturing firms. We linked these to OSHA inspection records. RESULTS Inspections with penalties did affect injury types unrelated to standards as well as those related. We also found again that citations for violations of the standard requiring personal protective equipment had the largest impact on preventing injuries. IMPACT ON INDUSTRY Programs requiring protective equipment use deserve added attention from consultants and inspectors. In addition, some inspections spur managers to undertake safety measures that go beyond compliance with standards.

Health Care Experiences of Hispanics in New and Traditional U.S. Destinations

Over the past 15 years, striking new settlement patterns have emerged that have brought about unprecedented geographic dispersion in the population of approximately 45 million Hispanics in the United States. In this study, the authors compare the health care experiences of working age U.S.-born Mexican Americans and Mexican immigrants living in new and traditional Hispanic destinations. They use a geocoded version of the Medical Expenditure Panel Survey Household Component linked to contextual data from secondary sources. They characterize destinations as new or traditional using information on the percentage of the population that was Hispanic in 1990 and the growth in percent Hispanic between 1990 and 2000. The authors find that, compared with living in destinations with a well-established Hispanic presence, U.S.-born Mexican Americans living in new destinations have less favorable health care outcomes, including a greater probability of having an unmet need for or delay in receiving medical care and reduced satisfaction with care.

Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications

Antibiotics were prescribed during 60% of pharyngitis visits for children (Table). Narrow-spectrum penicillins accounted for 61% of antibiotics prescribed. During the 14-year study period,narrow-spectrumpenicillinprescribingdecreasedfrom65% (95% CI, 57%-72%) of antibiotics in 1997 to 1998 to 52% (95% CI, 44%-60%) in 2009 to 2010 (P = .08), while macrolides increased (P < .01) (Figure). Macrolides and first-generation cephalosporins (second-line antibiotics for GAS pharyngitis) and second-/thirdgeneration cephalosporins and amoxicillin-clavulanate (not recommended)accountedfor21%and18%ofantibioticsprescribed, respectively.

PartyIntents: A Portal Survey to Assess Gay and Bisexual Men’s Risk Behaviors at Weekend Parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party–oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.

Impact of Socioeconomic Adjustment on Physicians' Relative Cost of Care

Background:Ongoing efforts to profile physicians on their relative cost of care have been criticized because they do not account for differences in patients’ socioeconomic status (SES). The importance of SES adjustment has not been explored in cost-profiling applications that measure costs using an episode of care framework. Objectives:We assessed the relationship between SES and episode costs and the impact of adjusting for SES on physicians’ relative cost rankings. Research design:We analyzed claims submitted to 3 Massachusetts commercial health plans during calendar years 2004 and 2005. We grouped patients’ care into episodes, attributed episodes to individual physicians, and standardized costs for price differences across plans. We accounted for differences in physicians’ case mix using indicators for episode type and a patient’s severity of illness. A patient’s SES was measured using an index of 6 indicators based on the zip code in which the patient lived. We estimated each physician’s case mix-adjusted average episode cost and percentile rankings with and without adjustment for SES. Results:Patients in the lowest SES quintile had

Identifying and Mapping “Hot Spots” of Low Health Literacy: A Potential Tool to Guide Intervention ☆

80 higher unadjusted episode costs, on average, than patients in the highest quintile. Nearly 70% of the variation in a physician’s average episode cost was explained by case mix of their patients, whereas the contribution of SES was negligible. After adjustment for SES, only 1.1% of physicians changed relative cost rankings >2 percentiles. Conclusions:Accounting for patients’ SES has little impact on physicians’ relative cost rankings within an episode cost framework.

A New Estimate of the Impact of OSHA Inspections on Manufacturing Injury Rates, 1998-2005

Abstract Purpose Low health literacy is a hidden epidemic. Identifying individuals with low health literacy is a formidable barrier to eliminating disparities and improving health care quality and health outcomes. However, screening individual patients for low health literacy can be prohibitively expensive, time consuming, and inefficient. Focusing on communities, rather than individuals, provides opportunities for action. Identifying geographic areas with large numbers of individuals with low health literacy can enable stakeholders to focus interventions in areas of greatest need. Creating such a measure also sheds light on health literacy as a community or neighborhood-level resource that contributes to health disparities and can inform health interventions. Methodology We applied regression coefficients from a predictive model of health literacy to US Census data to estimate health literacy scores for census geographic areas in Missouri. We then created maps displaying the variability in health literacy levels. Finally, we compared areas identified by the predictive model to those identified on the basis of educational attainment alone. Findings Areas identified by the predictive model as having the lowest health literacy were substantially different from those identified using educational attainment alone, suggesting that a multivariate approach using a limited set of widely available predictors is considerably more accurate. Practical implications This study demonstrates a cost-effective and feasible method for estimating and mapping community-level health literacy. Predicting and mapping areas of low health literacy is relatively straightforward and inexpensive and makes complex data readily accessible to many stakeholders. Such maps can also identify and prioritize geographic areas for intervention by health care and public health providers. Moreover, this focus on community-level health literacy may help foster stakeholder collaboration, leading to efficient resource use that is targeted effectively and resulting in a positive return on investment for stakeholders.