Tracey A. LaPierre

Grandparents Providing Care to Grandchildren: A Population-Based Study of Continuity and Change

This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60% of grandparents provided grandchild care over the 10-year period; more than 70% of those did it for 2 years or more. Grandparents with fewer functional limitations and more economic resources were more likely to start or continue nonresidential care, whereas relatively disadvantaged grandparents were more likely to start and continue coresidential care. Grandparents who were African American, younger, married, living with fewer minor children of their own, or had more grandchildren were more likely to start care, particularly nonresidential care. African Americans and Hispanics were more likely than Whites to start and continue coresidential care. These findings demonstrate the heterogeneity of caregiving and point to the lack of resources among those who provide coresidential care.

Career advancement and gender equity in healthcare management

Purpose – The purpose of this paper is to analyze the conditions for career advancement in healthcare management and examine factors that may be impeding gender equity.Design/methodology/approach – The authors assess gender differences in the odds of being promoted to senior management by: analyzing the relative impact of individual, organizational and family level variables in accounting for gender inequity; examining gender differences in experiences of perceived gender discrimination and sexual harassment, as well as attitudes regarding gender equity in senior management; and by exploring gender differences in aspirations for senior management. ANOVA, χ2 and logistic regression were used to analyze data from 685 respondents to the 2006 Gender and Careers in Healthcare Management Survey.Findings – Women were significantly less likely to be promoted to senior management, even after controlling for individual, organizational and family level characteristics. One third of women healthcare managers in our s...

Characteristics and contributions of non-kin carers of older people: a closer look at friends and neighbours

ABSTRACT Research on informal care-giving has largely neglected the contributions of non-kin carers. This paper investigated the characteristics and contributions of non-kin who care for older adults with a long-term health problem, and investigated friends and neighbours as distinct categories of care providers. Using data from 324 non-kin carers in the 1996 General Social Survey of Canada, this study compared individual and relationship characteristics, care tasks and amount of care provided for the two groups. Interpersonal and socio-demographic characteristics were investigated as mediators of potential differences between friends and neighbours in patterns of care. Results demonstrate that friend and neighbour carers differed on age, marital status, geographical proximity and relationship closeness. Friends were more likely than neighbours to assist with personal care, bills and banking, and transportation. Neighbours were more likely to assist with home maintenance. Friends provided assistance with a greater number of tasks and provided more hours of care per week, suggesting a more prominent role in the care of non-kin than neighbours. Age, income, a minor child in the household, proximity and relationship closeness significantly predicted amount of care provided, and relationship closeness largely explained differences between friends and neighbours. Future research on informal care-giving can build on the findings that distinguish friend and neighbour carers to further discriminate the dynamics of non-kin care.

Examining Status Discrepant Marriages and Marital Quality at the Intersections of Gender, Race, and Class

Purpose – This study examined the impact of educational differences between married women and men on marital quality at the intersections of gender, race, and class.Methodology/approach – Guided by an intersectional perspective we analyzed data for 4,835 black and white married couples from the National Survey of Families and Households (NSFH; 1987–1988). Dyadic multigroup models were estimated using structural equation modeling to examine how status differences affected four latent dimensions of marital quality: happiness, stability, perceived fairness, and disagreement.Findings – Our findings highlight how multiple dimensions of marital quality vary according to intersections of gender, race, and class, and reveal how these intersections moderate the impact of status on marital quality.Research limitations/implications – To our knowledge, the NSFH is the most up-to-date, nationally representative dataset available with couple-level data; however, the data were collected in the late 1980s and are insufficient for extending our analysis to other race-ethnic groups. Our findings demonstrate a strong need for more comprehensive contemporary data collection that has adequate numbers of respondents/couples at the intersections of gender, race, and class to facilitate further quantitative studies using an intersectional perspective.Originality/value – Our study is innovative in using education, an arena where women are currently outpacing men, as an indicator of status, and in embracing an intersectional perspective. By doing so we advance literature on status discrepant marriages, and contribute to the fields of gender and family studies which seek to understand how the changing roles of women may be affecting marital quality.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness

INTRODUCTION Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.

Awareness and Experience with Affordable Care Act Insurance Exchanges: Perspectives from Low-Income Adults in Two Nonexpansion States

ABSTRACT The success of the Affordable Care Act (ACA) and its policy goal of increasing health insurance coverage across the United States, particularly for low income populations, rests in part on community-based outreach activities focused on consumer education and strategies to encourage sign–up. This paper draws on focus group data collected to evaluate and learn from one such community effort, located in a two-state region with significant political opposition to the ACA. Specifically, the research objectives were to better understand low income consumers’ experiences with ACA marketplaces during the initial sign–up period, both barriers and facilitators, and to learn what improvements they recommend for future outreach efforts. Focus group results show very limited knowledge of basic insurance concepts as well as the ACA. Participants reported numerous technological and related access barriers, which further complicated sign–up and caused them to lose confidence and become suspicious of the process. When asked how best to provide information and assistance to individuals such as themselves, participants pointed to several reasons conventional outreach might not be effective and suggested alternative strategies. Although public attention has focused on technical aspects of ACA sign–up, our findings suggest that future obstacles for those who remain uninsured are also likely to be related to perceptions and culturally–based understandings of “Obamacare” and how insurance works. This study underscores the importance of incorporating trusted, community relationships into efforts to expand coverage.

Lessons from a Broad-based ACA Outreach Effort: Promises and Pitfalls

Abstract:The Marketplace Coverage Initiative (MCI) sought to expand awareness and ACA Marketplace enrollment in the greater Kansas City Area. The MCI was evaluated through interviews, surveys, and focus groups. Two main findings are particularly relevant for future Marketplace enrollment efforts. First, the link between contacting someone and actual enrollment is tenuous as follow-up is challenging. Outreach efforts that only track contacts, such as appointments and email addresses, lack information needed to assess enrollment. Linking outreach activities to enrollment outcomes leads us to a dramatically different conclusion about using big data and campaign-style tactics than evaluations of similar techniques such as that pioneered by Enroll America in 11 states. Second, there is a large chasm between the knowledge levels of the uninsured and the decisions they face on the Marketplace. Based on these findings, outreach efforts were redesigned for the 2014 open enrollment period to focus on smaller, community-driven projects.

Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line

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Women and Depression: A Handbook for the Social, Behavioral, and Biomedical Sciences

favourable to the commercial strategies of pharmaceutical firms. Science and marketing merge to create what Lakoff calls an “interested knowledge”: marketers, psychiatrists, industrial researchers and health bureaucracies all cooperate to identify “the right patient for the right drug.” Lakoff shows that this reversal of the usual relationships between diseases and drugs is facilitated by the constitution of private epidemiologies controlled by firms. He thus explains the increasing commercial success of anti-depressants and the flourishing profits of Argentinian firms selling illegal copies of these drugs at the same prices as the originals. What is more, the apparatus of biopsychiatry has constructed a very different patient from the one of psychoanalysis. The agnostic approach followed by biopsychiatry, based on on-going trials, values the patient’s expertise which psychoanalysis, on the other hand, denies. “Thinking in terms of bipolar disorder” also makes it possible to escape the tyranny of the neurosis-psychosis opposition, and opens a broad range of possibilities for intermediate diagnoses. Finally, Lakoff’s analysis suggests that the apparent superiority of biopsychiatry stems from its ability to design and propose tailored therapies, combining a wide variety of medications: what counts is what works. The growing mobilization of genomics, which increases the number of factors to take into account and inspires new forms of intervention, favours this eclecticism. Lakoff explains why these different psychiatries actually collaborate in daily practice. Over and above their differences, they share the same dualistic view of human nature: psychoanalysis believes in the existence of a subject already there, who has to be helped to refine his or her truth; biopsychiatry considers that the person is threatened by disease and needs to be given the means to exist. On the one hand, a dualism taken for granted, on the other, a dualism to be enacted. We understand why the confrontation leads to compromises and why biopsychiatry is in a dominant position. It would be interesting to explore, in other contexts, the dynamics and effects of these hybridizations as they contribute towards shaping the human being as an individual. Women and Depression: A Handbook for the Social, Behavioral, and Biomedical Sciences, edited by Corey L.M. Keyes and Sherryl H. Goodman. New York, NY: Cambridge University Press, 2006. 582 pp.

Women in Medicine

34.99 paper. ISBN: 0521539285.