Medicine and Health Commons^™

Afghan Refugees And The Coronavirus Pandemic, Grant M. Farr

Sociology Faculty Publications and Presentations

The coronavirus, along with international economic sanctions and the collapse of the world oil market, has devastated Iran and its economy, bringing the jobs that Afghan refugees have depended on for a livelihood to a halt. Over the last four decades thousands of Afghans have fled their war torn country and have been living in Iran. Now these Afghan refugees are returning to Afghanistan. Although some of the refugees are leaving on their own, many thousands are being forcefully expelled. These returning refugees are overwhelming the meager medical resources of Afghanistan, spreading the coronavirus across the country. These returning refugees …

Military Factors Associated With Smoking In Veterans, Sara E. Golden, Sujata Thakurta, Christopher G. Slatore, Hyeyoung Woo, Donald R. Sullivan

Sociology Faculty Publications and Presentations

Introduction: Given the high prevalence of smoking among Veterans and the economic, social, and clinical implications, it is important to understand the factors that contribute to smoking in order to focus efforts to mitigate these factors and improve smoking cessation efforts among Veterans. The availability of research on smoking in Veterans compared with civilians is limited given the military-specific differences in their life course. We aimed to identify military-specific factors combined with sociodemographic factors for ever smoking and current smoking among Veterans to inform future interventions. Materials and Methods: We used data from the 2010 National Survey of Veterans, the …

Racial Disparities In Infant Mortality, 1990 To 2004: Low Birth Weight, Maternal Complications And Other Causes, Ginny Garcia-Alexander, Hyeyoung Woo

Sociology Faculty Publications and Presentations

Demographers have long studied the unacceptably high rates of infant mortality in the U.S., relative to other advanced countries. These higher rates are largely attributable to persistent racial gaps in infant health outcomes and are likely a reflection of social inequalities, which manifest as poorer infant health outcomes in certain groups. We extend on previous research in this area by utilizing the restricted 1990 and 2000 cohort linked birth-death files to examine the risk of infant death due to several main causes including: maternal complications, low birth weight, and other causes, and how it has changed over time. We estimate …

Trends And Disparities In Postpartum Sterilization Following C-Section, 2000-2008, Ginny Garcia-Alexander, Dawn M. Richardson, Kelly Gonzales, Adolfo Gabriel Cuevas

Sociology Faculty Publications and Presentations

Objectives. We examined variations in the prevalence of postpartum tubal sterilizations following cesarean sections (C-sections) from 2000 to 2008. Methods. We used data from the National Hospital Discharge Survey (NHDS) to estimate odds ratios for patient- (race, marital status, age) and system-level factors (hospital size, type, region) on the likelihood of receiving tubal sterilization after C-section. Results. A disproportionate share of postpartum tubal sterilizations following C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and …

Citizenship Documentation Requirement For Medical Eligibility: Effects On Oregon Children, Brigit A. Hatch, Jennifer E. Devoe, Jodi A. Lapidus, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Religion And Infant Mortality In The United States: A Community-Level Investigation Of Denominational Variations, Ginny Garcia-Alexander, John P. Bartkowski, Xiaohe Xu

Sociology Faculty Publications and Presentations

A burgeoning body of scholarship has explored the influence of community-level religiosity (religious ecology) on various health outcomes. In this study, we enlist data from the Glenmary Census of Churches, county-level infant mortality rates from the NCHS, and select Census data to investigate the relationship between infant mortality and religion. Our study employs both aggregate analyses of major faith traditions (conservative Protestant, mainline Protestant, Catholic, and other religions) as well as decomposition analyses that subdivide conservative Protestants into four variants: fundamentalist, evangelical, Pentecostal, and other conservative Protestant. Our preliminary findings suggest that counties with a high prevalence of Catholic and …

The Healthy Kids Evaluation Survey: Early Results From A Baseline Survey Of Program Applicants, Bill J. Wright, Heidi Allen, Matthew J. Carlson

Sociology Faculty Publications and Presentations

Since its launch in 2009 the Healthy Kids program has worked to provide health insurance for children in Oregon. Marketed as one program available to all Oregon children, Healthy Kids enrolls families making below 200% of the Federal Poverty Level (FPL) into the Oregon Health Plan, while families above 200% FPL are enrolled in a sliding‐fee private insurance product offered through a health insurance exchange called KidsConnect.

This project is an evaluation of the effects of the Healthy Kids program, conducted by the Center for Outcomes Research (CORE) at Providence Health and Services along with Portland State University. As families …

Religion And Infant Mortality In The U.S.: A Preliminary Study Of Denominational Variations, John P. Bartkowski, Xiaohe Xu, Ginny Garcia-Alexander

Sociology Faculty Publications and Presentations

Prior research has identified a number of antecedents to infant mortality, but has been focused on either structural (demographic) forces or medical (public health) factors, both of which ignore potential cultural influences. Our study introduces a cultural model for explaining variations in infant mortality, one focused on the role of community-level religious factors. A key impetus for our study is well-established religious variations in adult mortality at the community level. Seeking to extend the growing body of research on contextual-level effects of religion, this study examines the impact of religious ecology (i.e., the institutional market share of particular denominational traditions) …

The Fast Food And Obesity Link: An Investigation Of Consumption Patterns And Severity Of Obesity In Pre-Bariatric Surgery Patients, Ginny Garcia-Alexander, Thankam S. Sunil, Pedro Hinojosa

Sociology Faculty Publications and Presentations

We examined selected behavioral factors associated with severity of obesity among pre-operative bariatric surgery patients in the San Antonio area; focusing specifically on the effects of fast food consumption. We used ordered logistic regression to model the effects of behavioral and attitudinal variables on obesity outcomes. Our results indicated that among the behavioral factors, fast food consumption exerted the largest influence on higher levels of obesity. After controlling for several social and demographic characteristics, the effects of fast food consumption remained significant in the model. In fact, for each increase in fast food consumption there was a 26% increase in …

Uncertain Health Insurance Coverage And Unmet Children’S Health Care Needs, Jennifer E. Devoe, Moira Ray, Lisa Krois, Matthew J. Carlson

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The State Children's Health Insurance Program (SCHIP) has improved insurance coverage rates. However, children's enrollment status in SCHIP frequently changes, which can leave families with uncertainty about their children's coverage status. We examined whether insurance uncertainty was associated with unmet health care needs.

METHODS: We compared self-reported survey data from 2,681 low-income Oregon families to state administrative data and identified children with uncertain coverage. We conducted cross-sectional multivariate analyses using a series of logistic regression models to test the association between uncertain coverage and unmet health care needs. RESULTS: The health insurance status for 13.2% of children …

Impacts Of Early Sexual Experience And Associated Risk Of Sexually Transmitted Infection (Sti) Among Teens And Adults In The United States, Ginny Garcia-Alexander

Sociology Faculty Publications and Presentations

This analysis explores incidence rates of sexually transmitted infections (STIs) among minority group teenagers (aged 15-19) and adults aged 20-34 in the United States. The primary research question is aimed at whether or not the early onset of sexual activity is directly related to the incidence of STI transmission among Americans. Discussion is given to the current literature with respect to the most recent trends in STIs as well as some historical background on classifications. Also examined are the differing impacts observed for those who are affected by bacterial infections (young minorities) and those who are affected by viral infections …

Socioeconomic Status And Health: Focusing On Co-Morbidity Of Self Rated Health And Psychological Well-Being, Seung-Eun Song, Hyeyoung Woo

Sociology Faculty Publications and Presentations

Despite the well-documented associations between social and economic positions and diverse health conditions, the necessity and urgency of exploring the social and economic consequences of an array of health dimensions together have been proposed as a critical area of research to fully appreciate socioeconomic-health inequalities. The overall objective of the present study is to estimate the variance and covariation of two dimensions of health, i.e., self-rated health and psychological well-being, simultaneously, with specific attention to the social and economic influences, utilizing the multivariate response model. We use the 2005 National Health Interview Survey. Primary results indicate that variance in both …

Issue Brief: The Impact Of Cost Sharing And Benefit Changes To Oregon Health Plan Beneficiaries: Results, Two Years Later, Bill J. Wright, Matthew J. Carlson

Sociology Faculty Publications and Presentations

This study was launched in 2003 and followed a representative sample of OHP enrollees through the redesign of the program (OHP2) to gain a better understanding of the impact of those changes, including increased cost-sharing, cuts to benefits and stricter rules around payment of premiums. The objectives of this ongoing study are to assess the short and long-term impacts around five main outcome areas: health insurance coverage, access to care, utilization of care, individuals’ financial well being and health status. The key findings from the second round of surveying are detailed in this brief and reflect impacts approximately 18 months …

Impact Of Changes To Premiums, Cost-Sharing, And Benefits On Adult Medicaid Beneficiaries: Results From An Ongoing Study Of The Oregon Health Plan, Bill J. Wright, Matthew J. Carlson, Jeanene Smith, Tina Edlund

Sociology Faculty Publications and Presentations

In 2003, Oregon implemented changes to its Medicaid program to cope with budget shortfalls. In addition to reducing benefits, increasing premiums, and implementing copays for a substantial portion of enrollees, the Oregon Health Plan (OHP) also eliminated premium exemptions and instituted a six-month lockout for individuals missing premium payments. In 2004, OHP rolled back some of these policies. An ongoing study of the impact of OHP’s program changes finds that, after the initial cost-sharing increases and benefit reductions, nearly two-thirds of individuals surveyed had lost their coverage, many directly resulting from increased costs. Those who left because of premiums and …

An Assessment Of The Spanish-Language Oregon Medicaid Health Risk And Health Status Survey (Omhrhss), Sharon Lee, Matthew J. Carlson

Sociology Faculty Publications and Presentations

The purpose of this project was to assess the validity of the Spanish-language version of the Oregon Medicaid Health Risk and Health Status Survey (OMHRHSS)

The Impact Of Program Changes On Enrollment, Access, And Utilization In The Oregon Health Plan Standard Population, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

In February 2003, in an effort to expand Medicaid coverage within tight fiscal constraints, the Oregon Health Plan (OHP) underwent a significant redesign of benefits, cost-sharing and premium structure. The OHP2 redesign resulted in two tiers of coverage, OHP Plus and OHP Standard, and a premium subsidy program. The OHP Plus benefit package and cost sharing structure is similar to the original OHP and serves the federally-mandated Medicaid populations: children and pregnant women, low-income elderly and individuals meeting the SSI definition of disability. OHP Standard, designed for Oregon’s expansion population,1 includes a reduced benefit package, expanded co-pays and increased premiums. …

Satisfaction With Provider Communication Among Spanish-Speaking Medicaid Enrollees, David M. Mosen, Matthew J. Carlson, Leo S. Morales, Pamela P. Hanes

Sociology Faculty Publications and Presentations

OBJECTIVE: To determine if differences between English- and Spanish-speaking parents in ratings of their children's health care can be explained by need for interpretive services.

METHODS: Using the Consumer Assessment of Health Plans Survey-Child-Survey (CAHPS), reports about provider communication were compared among 3 groups of parents enrolled in a Medicaid managed care health plan: 1) English speakers, 2) Spanish speakers with no self-reported need for interpretive services, and 3) Spanish speakers with self-reported need for interpretive services. Parents were asked to report how well their providers 1) listened carefully to what was being said, 2) explained things in a way …

The Impact Of Program Changes On Health Care For The Ohp Standard Population: Early Results From A Prospective Cohort Study, Matthew J. Carlson, Bill J. Wright, Charles Gallia

Sociology Faculty Publications and Presentations

The purpose of this study is to assess the impact of benefit changes on the Oregon Health Plan (OHP) Standard Population across three domains: Enrollment; Access to care; Utilization

Next-Of-Kin Perceptions Of Physician Responsiveness To Symptoms Of Hospitalized Patients Near Death, Joel C. Cantor, Jan Blustein, Matthew J. Carlson, David A. Gould

Sociology Faculty Publications and Presentations

Many different medical providers visit critically ill patients during a hospitalization, and patients and family members may not feel any physician is truly in charge of care. This study explores whether perceiving that a physician was clearly in charge is associated with reports by surviving next of kin about the responsiveness of physicians to symptoms in hospitalized patients near the end of life. We conducted telephone interviews with surviving next of kin of adult patients (n = 1107) who died in one of five New York City teaching hospitals between April 1998 and June 1999 after a minimum 3-day inpatient …

Access To Care Among Vulnerable Populations Enrolled In Commercial Hmos, Matthew J. Carlson, Jan Blustein

Sociology Faculty Publications and Presentations

Abstract: This cross-sectional study compares self-reported access to care among a representative sample of 13,952 HMO enrollees in New Jersey. Using multivariate logistic regression, this study found that compared with college graduates, those with less than a high school education reported more difficulty obtaining tests or treatment. Compared with whites, Hispanics were more likely to report difficulty seeing their primary care provider, and African Americans reported greater difficulty seeing a specialist and obtaining tests and treatment. Enrollees in poor health were more likely to report problems seeing a specialist and obtaining tests and treatment than enrollees in excellent health. Income …