Down and Out in North America: Recent Trends in Poverty Rates in the U.S. and Canada

This paper documents the striking difference in U. S. and Canadian poverty trends from 1970 to 1986. While U.S. poverty has shown no consistent trend since 1970, Canadian poverty decreased by 60%. This paper examines why U. S. and Canadian poverty trends differed during two periods: 1970-1979 and 1979-1986. During the 1970s, we find that the principle reason for declining Canadian poverty rates is higher economic growth. During the 1980s, we find that differences in government transfers are the main cause of relative poverty change in the two countries. Virtually all of the 3.5 difference in U.S. and Canadian poverty changes from 1979 to 1986 can be attributed to differences in the proportion of families moved out of poverty by transfers. This may reflect both the expansion in social assistance levels in Canada, and the retrenchment in assistance levels in the U. S.

Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial

AddThis Sharing Buttons Share to Facebook 1Share to TwitterShare to LinkedInShare to PinterestShare to CiteULikeShare to Mendeley &nbsp;Citation Please cite as: Daugherty SL, Vupputuri S, Hanratty R, Steiner JF, Maertens JA, Blair IV, Dickinson LM, Helmkamp L, Havranek EP Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial JMIR Res Protoc 2019;8(3):e12498 DOI: 10.2196/12498 PMID: 30907744 PMCID: 6452278 &nbsp;Export Metadata END for: Endnote BibTeX for: BibDesk, LaTeX RIS for: RefMan, Procite, Endnote, RefWorks Add this article to your Mendeley library Add this article to your CiteULike library Download: &nbsp; &nbsp; Published on 25.03.19 in Vol 8, No 3 (2019): March Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/12498, first published Oct 12, 2018. This paper is in the following e-collection/theme issue: RCTs - Protocols/Proposals (funded, already peer-reviewed, non-eHealth) Hypertension Prevention and Treatment Article Cited By (0) Tweetations (4) Metrics Protocol Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial Stacie L Daugherty1, MD, MSPH&nbsp;;&nbsp; Suma Vupputuri2, PhD&nbsp;;&nbsp; Rebecca Hanratty3, MD&nbsp;;&nbsp; John F Steiner4, MD, MPH&nbsp;;&nbsp; Julie A Maertens5, PhD&nbsp;;&nbsp; Irene V Blair6, PhD&nbsp;;&nbsp; L Miriam Dickinson5, PhD&nbsp;;&nbsp; Laura Helmkamp5, MS&nbsp;;&nbsp; Edward P Havranek7, MD&nbsp; 1University of Colorado Denver, School of Medicine, Department of Medicine, Division of Cardiology, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States 2Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD, United States 3Denver Health and Hospital Authority, Department of Medicine, Denver, CO, United States 4Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States 5University of Colorado Denver, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States 6University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States 7University of Colorado School of Medicine, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Denver Health and Hospital Authority, Department of Medicine, Denver, CO, United States Corresponding Author: Stacie L Daugherty, MD, MSPH University of Colorado Denver School of Medicine, Department of Medicine, Division of Cardiology Adult and Child Consortium for Health Outcomes Research and Delivery Science 12605 E. 16th Avenue Mailstop B130, PO Box 6511 Aurora, CO, 80045 United States Phone: 1 303 724 2088 Fax:1 303 724 2094 Email: [email protected] ABSTRACT Background: Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient&rsquo;s ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies. Objective: The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat. Methods: The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients&rsquo; adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients&rsquo; prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes. Results: This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes. Conclusions: The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition&mdash;hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations. </section

Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND) : a multicentre, parallel, randomised controlled trial in the UK

Background Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Acceptance and Commitment Therapy (ACT) is a psychological therapy incorporating acceptance, mindfulness, and behaviour change techniques. We aimed to evaluate the effectiveness of ACT plus usual care, compared with usual care alone, for improving quality of life in people with motor neuron disease. Methods We conducted a parallel, multicentre, two-arm randomised controlled trial in 16 UK motor neuron disease care centres or clinics. Eligible participants were aged 18 years or older with a diagnosis of definite or laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis; progressive muscular atrophy; or primary lateral sclerosis; which met the World Federation of Neurology's El Escorial diagnostic criteria. Participants were randomly assigned (1:1) to receive up to eight sessions of ACT adapted for people with motor neuron disease plus usual care or usual care alone by a web-based system, stratified by site. Participants were followed up at 6 months and 9 months post-randomisation. Outcome assessors and trial statisticians were masked to treatment allocation. The primary outcome was quality of life using the McGill Quality of Life Questionnaire-Revised (MQOL-R) at 6 months post-randomisation. Primary analyses were multi-level modelling and modified intention to treat among participants with available data. This trial was pre-registered with the ISRCTN Registry (ISRCTN12655391). Findings Between Sept 18, 2019, and Aug 31, 2022, 435 people with motor neuron disease were approached for the study, of whom 206 (47%) were assessed for eligibility, and 191 were recruited. 97 (51%) participants were randomly assigned to ACT plus usual care and 94 (49%) were assigned to usual care alone. 80 (42%) of 191 participants were female and 111 (58%) were male, and the mean age was 63·1 years (SD 11·0). 155 (81%) participants had primary outcome data at 6 months post-randomisation. After controlling for baseline scores, age, sex, and therapist clustering, ACT plus usual care was superior to usual care alone for quality of life at 6 months (adjusted mean difference on the MQOL-R of 0·66 [95% CI 0·22–1·10]; d=0·46 [0·16–0·77]; p=0·0031). Moderate effect sizes were clinically meaningful. 75 adverse events were reported, 38 of which were serious, but no adverse events were deemed to be associated with the intervention. Interpretation ACT plus usual care is clinically effective for maintaining or improving quality of life in people with motor neuron disease. As further evidence emerges confirming these findings, health-care providers should consider how access to ACT, adapted for the specific needs of people with motor neuron disease, could be provided within motor neuron disease clinical services

Down and Out in North America: Recent Trends in Poverty Rates in the United States and Canada.

This paper examines why Canadian poverty rates fell relative to U.S. poverty rates during the periods 1970-79 and 1979-86. During the 1970s, the principal reason for declining Canadian poverty rates is higher economic growth. During the 1980s, however, differences in government transfer policy are the main cause of relative poverty change in the two countries. Virtually all of the 3.3 point fall in relative Canadian/U.S. poverty rates from 1979 to 1986 can be attributed to expansions in the Canadian transfer system and simultaneous contractions in U.S. transfers. Copyright 1992, the President and Fellows of Harvard College and the Massachusetts Institute of Technology.