Impact of Welfare Reform on Mortality: An Evaluation of the Connecticut Jobs First Program, A Randomized Controlled Trial

Objectives. We examined whether Jobs First, a multicenter randomized trial of a welfare reform program conducted in Connecticut, demonstrated increases in employment, income, and health insurance relative to traditional welfare (Aid to Families with Dependent Children). We also investigated if higher earnings and employment improved mortality of the participants. Methods. We revisited the Jobs First randomized trial, successfully linking 4612 participant identifiers to 15 years of prospective mortality follow-up data through 2010, producing 240 deaths. The analysis was powered to detect a 20% change in mortality hazards. Results. Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients, particularly for the most disadvantaged groups. However, although none of these reached statistical significance, all participants in Jobs First (overall, across centers, and all subgroups) experienced higher mortality hazards than traditional welfare recipients. Conclusions. Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival

The impact of low-cost, optimal-fidelity simulation on physical therapy students’ clinical performance and self-efficacy: a pilot study

Purpose: Patient simulation has emerged as a useful tool to refine cognitive, psychomotor, and affective skills in realistic yet controlled settings. However, the cost associated with simulation labs can be a barrier. The purpose of this pilot study was to 1) assess the feasibility of a low-cost optimal-fidelity simulation lab integrated into an academic course and 2) assess the effectiveness of a low-cost optimal-fidelity patient simulation on self-efficacy and clinical performance of Doctor of Physical Therapy (DPT) students. Methods: This prospective study utilized a repeated measures quasi-experimental research design. Subjects were recruited through convenience sampling from two branches of the same accredited program run separately on different campuses. Students from one campus served as the experimental group and students from the other campus served as the control group. The control group received usual training for a course on patient assessment. Simultaneously, the experimental group received usual training with the addition of simulation. The Jones and Sheppard self-efficacy questionnaire was administered at baseline (T0), after simulation (T1), and after the subjects’ first clinical experience (T2). The PT Clinical Performance Instrument (CPI) assessed clinical performance. Faculty time, space, equipment, and funds were recorded for descriptive analysis Results: A low-cost optimal-fidelity simulation lab was developed in a 360 square feet room with approximately $500 of supplies. Mann–Whitney independent sample tests demonstrated no statistical significance between groups at each of the data collection points. Within group changes in self-efficacy were statistically significant from T0 to T1 in the experimental group only. No statistically significant changes in CPI scores were noted between groups at the midterm or final assessment. A small-to-moderate effect size (d = 0.386) was noted. Conclusion: The feasibility of the low-cost optimal-fidelity simulation was demonstrated by the limited cost and space requirements. Exposure to one simulated patient encounter appeared to accelerate the development of self-efficacy prior to a first clinical placement compared to usual training in this pilot study

The Impact of Socioeconomic Status on the Neural Substrates Associated with Pleasure

Low socio-economic status (SES) is associated with increased morbidity and premature mortality. Because tonic adversity relates to a diminished ability to experience pleasure, we hypothesized that subjects living in poverty would show diminished neural responsivity to positive stimuli in regions associated with positive experience and reward. Visual images were presented to twenty-two subjects in the context of a EPI-BOLD fMRI paradigm. Significant differences in neural responses between SES groups to poverty vs. neutral images were assessed, examining group, condition, and interaction effects. The data suggest that persons living in low-SES have neural experiences consistent with diminished interest in things generally enjoyed and point toward a possible explanation for the relationship between socioeconomic inequalities and mood disorders, such as depression, by SES

Gender Differences in Material, Psychological, and Social Domains of the Income Gradient in Mortality: Implications for Policy

We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status

The Effect of the Earned Income Tax Credit on Physical and Mental health—Results from the Atlanta Paycheck Plus Experiment

Policy Points: The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children r over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health r and may have worsened mental health. In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health

The general social survey-national death index: an innovative new dataset for the social sciences

<p>Abstract</p> <p>Background</p> <p>Social epidemiology seeks in part to understand how social factors--ideas, beliefs, attitudes, actions, and social connections--influence health. However, national health datasets have not kept up with the evolving needs of this cutting-edge area in public health. Sociological datasets that do contain such information, in turn, provide limited health information.</p> <p>Findings</p> <p>Our team has prospectively linked three decades of General Social Survey data to mortality information through 2008 via the National Death Index. In this paper, we describe the sample, the core elements of the dataset, and analytical considerations.</p> <p>Conclusions</p> <p>The General Social Survey-National Death Index (GSS-NDI), to be released publicly in October 2011, will help shape the future of social epidemiology and other frontier areas of public health research.</p

Vision zero: a toolkit for road safety in the modern era

Vision Zero (VZ) is a public program that aims to have zero fatalities or serious injuries from road traffic crashes. This article examines various major components of VZ: how VZ redefines road safety, how VZ principles and philosophies can be applied to modern car and road designs, and how VZ can be applied to traffic. Applications of these principles to real-world traffic infrastructure are explored in order to show policymakers the toolkits available to increase road safety while taking into consideration local contexts

More money, fewer lives : the cost effectiveness of welfare reform in the United States

Objectives. We evaluated the economic benefits of Temporary Assistance to Needy Families (TANF) relative to the previous program, Aid to Families with Dependent Children (AFDC). Methods. We used pooled mortality hazard ratios from 2 randomized controlled trials—Connecticut Jobs First and the Florida Transition Program, which had follow-up from the early and mid-1990s through December 2011—and previous estimates of health and economic benefits of TANF and AFDC. We entered them into a Markov model to evaluate TANF’s economic benefits relative to AFDC and weigh them against the potential health threats of TANF. Results. Over the working life of the average cash assistance recipient, AFDC would cost approximately $28 000 more than TANF from the societal perspective. However, it would also bring 0.44 additional years of life. The incremental cost effectiveness of AFDC would be approximately$64 000 per life-year saved relative to TANF. Conclusions. AFDC may provide more value as a health investment than TANF. Additional attention given to the neediest US families denied cash assistance could improve the value of TANF