Understanding disparities in emergency department visits for asthma

Asthma is the most common chronic disorder in childhood, affecting an estimated 6.2 million children under 18 years (1). The purpose of this study was to look at individual- and community-level characteristics simultaneously to examine and explain the factors that contribute to the use of emergency department services by children 18 years old or less and to determine if there was an association between air quality and ED visits in the same population, from 2005-2007 in Houston/Harris County. Data were collected from the Houston Safety Net Hospital Emergency Department Use Study and the 2000 US Census. Bivariate and multivariate logistic regression models and mixed effects models were used to analyze data that was collected during the study period.^ There were 704,902 ED visits made by children 18 and younger, who were living in Houston from January 1, 2005 to December 31, 2007. Of those, 19,098 had a primary discharge diagnosis of asthma. Asthma ED visits varied by season, with proportions of ED visits for asthma highest from September-December. African-American children were 2.6 (95% CI, 2.43-2.66) times more likely to have an ED visit for asthma compared to White children. Poverty, single parent headed households, and younger age all a greater likelihood of having gone to the ED for asthma treatment. Compared to Whites living in lightly-monitored pollution areas, African-Americans and Hispanics living in heavily monitored areas were 1.15 (95% CI, 1.04-1.28) times more likely to have an ED visit for asthma.^ Race and poverty seem to account for a large portion of the disparities in ED use found among children. This was true even after accounting for multiple individual- and community-level variables. These results suggest that racial disparities in asthma continue to pose risks for African American children, and they point to the need for additional research into potential explanations and remedies. Programs to reduce inappropriate ED use must be sensitive to an array of complex socioeconomic issues within minority and income populations. ^

A study of the determinants of the utilization of preventive health care service among Chicanos

This study examines the individual and health care system determinants of two types of preventive health care practice behaviors, having a routine physical exam or a preventive dental exam, in the past year among Chicanos in the Southwestern United States. The study utilizes the Health System Model, developed by Aday and Andersen in 1974, to analyze the relative effect of education, income and occupation on the use of discretionary health care, controlling for other individual and health care system determinants.^ The study is based on a sample of 4,111 Mexican origin adults, drawn from the Hispanic Health and Nutrition Examination Survey (HHANES). This sample is representative of Mexican American residing in the Southwestern United States.^ The study tests the hypothesis that education is the most important social class predictor of preventive health care practice behavior. The fully elaborated model tests the hypothesis that individual determinants alone are insufficient to explain the use of preventive health care services among Chicanos.^ The study found that education and income are statistically significant social class indicators only as it relates to having a preventive dental exam. Education is not the most important social class predictor of either preventive health care practice behavior. Health care system determinants are key predictors of both behaviors. Need, as measured by self-perceived health status of teeth and gender, is as important a determinant as having dental insurance coverage as it relates to having a preventive dental exam. Implications for health programs to effectively reach Chicano target groups and remove access barriers to their use of discretionary health care services are discussed. ^

The impact of social support networks on compliance with hypertensive therapeutic regimens among noninstitutionalized black adults

A conceptual framework based on the Health Belief Model was proposed which identified those factors most significant in the prediction of compliance behavior. The hypothesized model was applied to analyze the effects of sociodemographic characteristics, self-assessed health status, and social support networks on compliance with antihypertensive regimens, focusing on black adults.^ The study population was selected from the National Health and Examination Survey II (NHANES II) which produced a sample of 3,957 eligible persons 35-74 years of age.^ The study addressed the following research questions: (a) what is the relationship between demographic variables and self-assessed health status, (b) what is the relationship between social support network and self-assessed health status, (c) what is the compliance, (d) what factors, e.g., demographic characteristics, social support network, self-assessed health status, are most related to compliance, and (e) does the effect of these factors on compliance differ between black and white adults?^ The results of the study found that blacks: (a) had poorer health than whites, and education and income were significantly related to self-assessed health status, (b) the stronger social support networks of blacks, the better their health status, and (c) older blacks and those in poorer health were more likely to comply with recommended treatment. The hypothesized conceptual model for the prediction of compliance behavior was partially substantiated for both blacks and whites.^ Implications for the application of the conceptual model are also discussed. ^

FACTORS INFLUENCING ACCESS TO HEALTH CARE AMONG MEXICAN AMERICAN ELDERLY IN TEXAS

Differential access to health care services has been observed among various groups in the United States. Minorities and low-income groups have been especially notable in their decreased access to regular providers of care. This is believed by many to account for some of the higher rates of morbidity and mortality and shorter life expectancies of these groups.^ This research delineated the factors associated with health care access for a particular subset of a minority group, the Mexican American elderly in Texas. Hospital admission and evidence of a regular source of medical care and dental care were chosen as the indicators of access to health care.^ This study analyzed survey interview data from the Texas Study on Aging, 1976. The 597 Mexican American elderly included in this study were representative of the non-institutionalized Mexican American elderly in Texas aged 55 or older.^ The results indicate that hospital admission is not a question of discretion and that common barriers to access, such as income, health insurance, and distance to the nearest facility, are not important in determining hospital admission. Mexican American elderly who need to be hospitalized, as indicated by self-perception of health and disability days, will be hospitalized.^ The results also indicate that having a regular source of medical care is influenced by many factors, some mutable and some immutable. The well-established and immutable factors of age, sex, and need were confirmed. However, the mutable factors such as area of residence and income were also found to have a significant influence. Mexican American elderly living in urban areas had significantly less access to a regular source of medical care as did those who were near the poverty level (as opposed to those who were well below the poverty level). In general, persons claiming a regular source of medical care were more likely to be women, persons who had many health needs, were near the poverty level, lived in urban areas, and had extensive social support systems.^ Persons claiming a regular source of dental care tended to be more advantaged. They had more education, a more extensive informal social support network, higher income, and were generally younger and in better health. They were also more likely to have private health insurance. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of author.) UMI ^

Occupational injuries among day laborers in Houston

Research has indicated that day laborers engage in higher risk occupations and suffer a high number of occupationally related fatal and non-fatal injuries. Although there have been some studies focusing on immigrant workers and their occupational injuries, none to our knowledge has studied Houston’s day laborers. An exploratory study of Houston’s day laborer population was conducted in 2008 by Dr. Fernández-Esquer from the University of Texas. ^ The aims of the current study are to analyze secondary data from this parent study and describe the prevalence of the self reported occupational injuries among Houston immigrant day laborers seeking work during the months of October through December 2008. The study also aims to determine if the reported injuries varied by age group, education level, length of time living in the U.S. and length of time working as day laborers and describe if injuries were more common by the number of different job types or job conditions reported or the use of personal protective equipment used (PPE). ^ This study analyzed 325 questionnaires that included job-related information from the parent study. One hundred and nine workers (35 %) reported an occupational injury or illness in the year before the interview. The most frequent injuries or illnesses reported were falls (26.7 %), cuts and lacerations (23.3 %) and being struck by an object (18.3 %). Over half of the workers (57 %) reported working 4 to 6 different jobs in the year before the interview, followed by 22.5 % reporting 1 to 3 different jobs. A combined 79 % of day laborers in Houston reported exposure to 7 or more of the job conditions listed and 69 % of those workers also reported an injury or illness. PPE use varied from 44 % of workers reporting using 4 to 6 PPE items to 6.8 % reporting not using any type of PPE. Thirty two percent of workers reporting not using any PPE also reported an injury or illness. ^ Injuries were found not to have varied significantly by age group, time living in the US, time working as a day laborer, numbers of different job types and the number of PPE used. Injuries did vary significantly by education level of the participants and the number of different job conditions reported (education, X2 (4, N = 315) = 12.651, p =0.013; and job conditions, X2 (3, N = 319) = 14.698, p = 0.002). ^ Although this first study of Houston’s day laborers was successful at engaging the population and getting background information regarding the occupational health of these workers, more studies are needed to further characterize the day laborers occupational experiences and injuries along with determining what specific job types and job conditions were present when injuries occurred and what kind of PPE was being used at the time. It is also clear that these workers need better safety training programs regarding working in potentially dangerous jobs and job conditions. They would also benefit from programs that would help empower them to negotiate for safer conditions.^

Investigating the effects of the 2007 Texas tobacco tax increase on the smoking behavior of adults

Smoking is major cause of premature mortality and morbidity in the United States. The health consequences of tobacco usage are increasingly concentrated in minority and lower socioeconomic groups. One of the most effective means of deterring tobacco consumption and generating revenue to fund prevention activities is the levying of excise taxes. In 2007 the state of Texas increased the excise tax on cigarettes by $1.00 per pack. This study sought to determine if there was a significant effect on smoking prevalence in the state by examining Behavioral Risk Factor Surveillance System (BRFSS) data for two years leading up to the tax increase-2005 and 2006- and two years post tax increase -2007 and 2008. Results were compared against a chi square distribution and three multiple logistic regression models were created to adjust for race/ethnicity, age, education and income. Results from this study show that there was not a significant decrease in smoking prevalence for most of the groups stratified by age, income and ethnicity. There was not a significant decrease in the younger adults aged 18-34 by income, ethnicity, or education. Smoking prevalence increased for some groups, e.g., Hispanic females. In the regression models, the tax effect was not significant. While overall prevalence decreased by 9%, there were not significant reductions among non-White or Hispanic survey participants. Taxed sales dropped by approximately 17% according to the Texas Comptroller. Without BRFSS data measuring daily cigarette consumption among current smokers, now not assessed, it is impossible to determine whether the discrepancy in reported prevalence and taxes sales is attributable to consumption of fewer cigarettes among smokers or tax avoidance.^

Cancer screening behaviors among Asian Americans in Houston, Texas

Background: Cancer is the second-leading cause of death in the United States, and Asian Americans/Pacific Islanders are the only racial/ethnic group for which cancer is the leading cause of death. Regular cancer screenings help to identify precancerous lesions and cancer at an earlier stage, when the cancer is more treatable. Ethnic disparities in participation in cancer screenings are also striking, and evidence indicates that Asian Americans may have lower rates of cancer screening participation than other racial/ethnic groups. The Health of Houston Survey 2010 (HHS 2010) is an address-based survey, administered via telephone, website, and mail, of over 5,000 respondents in Houston and Harris County that provides recent data on the health status and needs of the Houston community. HHS 2010 researchers oversampled for Asians and Vietnamese Americans in order to obtain a sample size large enough to obtain statistical power. This dataset provides a unique opportunity to examine the cancer screening behaviors and predictors of Vietnamese and Chinese Americans living in Houston, Texas.^ Methods: This study was a secondary data analysis of HHS 2010 data. The data were analyzed to compare the breast, cervical, and colorectal cancer screening compliance rates of Vietnamese and Chinese Americans with other racial/ethnic groups in Houston, Texas. Key predictors of participation and barriers to cancer screening were identified.^ Results: The results of this study indicate that in Houston, Vietnamese Americans and Asian Americans as a whole have strikingly lower rates of participation in cancer screenings compared to other ethnic groups. Chinese Americans had the highest rate of noncompliance for mammography of all ethnic groups; Asian Americans and Vietnamese Americans also had high rates of noncompliance. Similarly, Vietnamese and Asian Americans had high rates of noncompliance with colorectal cancer screening recommendations. Importantly, Vietnamese, Chinese, and Asian Americans had by far the worst pap test participation, with noncompliance rates more than double that of all other racial/ethnic groups. In general, the findings indicated several key predictors in cancer screening behaviors, including English language proficiency, years lived in the United States, health insurance, college education, and income; however, the significance and patterns of these variables varied by ethnic group as well as cancer site.^ Conclusions: This secondary analysis highlights the disparities in cancer screening participation among Vietnamese, Chinese, and Asian Americans in Houston, Texas and indicate the need to identify Asian Americans as a high-risk group in need of health promotion attention. Barriers to screening and educational needs appear to be specific to each target ethnic group. Thus, health educators and health professionals in Houston must focus on the specific educational needs of the key ethnic groups that make up the Houston population. Further, more ethnic-specific research is needed to examine the health behaviors and needs of Houston's Asian American subgroups.^

A geographic information science (GIS) approach to conducting comparative area-level community assessments in the Texas CORD Study

This study assessed and compared sociodemographic and income characteristics along with food and physical activity assets (i.e. grocery stores, fast food restaurants, and park areas) in the Texas Childhood Obesity Research Demonstration (CORD) Study intervention and comparison catchment areas in Houston and Austin, Texas. The Texas CORD Study used a quasi-experimental study design, so it is necessary to establish the interval validity of the study characteristics by confirming that the intervention and comparison catchment areas are statistically comparable. In this ecological study, ArcGIS and Esri Business Analyst were used to spatially relate U.S. Census Bureau and other business listing data to the specific school attendance zones within the catchment areas. T-tests were used to compare percentages of sociodemographic and income characteristics and densities of food and physical activity assets between the intervention and comparison catchment areas.^ Only five variables were found to have significant differences between the intervention and comparison catchment areas: Age groups 0-4 and 35-64, the percentage of owner-occupied and renter-occupied households, and the percentage of Asian and Pacific Islander residents. All other variables showed no significant differences between the two groups. This study shows that the methodology used to select intervention and comparison catchment areas for the Texas CORD Study was effective and can be used in future studies. The results of this study can be used in future Texas CORD studies to confirm the comparability of the intervention and comparison catchment areas. In addition, this study demonstrates a methodology for describing detailed characteristics about a geographic area that practitioners, researchers, and educators can use.^

El hábitat como dimensión de la seguridad humana

La respuesta a la inseguridad se ha basado en enfoques policiales y represivos que no han dado los resultados esperados. Las causas son muchas y complejas, pero tres de ellas resultan fundamentales: la exclusión laboral ya educativa de los jóvenes y la desarticulación de las familias. Pero existen otras amenazas relacionadas con el hábitat. Este tema es objeto de estudio del proyecto Habitabilidad y seguridad humana en ambientes urbanos y rurales en el que se demuestra que las condiciones de habitabilidad determinan diferentes situaciones de seguridad y que es posible focalizar en el territorio acciones que respondan a los conflictos sociales y problemáticas del lugar. Se identifican indicadores geográficos complejos con el propósito de detectar la diversidad de situaciones que se presentan, se analizan y ponderan la fragilidad y aptitud del lugar, las modalidades de asentamiento humano y las condiciones en que vive la población. Se llega a la conclusión que el hábitat es una dimensión de la seguridad humana porque si bien el bienestar y equidad son principios de una vida sin necesidades y carencias, el sello distintivo de una vida sin temor lo da la paz, la justicia y condiciones de vida dignas en un ambiente sano y seguro.

Proyecto de Desarrollo Inteligente Departamento Burruyacu - Tucumán Propuesta integrada con distintos actores institucionales a partir de mesa de gestión territorial

El presente proyecto 'Desarrollo Inteligente del Departamento Burruyacu - Tucumán' elaborado en base a un diagnostico participativo que dio como resultado, 'ex ante', el poder identificar una realidad con una problemática de territorio, basada en las siguientes dimensiones: a) Ambientales y de infraestructura, b) Organizacionales y económicos, c) De competitividad, en las economías locales, d) Educativos y de articulación institucional. Las posibilidades de avanzar en proyectos que contemplen solo las inherentes a inversiones productivas no tenían un origen genuino en el espíritu emprendedor de los habitantes y productores de la zona Este del Departamento (Gobernador Piedrabuena, Gobernador Garmendia y 7 de Abril) pero si se pudo identificar un importante sector de potenciales productores porcinos, bovinos de carne y avícolas, - cadenas no relevantes en la zona -, más un gran número de productores agrícolas -pequeños y medianos- en plena actividad, pero con nulas experiencias en producción pecuaria. Con esto, la provincia a través de sus herramientas de políticas publicas, puso la mirada en la concepción de estos nuevos enfoques de desarrollo territorial, con proyectos que posibilitarán desarrollar con equidad y sustentabilidad dicha zona profundizando los 4 ejes estratégicos. El concepto de desarrollo de los territorios, incluidos en el ámbito rural, se ha asociado tradicionalmente a la búsqueda de viabilidad de las zonas más alejadas, poco accesibles y que sufren distintas formas de marginalidad. Sin embargo, la ruralidad ha cambiado de manera significativa. Entre los cambios identificados por diferentes autores (Sarraceno, 1994; Pérez, 2001; Echeverri y Ribeiro, 2002), se destacan: a) el incremento en la importancia de las actividades no agrícolas como generadoras de empleo e ingresos para la población rural; b) la creciente integración de los espacios urbanos y rurales; c) la importancia de integrar las preocupaciones por la gestión sostenible del ambiente y de los recursos naturales; d) las transformaciones en la institucionalidad rural; e) el reconocimiento de la importancia de nuevos actores sociales; f) las nuevas y mayores expectativas de los consumidores y de los mercados; g) el papel de las nuevas tecnologías de información y comunicación, h)la persistencia de la pobreza rural y la desigualdad, i) la persistencia de brechas regionales y sectoriales

El concepto de renta en los clásicos aplicado al estudio del conflicto agrario del año 2008

El conflicto agrario del año 2008 dividió a la sociedad argentina en sectores que apoyaron y se opusieron a la aprobación de la Resolución Nº 125 de la Secretaria de Agricultura, Ganadería. Pesca y Alimentación referida a establecer derechos de exportación móviles a la exportación de granos y derivados de la soja. La confrontación abordó, indirectamente, un clásico debate teórico en la historia económica argentina, el del origen y definición del concepto renta de la tierra y su distribución, cuestiones que incluyen como tema principal a la Renta Diferencial. La problemática abordada por diversos autores, entre los que se pueden citar trabajos recientes de Ernesto Laclau, Guillermo Flichman, Eduardo Azcuy Ameghino y Juan Iñigo Carreras, remite a los enfoques teóricos propuestos por Adam Smith, David Ricardo y Carlos Marx sobre esas cuestiones aplicados a países europeos en el siglo XIX. El objeto de este trabajo es analizar aquellos conceptos clásicos sobre la renta y contrastar los enunciados de esos enfoques teóricos con datos estadísticos referidos a la evolución de la producción y renta derivada de la producción de soja y sus derivados en las décadas inmediatamente anteriores y durante el año 2008, cuando se produjo el largo conflicto agrario. A la luz de lo señalado, se pretende analizar la vigencia y limitaciones de los enfoques teóricos tradicionales para analizar la realidad agraria presente

Dinámica macroeconómica, mercado de trabajo y distribución del ingreso en el período 2003-2005

El período post-devaluación 2003-2005 presenta una combinación de cambios y continuidades en la dinámica socioeconómica y territorial con respecto a la fase de recesión y crisis del Régimen de Convertibilidad. Se registra una significativa recuperación de la actividad socioeconómica en diversos sectores, ramas y empresas que no se traduce con el mismo vigor en los indicadores sociales sobre mercado de trabajo y pobreza, o incluso sin que se produzcan modificaciones sustantivas en los referidos a distribución del ingreso. En el territorio argentino estos procesos se reflejan a través de una desigual distribución de las inversiones y de la captación de los beneficios que el crecimiento económico genera. El presente artículo tiene como objetivos caracterizar este período a partir de un análisis de las principales variables socioeconómicas, presentar los principales debates en torno a los cambios y continuidades respecto del régimen de convertibilidad y dar cuenta de sus vinculaciones con la dinámica territorial.

La crisis económica y sus impactos sobre la política de empleo e ingresos en Argentin

La crisis global comenzó en 2008 a golpear la economía argentina y puso en cuestión nuevamente las políticas sociales y de empleo. La respuesta del gobierno fue profundizar un esquema que asume que el crecimiento podrá resolver -por sí solo- el problema del bienestar. En este trabajo nos proponemos alcanzar dos objetivos principales. Primero discutir la actual crisis y las formas en que se articula el ciclo del capital en Argentina. Segundo analizar las políticas de empleo y sostenimiento de ingresos implementadas con posterioridad al 2001, en especial aquellas que se creadas en el marco de la crisis. Con este fin se trabajará a partir de información estadística e informes y evaluaciones de los principales programas implementados: el Plan Jefes y Jefas de Hogar Desocupados, el Programa de Recuperación Productiva (REPRO) y el Plan de Ingreso Social con Trabajo "Argentina Trabaja".

El impuesto al latifundio en la provincia de Buenos Aires durante las décadas de 1940 y 1950

El propósito de este artículo es el estudio del proceso de gravamen sobre el latifundio durante las décadas de 1940 y 1950 como parte de un conjunto de políticas agrarias en torno a la propiedad y tenencia de la tierra (arrendamientos y colonización) que contemplan los niveles de producción, de acumulación y la distribución del ingreso en función de controlar el orden social y asegurar la legitimidad del poder político; articulado con el análisis de las resonancias y respuestas de las corporaciones de grandes propietarios en los contextos específicos, lo que permite una aprehensión más integral de la naturaleza y desempeño de esta clase social rural.

Ferroviarios y Zapleros en Jujuy : De la seguridad social a la inestabilidad laboral

El presente trabajo propone un recorrido analítico y comparativo conducente a identificar e interpretar cómo las transformaciones de Ferrocarriles Argentinos (FA) y Altos Hornos Zapla (AHZ) a principios de la década de 1990 afectaron las condiciones de trabajo de sus hasta entonces empleados, tanto en el aspecto material como en el simbólico-identitario. Para ello, en un primer momento, se reconstruye, brevemente, la historia de ambas empresas haciendo foco en el empleo y las condiciones laborales antes y durante los procesos de privatización o desmantelamiento, según el caso. Luego se analizan las condiciones laborales de los ahora ex empleados y se intenta identificar sus nuevas inserciones ocupacionales y las características de las mismas. En las conclusiones se recuperan las similitudes y divergencias entre ambos casos. Se observa que en su situación actual parece jugar de manera diferenciada el rol del sindicato (en el caso de FA) y el de la empresa (en AHZ), dando lugar a distinta capacidad de respuestaante la desaparición de la fuente de trabajo. Entre las conclusiones también se destaca el hecho de que, en su mayoría, los ex empleados de fa y de ahz en Jujuy no han logrado reinsertarse laboralmente en una situación similar a la que tenían en dichas empresas, generando no solo consecuencias en el plano material (para la subsistencia de ellos y sus familias) sino también en la construcción y valorización de sus identidades sociolaborales