|
Items in cart [1] |
Questions? Call 888-624-8373 |
PAPERBACK Free PDF Access |
||||||||||||||||
|
||||||||||||||||
|
||||||||||||||||
| ||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
Concerns about the well being of children
and adolescents who live in poverty have
grown as the nation has embarked on cz
major restructuring of welfare, income
support, health, and social service policies
over recent years. As such decisions are
macle, it is critical that they consider the
most current research regarding the effects
of poverty anc3 welfare clepenclency on chil-
ciren, anc3 the outcomes of efforts to inter-
vene in the lives of children anc3 their fami-
lies.
Although the attention of those who craft
welfare reform proposals has been focused
largely on the objectives of job training anc3
placement of welfare clients, the new fec3-
eral welfare law highlights the health anc3
well-being of children as outcomes that
warrant assessment in efforts to evaluate the
effects of welfare reform. And while a grow-
ing number of interdisciplinary teams are
engaged in empirical anc3 evaluation work
focused on children living in poverty anc3 in
families receiving welfare, little of this re-
search actresses issues related to physical
health anc3 nutrition.
Furthermore, although there is a broacler
research literature on the links between
income anc3 health (Newacheck et al., 1994;
Wise anc3 Meyers, 1988; Wilkinson, 1996),
as well as on low-income chilciren's access
to health care (Fossett et al., 1992), more
information is needled about this complex
relationship, including the reasons for anc3
extent of the links. Moreover, although
scientists are studying issues related to
chilciren's nutrition, their work is largely
being carried out in Third World countries.
Complicating efforts to assure health care
for impoverished children anc3 adolescents
are difficulties obtaining accurate estimates
of the number lacking health insurance.
In an effort to bring together researchers
engaged in current studies of poverty anc3
child health anc3 nutrition, to encourage
discussion of these issues, anc3 to identify the
gaps in U.S.-basec3 research in this field, the
Board on Children, Youth, anc3 Families (of
the National Research Council anc3 the
Institute of Medicine) chose this issue as the
subject of its third annual research briefing
on welfare anc3 chilciren's development.
The briefing, held in May 1997, was co-
sponsorec3 by the Family anc3 Child Well-
Being Research Network (of the National
Institute of Child Health anc3 Human De-
velopment, U.S. Department of Health anc3
Human Services).
The briefing hac3 three objectives:
· to highlight research that bears on
contemporary clebates about welfare policy
anc3 health care policy for the poor,
· to bring this research some of it
preliminary to the attention of federal anc3
state policy makers, anc3
· to consider next steps for research
that confirms some of these findings, anc3 to
explore areas of new research on the well-
being of children anc3 youth in the context
of devolving responsibility for welfare anc3
health care.
1
OCR for page 2
This report is organized around the follow-
ing three questions that emerged from the
presentations and discussions at the briefing:
.
How do income and poverty affect
the health of children and adolescents?
How does nutritional status affect
children's development?
How are children and youth affected
by changing patterns of health insurance
coverage?
Each of these Questions has been the tonic
~ . ~
ot research tor a number ot years. But as
with any research, the accumulation of
knowledge is incremental and new policy
contexts pose new questions that can chal-
lenge prior evidence. The briefing as-
sembled both well-known and new re
searchers investigating these questions to
present new findings that, collectively, can
expand the knowledge base. In some cases
their findings were generated from reanaly-
ses of existing datasets (e.g., the Infant
Health and Development Project, the Na-
tional Health Interview Survey). In other
cases, new datasets were analyzed specifi
'' r ~. a. ~
1 ~
catty tor the briefing te.g., the Add Health
Study, the Iowa Youth and Family Project,
the Community Tracking Study). Most of
these data were collected before the enact-
ment of major changes in federal welfare
and health care policy. In every case, the
researchers tried to respond to new informa-
tion requirements emerging because of con-
temporary policy changes.
In the area of child and adolescent health,
2
for example, there is new interest in exam-
ining neighborhood-level influences on
health care and health status. The ~resent
~ ~ . a. ~ ~
ers at the briefing shared an interest in ex-
amining the context in which health care is
sought and provided, and in understanding
the family processes that may mediate the
effects of both neighborhood and economic
factors on child and adolescent health. In
the area of child nutrition, emerging issues
addressed at the briefing include the re-
versability of different types and degrees of
early malnutrition, the differing conse-
quences of the developmental timing of
malnutrition, and how environmental fac-
tors interact with malnutrition to affect
development.
r
The briefing included pre-
sentat1ons trom new longitudinal and evalu-
ation research designed to address these
questions. Research on children's insurance
coverage, as a major determinant of their
access to care, is relatively new and has
received focused attention in today's policy
context. The research on this issue pre-
sented at the briefing comes from the new
Community Tracking Study, new analyses
of the National Health Interview Survey,
and a new survey of state Medicaid officials.
The briefing also featured a discussion by
state health administrators of data and re-
search needs from the perspective of state
and local officials. Comments from this
discussion are presented in quotations that
appear throughout the report. Participants'
.
· . . · .
r. 1
Ideas about topics that warrant turtner re-
search are included in a section at the end
of the report.
OCR for page 3
The research briefing also incluclec3 presen-
tations anc3 discussions of several new child
health interventions, some of which are
expected to yield data in the near future.
These projects are clescribec3 in Appenclix
A. Appenclix B contains a list of projects
monitoring the effects of welfare reform.
The presenters were selected through a
lengthy process of peer nominations, start-
ing with calls to major experts on child
poverty, health, anc3 nutrition. The goal
was to identify investigators who hac3 new
findings on the issues of concern so that the
information could move quickly from re-
searchers to policy makers. Although efforts
were macle to identify the most significant
new research at the intersection of child
poverty, health, anc3 nutrition, some rel-
evant areas of inquiry were not incluclec3 (for
example, although incidence in children of
asthma anc3 injuries can be related to pov-
erty status see Halfon anc3 Newacheck,
1993, anc3 Rivara, 1995 this report floes
not include literature on these areas because
they were not part of the research briefing)
anc3 there is uncloubtecily much more re-
search uncler way than we iclentifiec3 in our
planning process.
This summary of findings is best viewed as a
supplement to the literature on child pov-
erty, health, anc3 nutrition, rather than a
comprehensive or representative review of
current research on these issues. The report
offers important new incremental eviclence
on these topics from one of a series of re-
search briefings of the Board on Children,
Youth, anc3 Families that present work in
progress anc3 recent findings on various as-
pects of welfare anc3 chilciren's development.
3
OCR for page 4
HOW DO INCOME AND
POVERTY AFFECT THE
HEALTH OF CHILDREN AND
ADOLESCENTS?
At a time of tightening health care budgets
and enormous health system change, re-
searchers are attempting to determine the
specific ways in which poverty affects the
health of children and youth, and policy
makers are searching for the most effective
solutions to poor children's lack of health
care. Twenty-one percent of children were
poor in 1995 (U.S. Bureau of the Census,
1996~.1 The association between poverty
and poor child health outcomes has been
well documented. For example, research
has shown that low-income children were
73 percent more likely to have a severe
health condition than nonpoor children
(Newacheck, 1994~. Further studies have
found that poverty is associated with in-
creased neonatal and post-neonatal mortal-
ity rates, higher risk of injuries from acci-
dents or physical abuse and neglect, higher
risk of asthma, and lower developmental
scores in a range of tests at multiple ages
(Aber et al., 1997~. Less is known about the
mechanisms through which poverty oper
ates, which aspects of poverty are most dam
aging, and the multivariate nature of pov
erty and its effects on children and youth.
Longitudinal studies show that family
income is more strongly associated with
children's ability and achievement than
emotional outcomes, and early childhood
poverty may have an even larger impact
(Brooks-Gunn and Duncan, 1997~. Re-
searchers studying the relation between
income and poverty and the health of chil-
dren and youth have found that child
health varies by family income, with the
percentage of children and adolescents in
very good or excellent health rising as fam-
ily income increases2 (Federal Interagency
Forum on Child and Family Statistics,
1997~. Researchers have also shown that
health problems affecting children in the
United States, including iron deficiency
anemia, underweight and obesity, and
asthma, are more prevalent among the poor
(Newacheck et al., 1994; Wise and Meyers,
1988~.
Research on child health outcomes pre-
sented at the briefing addresses these issues
by focusing on the context (e.g., families,
neighborhoods, etc.) in which health care is
provided and seeking to understand how
poverty affects children's health. (The sec-
ond and third sections of this report also
1This statistic uses the official poverty line, which has been criticized for being too low (Betsen and Michael, 1997~.
2About 88 percent of children and youth in families with annual incomes of $35,000 or more were in very good or
excellent health in 1994, compared to 63 percent of children and youth in families with annual incomes under
$10,000 (Federal Interagency Forum on Child and Family Statistics, 1997~.
4
OCR for page 5
explore how poverty
influences child health
anc3 nutrition anc3
health insurance cov-
erage. ~
A study presented by
Jeanne Brooks-Gunn
of Columbia Univer-
sity examined the ef-
fect of family anc3
neighborhood income
1 1 1 1
"There has been a transition
away from being able to name
and count the problems to
wanting to know what are our
strengths, what is protective of
our problems."
Susan Nalcler, New Mexico
Department of Health
on the health care use of young children
who were born premature anc3 at low birth-
weight (Brooks-Gunn et al., 1997~. The
study used data from the Infant Health anc3
Development Program (1HDP), which in-
clucles 985 low-birthweight preterm infants
anc3 their families in eight sites across the
country; the children were seen ~ ~ times
from birth to age 8 (Gross et al., 1997~. A
quarter of the mothers were white, half were
black, anc3 the rest were I-atina. Maternal
reports about health care use, family in-
come, health insurance, anc3 family charac-
teristics were obtained when the children
were 12, 24, anc3 36 months of age. Neigh-
borhooc3 income was based on census tract
residence at time of birth. In the study, the
mothers proviclec3 information on hospital-
izations. clays spent in the hospital, doctor
visits (for well-baby
care as well as illness),
anc3 emergency room
visits in the past year.
Data were averaged
over the chills first
three years of life.
Low-birthweight chil-
ciren from poorer3
families were more
likely to be hospital-
izec3, to spend more
clays in the hospital, anc3 to have more visits
to the emergency room than low-
birthweight children from more affluent
families, taking into account all other vari-
ables, including public and private health
insurance. Number of doctor visits was not
associated with poverty status. Residence in
poor and middle-income neighborhoods was
associated with more visits to the emergency
room than residence in affluent neighbor-
hoods, independent of family-specific in-
come and all other characteristics measured
(a finding that has heretofore been largely
linked to low-income families and low-
income neighborhoods). Interestingly, the
finding about middle-income families runs
counter to the conventional wisdom that
low-income families primarily account for
3Families in the study were classified as poor or nonpoor using the 1986 U.S. poverty thresholds, based on family
income and size at the 12-month assessment (conducted in 1996~. Regarding neighborhood income, families living
in neighborhoods in which fewer than 10 percent of neighbors earned more than $30,000 were designated as poor;
families in neighborhoods in which 10 to 29 percent or more of neighbors earned $30,000 or more were designated
as middle income; and families in neighborhoods in which 30 percent or more of the neighbors earned more than
$30,000 were designated as affluent.
5
OCR for page 6
emergency room visits. Families in middle-
income neighborhoods also reported more
well-baby visits than families in poor or
affluent neighborhoods, controlling for
health insurance coverage. The study also
found that health insurance was associated
with more doctor visits for the low-birth-
weight babies, but not with hospitalizations
or emergency room use.
Based on the findings of this study. Brooks
~1 1 11
i,
Dunn and ner colleagues concluded that
among families with low-birthweight babies
not only does family income shape the pat-
tern of health care use, but the neighbor-
hood in which the family resides also plays a
role. They called for further exploration
1 . ~ . 1
into identi~vina how novertv affects chil
a variety of neighborhoods may alter the
relationship between neighborhood and
. .
emergency V1S1tS.
A study presented at the briefing by
Kathleen Mullan Harris of the University of
North Carolina looked at the effects of nov
. i'
erty anct welfare receipt on physical health
and health risk behavior among adolescents
(Harris, 1997~. The study used data from
the National Longitudinal Study of Adoles-
cent Health (Add Health), a nationally
representative sample of 12,105 adolescents
in grades 7 to 12 in the United States in
1995. The Add Health survey, which fea-
tures a school-based design, was geared to
help explain the causes of adolescent health
and health behavior. with special emphasis
,, ~
- - -- - - ~ 0 - - - r - - - ~ - - - -- - - -- - - - -- - - - ~ - - - -A - - - - r
1 ~ 1 1 1 A ~ 1 ~1 '' ~1 1 . 1 . ~
dren s health care use. As ~rooks-~unn
noted, the study suggests that reducing fam-
ily poverty might reduce emergency room
use and the number of hospitalizations
among low-birthweight babies. In contrast,
increasing the number of children with
insurance would be more likely to affect
. ... . .
routine and well-baby doctor V1S1tS. 1 bus,
this study suggests that a combination of
economic and health care policies would be
most effective in improving health care use
among poor families with low-birthweiaLt
1 1 . A 1 .1 1
babies. As children are increasingly covered
by health maintenance organizations
(HMOs) and similar plans, efforts to pre-
vent emergency room visits may increase.
The ability of HMOs to offer urgent care in
on the ettects ot the multiple influences on
adolescent life.4
Among the sample, 7,644 adolescents (63
~ ~ A.
percent' were non-~1snanic white. 2.294
is ~
~ , ,
id percept J were non-Hispanic black,
1,442 (12 percent) were Hispanic, and 667
(5 percent) were non-Hispanic other. Eigh-
teen percent of the adolescents surveyed
lived below the poverty line ($16,000 in
1995) and 29 percent lived within 150 per-
cent of poverty ($24,000~; 19 percent lived
in families that had received some form of
social welfare within the previous month.
The study found that the effects of poverty
and welfare receipt on health and risk be
4Subsequent to the research briefing, the first data from the Add Health study were released (in September 1997~.
6
OCR for page 7
havior were negative and consistent across a
range of outcomes (see Table ~ ). that is. for
, , ,
each neattn outcome, adolescents who live
below poverty experience poorer health
than nonpoor adolescents; in most cases,
the welfare poor those receiving either
Aid to Families with Dependent Children
(AFDC) or food stamps have the poorest
1 1 1 1 . 1
neattn ancr engage In the riskiest health
behavior. Specifically, adolescents living
below the poverty line had poorer general
health (as reported by the adolescents and
their parents); were more likely to miss
school due to health or emotional problems;
were more likely to have neurological im'
pairment, obesity, and asthma; and were
more likely to engage in risky behaviors
than nonpoor adolescents. The only nega'
live behavior that low income adolescents
engaged in at a lower rate than or at the
same rate as nonpoor adolescents was sub'
stance abuse (defined as use of drugs, alco'
hoi, and tobacco). This finding may indi'
care that this behavior occurs across income
lines, although different factors may account
for the same rates of use within the two
income groups. Furthermore, no differences
on any of these outcome measures were
found between adolescents who lived below
the poverty line and those living in families
who were also poor and received welfare.
Harris explained the study's findings by
noting that access to health care and insure
ance coverage differs between nonpoor and
poor adolescents, with poor adolescents
more likely to lack insurance or have
trouble obtaining medical care. Even if they
are covered by Medicaid, poor adolescents
can encounter difficulties obtaining high'
quality care (see section on health insure
ance). In addition, when low income ado'
lescents have health insurance, they are less
likely than adolescents without health in'
surance to report that they are in poor
health, but they still report poorer health
than nonpoor adolescents, according to
Harris.
Characteristics associated with increased
risks of poverty (e.g., family structure-
living with a single mother, urban residence,
minority and immigrant status) are also
1 . 1 . 1
assoc~atecr with ~ncreasecr risks of health
problems among adolescents, according to
Harris. In addition, contextual influences,
such as family interaction and parenting
behaviors, affect adolescents' health and risk
behavior. Parents in low~income families
tend to monitor their teenage children's
behavior to the same extent or more than
nonpoor parents, the study found, while
low-income parents seem to be less involved
in other dimensions of their adolescents'
lives (e.g., talking to other parents; becom'
1 1 .
ing involved in their children's school; and
5Risky behaviors include ever having sex, lack of birth control at first intercourse, lack of birth control at last
intercourse, ever having a sexually transmitted disease, excessive symptoms of depression, delinquent behavior,
violence toward another, violence as a victim, and substance abuse.
7
OCR for page 8
Table
Adolescent Health Status and Health Behavior by Poverty Status
Percent Percent
Nonpoora poorb
Percent
Welfare PoorC
Physical Health
General health fair to poor
Missed school due to health or
emotional problem
Neurological impairment
Obesity
Asthma
4.6
33.7
15.9
24.5 31.2
1.5
9.1 10.1
40.8
13.2
44.5
26.4
32.0
13.9
Health Risk Behavior
Ever had sex 35.3 47.0 48.3
Birth control at first intercourse 66.5 58.9 55.0
Birth control at last intercourse 69.8 62.5 62.5
Ever had a sexually transmitted disease 5.7 8.4 10.0
Depression 19.8 29.5 32.5
Delinquency 21.8 25.5 25.5
Violence toward others 32.0 44.2 47.5
Violence as a victim 18.4 26.0 28.1
Substance abuse 20.0 17.3 17.9
a Nonpoor adolescents live in families with incomes above the poverty line for a family of four {$ 16,000 in 1995~.
b Poor adolescents live in families with incomes below the poverty line.
c Welfare poor adolescents live in families with income below the poverty line and receipt of either AFDC or food stamps.
SOURCE: Data from Harris ~ 1 997] .
communicating with their children about
friends, personal problems, anc3 school ac-
tivities). The study also found that in fami-
lies that ate dinner together anc3 parented
clemocratically,6 aclolescents were less likely
to have sex, be clepressec3, or act violently
toward others. School anc3 neighborhood
effects, which the presentation clic3 not ex-
plore, could also play a role in explaining
the findings, Harris said; among the school
anc3 neighborhood effects that research has
shown as most promising are neighborhood
anc3 community resources such as youth
groups anc3 community centers, the quality
of schools anc3 teachers, levels of crime anc3
6Shared meals, one of the measures of "family connectedness," represent parents' involvement with their children
by virtue of their presence during the meal and the likely communication exchanged, according to Harris; demo'
cratic parenting represents a type of parenting behavior (which has beneficial eEects on most outcomes) in which
parents and adolescents jointly make decisions about the adolescent's life.
8
OCR for page 9
violence in neighborhoods, and the socio-
economic status of neighborhoods.
This study suggests that adolescent health,
broadly defined, is associated with poverty,
and that family behavior such as sharing
meals may contribute to improved out
comes among low-income adolescents. Ad-
ditiona1 longitudinal research is needed to
uncover the causal direction of these rela-
tionships and isolate parenting behaviors
that improve outcomes.
Another study, presented by K.A.S.
Wickrama of Iowa State University, ex-
plored adolescent health in a rural
economy, specifically the effect of family
economic pressure on adolescent physical
health status. The study (Conger and
Wickrama, 1997) used as its sample the
Iowa Youth and Family Project, which in-
cludes 350 white adolescents and their par-
ents in a rural, predominantly agricultural,
eight-county area in northern Iowa. Data
were collected from ~ 989 to ~ 994.
The study considered three variables-
economic pressure, parental rejection (signi-
fying parents' feelings about their children),
and adolescent physical complaints7 as
well as changes in these variables over a
period of a few years. According to the
researchers, economic pressure contributes
to the psychological well-beina of parents.
. .. .
- - O - r- - --,
and distressed parents tend to be more irri-
table, more power-assertive, less tolerant,
more rejecting, and more hostile toward
their children. Among the questions the
study asked: Does family economic pressure
during early adolescence influence parental
rejection? Does parental rejection influence
adolescent physical health? Does growth or
decline in parental rejection parallel growth
or decline in family economic pressure?
Does growth or decline in adolescent physi-
cal health parallel growth or decline in pa-
rental rejection? Does parental rejection
~ J
during early adolescence directly influence
later growth in adolescent physical health
complaints?
At the outset of the study, parental rejec-
tion was higher in families experiencing
high economic pressure and both of these
factors were associated with more physical
complaints by the adolescents. Further-
more, these dimensions of family economics
and functioning interacted over time so that
changes in adolescents' physical complaints
co-occurred with changes in economic pres-
sure and in parental rejection.
7Family economic pressure was measured by parents' responses to questions about ability to meet their basic mate'
. 1 1 r 1 . 1 1 1 . 1 1 1 1 .
~1
rial needs tor such items as a home, clothing, household items, a car, food, medical care, and recreational activities.
Parental rejection was measured by parents' and adolescents' responses to allestions aholit parents' feelings of trilst.
1 1 . r . . 1 1 . 1 .1 1
love, and satisfaction with their children. Adolescent nhvsical health status was determined bv responses to Guess
tions about common physical -~---r2~-
diarrhea, stomach aches, and skin rashes.
~/ / ~1
complaints over the past three months, including headaches, coughs, sore throats,
9
OCR for page 10
The findings presented at the workshop
confirm previous findings that illustrate an
association between poverty anc3 health.
They further suggest that community anc3
family may alter the relationship between
the two. As policy makers seek to improve
health outcomes for children anc3 families
living in poverty, findings such as these are
relevant because they suggest options for
intervention. For example, the association
between community income anc3 emergency
room visits for low- anc3 moclerate-income
low-birthweight babies suggests that inter-
ventions targeting the incliviclual overlook
the potential value in community-level
responses.
The research presented raises a diverse set of
questions for study, many of which are not
commonly brought up in discussions of
health care among the poor. What is the
role of neighborhood context in families'
access to health care? How can research
explore aspects of health care delivery (i.e.,
proximity anc3 hours of operation of physi-
cian versus hospital services), family anc3
community norms, anc3 prevailing health
behaviors? What are the likely conse
~ .
quences ot 1mprovmg access to insurance
among children with special health risks
(such as low birthweight or special health
care needs), as compared to children with-
out these special circumstances? Should
differential effects on amounts anc3 types of
health care used be anticipated?
10
The unique health risk behaviors anc3 needs
of adolescents, which appear to be worse
among the poor, raise questions about the
need to adapt tociay's institutions anc3 mech-
anisms for delivering health care for cliffer-
ent age groups. Does the location of health
care facilities anc3 the type of professionals
who provide health care affect access to anc3
effectiveness of health care for adolescents,
particularly those living in poverty? What
is the role of the family alone anc3 jointly
with health providers in promoting health
among adolescents living in high-risk com-
munities? How will recent changes in
health care delivery affect this age group,
anc3 will the effects cliffer by family income
anc3 economic composition of the neighbor-
hooc3? Will managed care contracts for the
care of adolescents take into consideration
the longstanding recognition by medical
professionals that special skills anc3 knowl-
ecige are required to treat adolescents?
Furthermore, what can be learned from
families that have successfully navigated
their way out of poverty in crafting effective
health-care programs for low-income chil-
ciren anc3 youth? Does urban poverty affect
the health of children anc3 adolescents clif-
ferently than rural poverty? What clifferent
challenges JO the geographic location of
poor populations pose to the health care
delivery system? How can racial anc3
income-basec3 disparities in health outcomes
be reclucec3?
OCR for page 11
As states contend with the redesign of
health-care delivery systems now uncler
ways amid major health system change, how
should low-income children anc3 youth, anc3
those with special needs, be tracked to en-
sure that they c30 not fall through the
cracks? How will cutbacks in state anc3 local
funding, the diversion of Meclicaic3 revenues
to managed care organizations, anc3 pro-
posec3 reductions in disproportionate share
funding uncler Medicare anc3 Meclicaic3 affect
the ability of public hospitals, teaching hos-
pitals, academic health centers, community
health centers, anc3 others who have tracli-
tionally served the poor anc3 uninsured to
continue to serve these populations?
Under the proposed Performance Partnership Grants Program, each state must negotiate a maternal and child
health action plan with the U.S. Department of Health and Human Services in 1998; the plan will include perfor'
mance objectives that are specific in terms of outcomes, processes, and capacity, and that can be achieved over 3 to
5 years.
11
OCR for page 52
Roncagliolo, M., M. Garrido, A. Williamson, B.
Lozoff, and P. Peirano
1996 Delayed maturation of auditory brainstem
. . . . . . .
responses In lron-ueflclent anemic infants.
Pediatric Research (39~:20A.
Rosenbach, M.L.
1985 Ir~surar~ce Coverage arid Ambulatory Medical
Care of Low~lr~come Children: fruited States,
1980. Series C Analytical Report No. 1.
National Medical Care Utilization Expendi
ture Survey, National Center for Health
Statistics, Public Health Service, U.S.
Department of Health and Human Services.
Rowland, D., and K. Hanson
1996 Medicaid: Moving to Managed Care.
Health Affairs 15:150-152.
Rush, David, Daniel G. Horvitz, W. Burleigh Seaver,
Jose M. Alvir, Gail C. Garbowski, Jessica Leighton,
Nancy L. Sloan, Sally S. Johnson, Richard A. Kulka,
and David S. Shanklin
1988 The National WIG Evaluation: Evaluation
of the Special Supplemental Food Program
for Women, Infants, and Children. Back
ground and introduction. American ;Iourr~al
of C lyrical Nutrition 48:389 - 393.
Scholle, S.H., K.~. Kelleher, G. Childs, I. MendeloE,
and W.P. Gardner
1997 Changes in Medicaid managed care enroll
ment among children. Health Affairs 17:
164-170.
Schonfeld-Warden, N., and C.H. Warden Walka
1997 Pediatric obesity: An overview of etiology 1997
and treatment. Pediatric Clinics of North
America 44~2~:339-361.
Short, P.F., and D.C. Leftkowitz
1992 Encouraging preventive services for low
income children: The eEect of expanding Walter,
Medicaid. MedicalCare30:766-780. 1989
Sigman, Marian
1995 Nutrition and child development: More
food for thought. Current Directions ire
P. s y c h o l o g i c a l S c i e r I c e ~ 4 ~ 2 ~ A p r i l ~ : 52 - 55.
52
Simpson, G., B. Bloom, R.A. Cohen, and P.E.
Parsons
1997 Access to Health Care. Part 1: Chillers.
National Center for Health Statistics, Vital
end Hearth Statistics. Series 10: Data from
the National Health Survey, No. 196.
Hyattsville, Md.: U.S. Department of
Health and Human Services, July.
Spillman, Brenda
1992 The impact of being uninsured on the use of
basic health care services. Inquiry (29)win-
ter 1992:457-466.
Troiano, Richard P., Katherine M. Flegal, Robert I.
Kuczmarski, Stephen M. Campbell, and Clifford L.
Johnson
1995 Overweight prevalence and trends for chil-
dren and adolescents: The National Health
and Nutrition Examination Surveys, 1963-
1991. Archives of Pediatrics arid Adolescent
Medicine 149~10~:1085-1091.
U.S. Bureau of the Census
1995 Ir~come,Poverty,ar~dValuatior~ofNor~cash
Benefits: 1993. Current Population Re
ports, Consumer Income, Series P60- 188.
Washington, D.C.: U.S. Department of
Commerce, February.
1996 Poverty in the Urlited States: 1995. Current
Population Reports, Series P60- 194. Wash
ington, D.C.: U.S. Department of Com
merce, September.
H., E. Pollitt, N. Triana, and A.B. Jahari
Early supplemental feeding and spontaneous
play in West Java, Indonesia. Paper pre
sented at meeting of Society for Research in
Child Development, Washington, D.C.,
April.
, T.
Infancy: mental and motor development.
American ;Jourrlal of Clinical Nutrition 50~3
supplement) :655 -661.
1994 EEect of iron-deficiency anemia on cogni-
tive skills in infancy and childhood.
Baillieres Clinical Haematology 7~4~:815-827.
OCR for page 53
Wilde, Parke
1997 A Monthly Cycle in Food Use by Food
Stamp Recipients. Paper presented at
research briefing, Board on Children,
Youth, and Families, May 19-20, 1997.
Cornell University.
Wilde, Parke, and Christine Ranney
1997 A Monthly Cycle in Food Expenditure and
Intake by Participants in the U.S. Food
Stamp Program. Working Paper 97-04.
Department of Agricultural, Resource, and
Managerial Economics, Cornell University,
March.
Wilkinson, Richard G.
1996 Unhealthy Societies: The Afflictions of Ir~-
equality. New York: Routledge.
Willis, E., R.M. Kliegman, I.R. Meurer, and I.M.
Perry
1997 Welfare reform and food insecurity: Influ-
ence on children. Archives of Pediatric
Adolescent Medicine 151:871 -875.
Wise, P., and A. Meyers
1988 Poverty and child health. Pediatric Clinics of
North America 35:1169-1186.
Yip, R., I. Parvanta, K. Scanlon, E.W. Borland, C.M.
Russell, and F.L. Trowhridge
1992 Pediatric nutrition surveillance system-
United States, 1980-1991. Morbidity arid
Mortality Weekly Report 41 (ss-7~:1-24.
Yudkowsky, B.K., I.D. Cartland, and S.S. Flint
1990 Pediatrician participation in Medicaid, 1978
to 1989. Pediatrics 85:567-577.
Further Reading on Child Health
and Nutrition
Board on Children, Youth, and Families and Board
on Health Promotion and Disease Prevention
1996 Paying Atter~tior~ to Chillers ire a Charging
Health Care System: Summaries of Work-
shops. National Research Council and
Institute of Medicine. Washington, D.C.:
National Academy Press.
Dallek, Geraldine
1996
Learning the Lessons of Medicaid Managed
Care. December. Washington, D.C.:
Families USA. Athttp://epn.org/families/
medaid.html; July 18, 1997.
Division of Health Care Services
1994 America's Health ire Trar~sitior~: Protecting
arid Improving Quality. Institute of Medi-
cine. Washington,D.C.: NationalAcad-
emy Press.
Earl, Robert, and Catherine E. Wotecki, eds.
1994 Iron Deficiency Anemia: Recommended
Guidelines for the Preverltiorl, Detection, arid
Marlagemerlt Among U.S. Children arid
Women of Childbearing Age. Committee on
the Prevention, Detection, and Manage-
ment of Iron Deficiency Anemia Among
U.S. Children and Women of Childbearing
Age, Institute of Medicine. Washington,
D.C.: National Academy Press.
Edmunds, Margaret, Richard Frank, Michael Hogan,
Dennis McCarty, Rhonda Robinson-Beale, and
Constance Weisner, eds.
1997 Marlagirlg Managed Care: Quality Improve-
merlt in Behavioral Health. Committee on
Quality Assurance and Accreditation
Guidelines for Managed Behavioral Health
Care, Division of Neuroscience and Behav-
ioral Health, Division of Health Care Ser-
vices, Institute of Medicine. Washington,
D.C.: National Academy Press.
Green, M., ed.
1994 Bright Futures: Guidelines for Preventive
Services for Irlfarlts, Children, arid Adoles-
cer~ts. Arlington,Va.: NationalCenter for
Education in Matemal and Child Health.
Holahan, John
1997
Expanding Insurance Coverage for Chil-
dren. May 1997. Washington, D.C.: Ur-
banInstitute. Athttp:///www.urban.org/
family/expanding.htm; July 11, 1997.
53
OCR for page 54
Koppelman, Jane
1997 Reaching Ur~ir~sured Chillers Eligible for
Medicaid arid Other Publicly Forged Ir~surar~ce
Programs: Federal arid State Issues. Issue
Brief. Washington, D.C.: National Health
Policy Forum.
Lewit, Eugene, and Linda Schuurmann Baker
1995 Health insurance coverage. The Future of
Chillers 5 (3 ~ winter: 1 - 13.
Milman, M., ed.
1993 Access to Health Care ire America. Commit-
tee on Monitoring Access to Personal
Health Care Services, Institute of Medicine.
Washington,D.C.: NationalAcademy
Press.
Newacheck, Paul W., Dana C. Hughes, and Miriam
Cisternas
1995 Children and health insurance: An over-
view of recent trends. Health Affairs 14(1
spring:244-254.
Newacheck, Paul W., Dana C. Hughes, and Jeffrey I.
Stoddard
1996 Children's access to care: Differences by
race, income, and insurance status. Pediat
rics 97~1~Ianuary:26-32.
Newacheck, Paul W., Jeffrey I. Stoddard, Dana C.
Hughes, and Michelle Pearl
1997 Children's access to health care: The role
of social and economic factors. Pp. 53-76 in
Ruth E.K. Stein, ea., Health Care for Chil-
drer~: What's Right, What's Wrong, What's
Next. New York: United Hospital Fund.
Perrin, Edward B., and Jeffrey I. Koshel, eds.
1997 Assessment of Performance Measures for
Public Health, Substance Abuse, arid Mental
Health. Panel on Performance Measures
and Data for Public Health Performance
Partnership Grants, Committee on National
Statistics, National Research Council.
Washington,D.C.: NationalAcademy
Press.
54
Schneider, Andy
1997 Reducing the Number of Ur~ir~sured Chillers:
Building Sport Medicaid Coverage is a Better
Approach Third Creating a New Block Grant
totheStates. Washington,D.C.: Center on
Budget and Policy Priorities, June 5.
Wise, Paul H.
1993 Confronting racial disparities in infant
mortality: Reconciling science and politics.
In Diane Rowley and Heather Tosteston,
eds., American ;Iourr~al of Preventive Medicine
Supplement to Vol. 9~6)November/Decem-
ber. Oxford University Press.
Further Reading on Income and
Poverty
Aber, Lawrence I., Jeanne Brooks-Gunn, and
Rebecca A. Maynard
1995 EEects of welfare reform on teenage parents
and their children. The Future of Childrer
5 ~ 2 Summer/fall 1995:53 - 71.
Bane, Mary Jo
1992 How much does poverty matter? Pp.37-44
in P.N. Van de Water and L.B. Schorr, eds.,
Security for America's Children: Proceedings
of the Fourth Corlfererlce of the National
Academy of Social Ir~surar~ce. Dubuque,
Iowa: Kendall/Hunt.
Bane, Mary Jo, and David Ellwood
1994 Welfare Realities: From Rhetoric to Reform.
Cambridge, Mass: Harvard University
Press.
Chase-Lansdale, P. Lindsay, and Jeanne Brooks-
Gunn, eds.
1995 Escape from Poverty: What Makes a Differ
er~ce for Children. New York:
Cambridge University Press.
OCR for page 55
Citro, Constance A., and Robert T. Michael, eds.
1995 Measuring Poverty: A New Approach. Panel
on Poverty and Family Assistance: Con
cepts, Information Needs and Measurement Mead, Lawrence M.
Methods,
Committee on National Statistics, National
Research Council. Washington,
D.C.: National Academy Press.
Danziger, Sheldon H., Gary D. Sandefur, and Daniel
H. Weinberg, eds.
1994 Cor~fror~tir~g Poverty: Prescriptions for
Charge. New York: Russell Sage Founda
tion, and Cambridge, Mass.: Harvard Uni
versity Press.
Duncan, Greg I., and Jeanne Brooks-Gunn, eds.
1997 Cor~sequer~ces of Growing Up Poor. New
York: Russell Sage.
Duncan, Greg I., Jeanne Brooks-Gunn, and Pamela
Klebanov
1994 Economic deprivation and early childhood 1997
development. Child Development 65:296
318.
Duncan, Greg I., Wei-Jun Young, Jeanne Brooks
Gunn, and Judith Smith
1996 Does Childhood Poverty Affect the Life
Chances of Children? Unpublished
paper. Department of Education and Social
Policy, Northwestem University.
Edin, Kathryn, and Christopher Jencks
1992 Reforming welfare. Pp. 204-234 in Christo
pher Jencks, ea., Rethir~kir~g Social Policy:
Race, Poverty, arid the Underclass. Cam
bridge, Mass.: Harvard University Press.
Huston, Aletha C., ed.
1994 Childrer~ir~Poverty. New York: Cambridge
University Press.
Huston, Aletha C., Vonnie C. McLoyd, and Cynthia
Garcia Coll
1994 Children and poverty: Issues in contempo
rary research. Child Development
65~2)April:275-282.
Korenman, S., and I. Miller
1995 Long-Term Poverty and Child Develop
ment in the United States: Results from the
NLSY. Institute for Research on Poverty
Discussion Paper 1044-94. Madison: Uni-
versity of Wisconsin.
1992 The New Politics of Poverty: The Norlworkirlg
Poor ire America. New York: Basic Books.
Moore, Kristin A., Donna Ruane Morrison, Martha
Zaslow, and Dana A. Glei
1995 Ebbing and Flowing, Learning and Growing:
Family Economic Resources and Children's
Development. Unpublished paper. Wash-
ington, D.C.: Child Trends, Inc.
Phillips, Deborah, and Anne Bridgman, eds.
1995 New Fir~dir~gs ore Children, Families, arid
Economic Self-Sufficier~cy: Summary of a
Research Briefing. Board on Children,
Youth, and Families, National Research
Council and Institute of Medicine. Wash-
ington, D.C.: National Academy Press.
New Firldirlgs on Welfare arid Childrerl's
Development: Summary of a Research Brief-
ir~g. Board on Children, Youth, and Fami-
lies, National Research Council and Insti-
tute of Medicine. Washington, D.C.: Na-
tional Academy Press.
Rainwater, Lee, and Timothy M. Smeeding
1995 Doing Poorly: The Reallr~comeofAmericar~
Children in a Comparative Perspective. Work-
ing paper #127. Department of Economics,
Syracuse University.
Shinn, Marybeth, Beth C. Weitzman, Rachel
Becker-Klein, Kirsten Cowal, Lisa Duchon, Yvonne
Rafferty, Nancy Bialo, and Judith Schteingart
1997 NYU Studies of Homeless Families. Paper
presented at research briefing, Board on
Children, Youth, and Families, May 19-20,
1997. Department of Psychology, New York
University.
U.S. Department of Health and Human Services
1996 Indicators of Welfare Deperlderlce arid Well-
Beirlg: Interim Report to Congress. Washing-
ton, D.C.: U.S. Department of Health and
Human Services, October.
55
OCR for page 56
56
OCR for page 57
BOARD ON CHILDREN, YOUTH, AND FAMILIES
JACK P. SHONKOFF (Chair), Heller Graduate School, Brandeis University
DAVID V.B. BRITT, Children's Television Workshop, New York City
LARRY BUMPASS, Center for Demography and Ecology, University of Wisconsin
FERNANDO A. GUERRA, San Antonio Metropolitan Health District, Texas
BERNARD GUYER, Department of Maternal and Child Health, Johns Hopkins University
AI-ETHA C. HUSTON, Department of Human Ecology, University of Texas, Austin
RENEE JENKINS, Department of Pediatrics and Child Health, Howard University Hospital
SARA McI-ANAHAN, Office of Population Research, Princeton University
ROBERT MICHAEI-, Harris Graduate School of Public Policy Studies, University of Chicago
PANIC NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics,
University of California, San Francisco
MARTHA PHII-I-IPS, The Concord Coalition, Washington, D.C.
JULIUS B. RICHMOND, Department of Social Medicine, Harvard University Medical School
TIMOTHY M. SANDOS, TCI Central, Inc., Denver, Colorado
DEBORAH STIPEK, Graduate School of Education, University of California, I-os Angeles
DIANA TAYLOR, Women's Health Program, Department of Family Health Care Nursing,
University of California, San Francisco
GAIL WII-ENSKY, Project Hope, Bethesda, Maryland
EVAN CHARNEY (Liaison), Council, Institute of Medicine
RUTH T. GROSS (Liaison), Board on Health Promotion and Disease Prevention, Institute of
Medicine
ELEANOR E. MACCOBY (Liaison), Commission on Behavioral and Social Sciences and
Education
DEBORAH A. PHII-I-IPS, Director
ANNE BRIDGMAN, Program Officer for Commur~icatiorts
DRUSII-I-A BARNES, Admir~istrative Associate
NANCY GEYEI-IN, Project Assistant
KAREN KUHI-THAU, Cor~sultar~t
57
OCR for page 58
PARTICIPANTS, RESEARCH BRIEFING ON POVERTY AND
CHILDREN'S HEALTH AND NUTRITION
WILLIAM G. BITHONEY, Brookciale University Hospital, State University of New York
Health Sciences Center
NTRA BONDER, Office of Chilciren's Health, Maryland Department of Health anc3 Mental
Hygiene
JEANNE BROOKS'GUNN,* Center for Children anc3 Families, Teachers College, Columbia
University
PATRICK CASEY, Center for Applied Research anc3 Evaluation anc3 Department of Pediatrics,
University of Arkansas for Medical Sciences
SUSAN CASTELLANO, Maternal anc3 Chilc3 Health Assurance, Minnesota Department of
Human Services
SALLY DAVIS, Center for Health Promotion, University of New Mexico
BARBARA DEVANEY, Mathematica Policy Research, Inc.
JEFFREY EVANS,* National Institute of Chilc3 Health anc3 Human Development, U.S.
Department of Health anc3 Human Services
AMY FINE, Association of Maternal anc3 Chilc3 Health Programs
HARRIETTE FOX, Fox Health Policy Consultants
DEBORAH FRANK, Growth anc3 Development Program, Boston Medical Center
RUTH T. GROSS, Department of Pediatrics (Emerita), Stanford University School of
Medicine
BERNARD GUYER, Department of Maternal anc3 Chilc3 Health, Johns Hopkins University
KATHLEEN MULLAN HARRIS, Carolina Population Center, University of North Carolina
at Chapel Hill
JAY HIRSCHMAN, Food anc3 Consumer Service, U.S. Department of Agriculture
ANDREA KANE, National Governors' Association
ROBERT KARP, Pediatric Resource Center of Kings County Hospital Center anc3 Chilciren's
Medical Center of State University of New York Health Science Center at Brooklyn
CLAIRE KOHRMAN. Department of Pediatrics, University of Chicago
BETSY LOZOFF, Center for Human Growth anc3 Development, University of Michigan
CINDY MANN, Center on Budget anc3 Policy Priorities
MARIE McCORMICK, Department of Maternal anc3 Chilc3 Health, Harvard School of Public
Health anc3 Department of Pediatrics, Harvard Medical School
* Members, Family and Child Well-Being Research Network, NICHD
58
OCR for page 59
MICHAEL McGINNIS, National Research Council (Scholar~in'Residence)
PEGGY McMANUS, McManus Health Policy, Inc.
KRISTIN A. MOORE,* Child Trends, Inc.
SUSAN NALDER, Maternal Child Health Epidemiology, Public Health Division, New Mexico
Department of Health
PAUL NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics,
University of California at San Francisco
ERNESTO POLLITT, Department of Pediatrics, University of California at Davis, and Visiting
Scholar, The World Bank
JAMES RESCHOVSKY, Center for Studying Health System Change
MARYBETH SHINN, Department of Psychology, New York University
MARIAN SIGMAN, Department of Psychiatry, University of California at Los Angeles
THEODORE WACHS, Department of Psychological Sciences, Purdue University
JAMES WELSH, Division of Planning and Policy and Resource Development, New York State
Department of Health
KATHY WIBBERLY, Office of Health Policy, Virginia Department of Health
K.A.S. WICKRAMA, Center for Family Research, Iowa State University
PARKE WILDE, Department of Agricultural Resource and Managerial Economics, Cornell
University
PAUL H. WISE, Department of Pediatrics, Boston Medical Center, Boston University School
of Medicine, Children's Hospital, Harvard Medical School
KATHRYN TAAFFE YOUNG, The Commonwealth Fund
Other members of the network are:
GREG J. DUNCAN, Institute for Policy Research, Northwestern University
ELIZABETH PETERS, Department of Consumer Economics and Housing, Cornell University
DESMOND K. RUNYAN, Department of Social Medicine, University of North Carolina
JAY D. TEACHMAN, Department of Human Development, Washington State University
ARLAND THORNTON, Institute for Social Research, University of Michigan
* Members, Family and Child Well'Being Research Network, NICHD
59
OCR for page 60
Other Reports from the Board on Children, Youth, and Families
Educatir~gLar~guage-Mirrority Chit~rerr (1998)
Violence ire Families: Assessing Prever~tiorr Arid Treatment Programs (1998)
Improving Schooling for L-arlguage-Mirlority Chimer: A Research Agenda (1997)
New Firrdir~gs or Welfare Arid Chit~rer`'s Development: Summary of a Research Briefing ~ 1997 ~
Youth Development arid Neighborhood frlfuerlces: Challenges arid Opportunities: Summary of a
Workshop (1996)
Paying Atter~tiorr to Chit~rerr ire a Chart g Health Care System: Summaries of a Workshop (with
the Board on Health Promotion and Disease Prevention of the Institute of Meclicine) (1996)
Beyond the Blueprint: Directions for Research or Head Start's Families: Report of Three Rourrdtable
Meetings ~ 1996)
Child Care for Low-Ir~come Families: Directions for Research: Summary of a Workshop (1996)
Service Provider Perspectives or Family Violence Ir~terver~tior~s: Proceedings of a Workshop (1995)
"Immigrant Children and Their Families: Issues for Research and Policy" in The Future of Chit-
drerr (1995)
Ir~tegratir~g Federal Statistics or Chit~rerr (with the Committee on National Statistics of the Na-
tional Research Council) ~1995)
Child Care for Low-Ir~come Families: Summary of Two Workshops (1995)
New Firrdir~gs or Chit~rerr, Families, Arid Economic Self-Sufficier~cy: Summary of a Research Briefing
(1995)
The Impact of War or Child Health ire the Countries of the Former Yugoslavia: A Workshop Sum-
mary (with the Institute of Medicine and the Office of International Affairs of the National
Research Council) ~1995)
60
OCR for page 61
Cultural Diversity Arid Early Education: Report of a Workshop (1994)
Benefits Arid Systems of Care for Maternal Arid Child Health: Workshop Highlights (with the Board
on Health Promotion and Disease Prevention of the Institute of Meclicine) (1994)
Protecting and Improving the Quality of Care for Children Under Health Care Reform: Workshop
Highlights (with the Board on Health Promotion and Disease Prevention of the Institute of
Meclicine) (1994)
America's Fathers Arid Public Policy: Report of a Workshop (1994)
Violence Arid the American Family: Report of a Workshop (1994)
61
OCR for page 62
The National Academy of Sciences is a private, nonprofit, self~perpetuating society of distin'
guished scholars engaged in scientific and engineering research, dedicated to the furtherance of
science and technology and to their use for the general welfare. Upon the authority of the char-
ter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise
the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of
the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the Na'
tional Academy of Sciences, as a parallel organization of outstanding engineers. It is autono'
mous in its administration and in the selection of its members, sharing with the National Acad-
emy of Sciences the responsibility for advising the federal government. The National Academy
of Engineering also sponsors engineering programs aimed at meeting national needs, encourages
education and research, and recognizes the superior achievements of engineers. Dr. William A.
Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to
secure the services of eminent members of appropriate professions in the examination of policy
matters pertaining to the health of the public. The Institute acts under the responsibility given
to the National Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identify issues of medical care, research, and educa-
tion. Dr. Kenneth T. Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in I 9 1 6 to
associate the broad community of science and technology with the Academy's purposes of fur'
thering knowledge and advising the federal government. Functioning in accordance with gen-
eral policies determined by the Academy, the Council has become the principal operating
agency of both the National Academy of Sciences and the National Academy of Engineering
in providing services to the government, the public, and the scientific and engineering commu-
nities. The Council is administered jointly by both Academies and the Institute of Medicine.
Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of
the National Research Council.
62
Representative terms from entire chapter:
child health
