Original Research

@article{bor_infective_2013,

title = {Infective endocarditis in the UṠ., 1998-2009: a nationwide study.},

author = {David H. Bor and Steffie Woolhandler and Rachel Nardin and John Brusch and David U. Himmelstein},

doi = {10.1371/journal.pone.0060033},

issn = {1932-6203},

year  = {2013},

date = {2013-01-01},

journal = {PloS one},

volume = {8},

number = {3},

pages = {e60033},

abstract = {BACKGROUND: Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates. METHODS AND FINDINGS: Using the 1998-2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness. CONCLUSIONS: Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_cost_2012,

title = {Cost control in a parallel universe: Medicare spending in the United States and Canada.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.1001/2013.jamainternmed.272},

issn = {1538-3679 0003-9926},

year  = {2012},

date = {2012-12-01},

journal = {Archives of internal medicine},

volume = {172},

number = {22},

pages = {1764–1766},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nardin_medical_2012,

title = {Medical spending and global budgets.},

author = {Rachel Nardin and David Himmelstein and Stephanie Woolhandler},

doi = {10.1377/hlthaff.2012.1100},

issn = {2694-233X 0278-2715},

year  = {2012},

date = {2012-11-01},

journal = {Health affairs (Project Hope)},

volume = {31},

number = {11},

pages = {2592; author reply 2592},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_access_2012,

title = {Access to care after Massachusetts' health care reform: a safety net hospital patient survey.},

author = {Danny McCormick and Assaad Sayah and Hermione Lokko and Steffie Woolhandler and Rachel Nardin},

doi = {10.1007/s11606-012-2173-7},

issn = {1525-1497 0884-8734},

year  = {2012},

date = {2012-11-01},

journal = {Journal of general internal medicine},

volume = {27},

number = {11},

pages = {1548–1554},

abstract = {BACKGROUND: Massachusetts' health care reform substantially decreased the percentage of uninsured residents. However, less is known about how reform affected access to care, especially according to insurance type. OBJECTIVE: To assess access to care in Massachusetts after implementation of health care reform, based on insurance status and type. DESIGN AND PARTICIPANTS: We surveyed a convenience sample of 431 patients presenting to the Emergency Department of Massachusetts' second largest safety net hospital between July 25, 2009 and March 20, 2010. MAIN MEASURES: Demographic and clinical characteristics, insurance coverage, measures of access to care and cost-related barriers to care. KEY RESULTS: Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newly-acquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced cost-related barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more cost-related barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured. CONCLUSIONS: Access to care improved less than access to insurance following Massachusetts' health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; cost-related barriers to access were worse for these patients than for the privately insured.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_concurrent_2012,

title = {Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study.},

author = {Amy Nunn and Samuel Dickman and Alexandra Cornwall and Helena Kwakwa and Kenneth H. Mayer and Aadia Rana and Cynthia Rosengard},

doi = {10.1071/SH11099},

issn = {1448-5028 1449-8987},

year  = {2012},

date = {2012-07-01},

journal = {Sexual health},

volume = {9},

number = {3},

pages = {288–296},

abstract = {BACKGROUND: African American women are disproportionately affected by HIV/AIDS. Concurrent sexual partnerships may contribute to racial disparities in HIV infection. Little is known about attitudes and practices related to concurrency among African American women, or the social, structural and behavioural factors influencing concurrency. METHODS: We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public clinic in Philadelphia in 2009. We conducted interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioural factors influencing concurrent sexual partnerships, guided by grounded theory. RESULTS: Seventeen women reported one main and one or more non-main partners; two reported no main partners. Many women used condoms more frequently with non-main than main partners, noting they trust main partners more than non-main partners. Social factors included social normalisation of concurrency, inability to negotiate partners' concurrent partnerships, being unmarried, and not trusting partners. Lack of trust was the most commonly cited reason that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners' dependence on women for economic support and incarceration that interrupted partnerships. Behavioural factors included alcohol and cocaine use. CONCLUSIONS: Social, structural and behavioural factors strongly influenced these African American women's concurrent sexual partnerships. Many HIV interventions disseminated by the CDC focus largely on behavioural factors and may fail to address the social and structural factors influencing African American women's sexual networks. Novel HIV prevention interventions that address the social determinants of African American women's HIV risks are urgently needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hanchate_massachusetts_2012,

title = {Massachusetts reform and disparities in inpatient care utilization.},

author = {Amresh D. Hanchate and Karen E. Lasser and Alok Kapoor and Jennifer Rosen and Danny McCormick and Meredith M. D'Amore and Nancy R. Kressin},

doi = {10.1097/MLR.0b013e31824e319f},

issn = {1537-1948 0025-7079},

year  = {2012},

date = {2012-07-01},

journal = {Medical care},

volume = {50},

number = {7},

pages = {569–577},

abstract = {BACKGROUND: The 2006 Massachusetts health reform substantially decreased uninsurance rates. Yet, little is known about the reform's impact on actual health care utilization among poor and minority populations, particularly for receipt of inpatient surgical procedures that are commonly initiated by outpatient physician referral. METHODS: Using discharge data on Massachusetts hospitalizations for 21 months before and after health reform implementation (7/1/2006-12/31/2007), we identified all nonobstetrical major therapeutic procedures for patients aged 40 or older and for which ≥70% of hospitalizations were initiated by outpatient physician referral. Stratifying by race/ethnicity and patient residential zip code median (area) income, we estimated prereform and postreform procedure rates, and their changes, for those aged 40-64 (nonelderly), adjusting for secular changes unrelated to reform by comparing to corresponding procedure rate changes for those aged 70 years and above (elderly), whose coverage (Medicare) was not affected by reform. RESULTS: Overall increases in procedure rates (among 17 procedures identified) between prereform and postreform periods were higher for nonelderly low area income (8%},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{dumont_public_2012,

title = {Public health and the epidemic of incarceration.},

author = {Dora M. Dumont and Brad Brockmann and Samuel Dickman and Nicole Alexander and Josiah D. Rich},

doi = {10.1146/annurev-publhealth-031811-124614},

issn = {1545-2093 0163-7525},

year  = {2012},

date = {2012-04-01},

journal = {Annual review of public health},

volume = {33},

pages = {325–339},

abstract = {An unprecedented number of Americans have been incarcerated in the past generation. In addition, arrests are concentrated in low-income, predominantly nonwhite communities where people are more likely to be medically underserved. As a result, rates of physical and mental illnesses are far higher among prison and jail inmates than among the general public. We review the health profiles of the incarcerated; health care in correctional facilities; and incarceration's repercussions for public health in the communities to which inmates return upon release. The review concludes with recommendations that public health and medical practitioners capitalize on the public health opportunities provided by correctional settings to reach medically underserved communities, while simultaneously advocating for fundamental system change to reduce unnecessary incarceration.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wallace_protein_2012,

title = {Protein phosphatase 2A regulates innate immune and proteolytic responses to cigarette smoke exposure in the lung.},

author = {Alison M. Wallace and Andrew Hardigan and Patrick Geraghty and Shaneeza Salim and Adam Gaffney and Jincy Thankachen and Leo Arellanos and Jeanine M. D'Armiento and Robert F. Foronjy},

doi = {10.1093/toxsci/kfr351},

issn = {1096-0929 1096-6080},

year  = {2012},

date = {2012-04-01},

journal = {Toxicological sciences : an official journal of the Society of Toxicology},

volume = {126},

number = {2},

pages = {589–599},

abstract = {Protein phosphatase 2A (PP2A) is the primary serine-threonine phosphatase of eukaryotic cells, and changes in its activity have been linked to neoplastic and neurodegenerative diseases. However, the role of PP2A in noncancerous lung diseases such as chronic obstructive pulmonary disease (COPD) has not been previously examined. This study determined that PP2A activity was significantly increased in the lungs of advanced emphysema subjects compared with age-matched controls. Furthermore, we found that cigarette smoke exposure increases PP2A activity in mouse lung in vivo and in primary human small airway epithelial (SAE) cells in vitro. In mice, intratracheal transfection of PP2A protein prior to cigarette smoke exposure prevented acute smoke-induced lung inflammation. Conversely, inhibiting PP2A activity during smoke exposure exacerbated inflammatory responses in the lung. To further determine how PP2A modulates the responses to cigarette smoke in the lung, enzyme levels were manipulated in SAE cells using protein transfection and short hairpin RNA (shRNA) techniques. Increasing PP2A activity in SAE cells via PP2A protein transfection downregulated cytokine expression and prevented the induction of proteases following cigarette smoke extract (CSE) treatment. Conversely, decreasing enzymatic activity by stably transfecting SAE cells with shRNA for the A subunit of PP2A exacerbated these smoke-mediated responses. This study establishes that PP2A induction by cigarette smoke modulates immune and proteolytic responses to cigarette smoke exposure. Together, these findings suggest that manipulation of PP2A activity may be a plausible means to treat COPD and other inflammatory diseases.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_giving_2012,

title = {Giving office-based physicians electronic access to patients' prior imaging and lab results did not deter ordering of tests.},

author = {Danny McCormick and David H. Bor and Stephanie Woolhandler and David U. Himmelstein},

doi = {10.1377/hlthaff.2011.0876},

issn = {2694-233X 0278-2715},

year  = {2012},

date = {2012-03-01},

journal = {Health affairs (Project Hope)},

volume = {31},

number = {3},

pages = {488–496},

abstract = {Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_african_2012,

title = {African American patient experiences with a rapid HIV testing program in an urban public clinic.},

author = {Amy Nunn and Whitney Eng and Alexandra Cornwall and Curt Beckwith and Samuel Dickman and Timothy Flanigan and Helena Kwakwa},

doi = {10.1016/s0027-9684(15)30125-5},

issn = {0027-9684},

year  = {2012},

date = {2012-02-01},

journal = {Journal of the National Medical Association},

volume = {104},

number = {1-2},

pages = {5–13},

abstract = {BACKGROUND: Of 1174 new human immunodeficiency virus (HIV) cases diagnosed in Philadelphia, Pennsylvania, in 2008, a total of 771 (66%) were among African Americans. Philadelphia recently introduced a citywide rapid HIV testing program in public clinics. METHODS: We conducted a qualitative study among 60 African Americans undergoing rapid HIV testing in one of Philadelphia's public clinics located in a zip code with high HIV incidence. Employing grounded theory, we used semistructured interviews to assess patients' motivations, perceptions, and clinical experiences with rapid HIV testing. Interviews were transcribed and coded; 20% were double coded to enhance reliability. RESULTS: Primary motivations for undergoing rapid HIV testing included: testing during routine clinical care, presenting for care with symptomatic sexually transmitted infections or opportunistic infections, knowing someone living with HIV/ AIDS, and perceiving oneself at risk for HIV. Most patients reported positive experiences with rapid testing and preferred it to conventional testing because it eliminated the need for return visits and decreased anxiety; however, many expressed concerns about accuracy of rapid HIV testing. Barriers to HIV testing among this population included low self-perceived risk, HIV stigma, and reported homophobia in respondents' communities. CONCLUSION: This rapid testing program was acceptable, convenient, and preferred over conventional HIV testing. Providing educational information about rapid and confirmatory HIV testing may further enhance acceptability of rapid HIV testing in this population. Nationwide expansion of rapid HIV testing in public health centers is an important and acceptable means of achieving President Obama's National AIDS Strategy goals of reducing racial disparities in HIV infection and improving linkage to HIV/AIDS treatment and care services.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nardin_reasons_2012,

title = {Reasons why patients remain uninsured after Massachusetts' health care reform: a survey of patients at a safety-net hospital.},

author = {Rachel Nardin and Assaad Sayah and Hermione Lokko and Steffie Woolhandler and Danny McCormick},

doi = {10.1007/s11606-011-1868-5},

issn = {1525-1497 0884-8734},

year  = {2012},

date = {2012-02-01},

journal = {Journal of general internal medicine},

volume = {27},

number = {2},

pages = {250–256},

abstract = {BACKGROUND: Following the 2006 Massachusetts health care reform, an estimated 316,492 residents remain uninsured. However, there have been no published studies that examine why Massachusetts residents remain uninsured four years into health reform. OBJECTIVE: To describe the characteristics of uninsured patients seeking acute medical care in Massachusetts after implementation of health care reform and reasons for lacking insurance. DESIGN AND PARTICIPANTS: We performed an in-person survey of a convenience sample of patients visiting the emergency department of the state's second largest safety net hospital between July 25, 2009 and March 20, 2010. We interviewed 431 patients age 18-64, 189 of whom were uninsured. MAIN MEASURES: Demographic and clinical characteristics, employment and insurance history, reasons for lacking insurance and views of the state's new "individual mandate". KEY RESULTS: The uninsured were largely employed (65.9%), but only a quarter (25.1%) of the employed uninsured had access to employer-sponsored insurance. The majority qualified for subsidized insurance (85.7% earned ≤ 300% of the federal poverty level), yet many reported being unable to find affordable insurance (32.7%). Over a third (35.2%) were uninsured because they had lost insurance due predominantly to job loss or policy cancellation. For nearly half of the uninsured (48.6%), the individual mandate had motivated them to try to find insurance, but they were unable to find insurance they could afford. CONCLUSIONS: After full implementation of the Massachusetts health reform, those remaining without insurance are largely the working poor who do not have access to, or cannot afford, either employer sponsored insurance or state subsidized insurance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_computed_2012,

title = {Computed tomography associated cancers and cancer deaths following visits to UṠ. emergency departments.},

author = {Leah Zallman and Steffie Woolhandler and David Himmelstein and David H. Bor and Danny McCormick},

doi = {10.2190/HS.42.4.b},

issn = {0020-7314},

year  = {2012},

date = {2012-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {42},

number = {4},

pages = {591–605},

abstract = {We estimated the number of future cancers and cancer deaths following computed tomography scans (CTs) performed in U.S. emergency departments annually and determined whether increases in the proportion of visits resulting in CTs over the past decade were accompanied by changes in markers of severity of illness or primary reason for visit. We applied national estimates of effective dose to adult emergency department visits in the 2008 National Hospital Ambulatory Medical Care Survey. We utilized the Biologic Effects of Ionizing Radiation Model VII to estimate the number of future cancers and cancer deaths caused by CTs performed in U.S. emergency departments. We calculated the proportion of visits resulting in CTs from 1998 to 2008. In 2008, 16,406,921 CTs were performed nationally on adults, which will cause an estimated 3,750 cancers and 1,994 cancer deaths. The increasing proportion of emergency department visits resulting in CTs was not accompanied by proportional increases in markers of severity of illness or primary reason for visit. The substantial number of future cancers and cancer deaths attributable to CTs and increases in CTs without accompanying increases in markers of severity or changes in primary reason for visit highlight the importance of examining the benefits of CTs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_impacts_2012,

title = {The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: a comparative analysis.},

author = {Amy Nunn and Samuel Dickman and Nicoli Nattrass and Alexandra Cornwall and Sofia Gruskin},

doi = {10.1080/17441692.2012.736681},

issn = {1744-1706 1744-1692},

year  = {2012},

date = {2012-01-01},

journal = {Global public health},

volume = {7},

number = {10},

pages = {1031–1044},

abstract = {Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_response_2012,

title = {Response to the Institute of Medicine's recommendation that cost determine insurance policies' "essential benefits".},

author = {David Himmelstein},

doi = {10.2190/HS.42.3.n},

issn = {0020-7314},

year  = {2012},

date = {2012-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {42},

number = {3},

pages = {571–573},

abstract = {An open letter to U.S. Secretary of Health and Human Services Kathleen Sebelius, signed by 2,425 individuals, including 1,280 U.S. physicians, protests the recommendations of an Institute of Medicine committee on the "essential benefits package" to be offered by health plans under the 2010 federal health reform act. The letter also criticizes conflicts of interest in the Institute of Medicine committee, which includes executives from two of the nation's largest health insurance firms and a major donor to the Institute.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{trigg_medication-assisted_2012,

title = {Medication-assisted therapy for opioid-dependent incarcerated populations in New Mexico: statewide efforts to increase access.},

author = {Bruce G. Trigg and Samuel L. Dickman},

doi = {10.1080/08897077.2011.611455},

issn = {1547-0164 0889-7077},

year  = {2012},

date = {2012-01-01},

journal = {Substance abuse},

volume = {33},

number = {1},

pages = {76–84},

abstract = {An acute awareness of the profound social and medical costs associated with heroin and opiate addiction in New Mexico has led a group of advocates from public health, state and local governments, corrections, academia, and community activists to collaborate for the purpose of increasing access to medication-assisted therapy (MAT) with buprenorphine and methadone in New Mexico. This paper describes these collaborations, with a focus on the evolution of harm reduction approaches to substance abuse disorders and successful efforts to make MAT available to incarcerated persons.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{harris_rate_2012,

title = {Rate of community methadone treatment reporting at jail reentry following a methadone increased dose quality improvement effort.},

author = {Andiea Harris and Daniel Selling and Charles Luther and Jason Hershberger and Joan Brittain and Samuel Dickman and Alvin Glick and Joshua D. Lee},

doi = {10.1080/08897077.2011.620479},

issn = {1547-0164 0889-7077},

year  = {2012},

date = {2012-01-01},

journal = {Substance abuse},

volume = {33},

number = {1},

pages = {70–75},

abstract = {The Rikers Island Key Extended Entry Program (KEEP) has offered methadone treatment for opioid dependent inmates incarcerated in New York City's jails since 1986. In response to a trend toward low-dose methadone maintenance prescribing, a quality improvement (QI) protocol trained KEEP counselors, physicians, and pharmacists in the evidence base supporting moderate-to-high methadone maintenance doses in order to maximize therapeutic effects and rates of successful reporting to community methadone treatment programs (MTPs) post release. Discharge dose level and length of incarceration data were analyzed for 2 groups of KEEP patients discharged pre/post-QI. Among patients incarcerated for 21 or more days, the proportion of those on moderate-to-high doses of methadone increased significantly. Patients who reached a moderate-to-high methadone dose demonstrated higher rates of reporting to community MTP versus lower doses, both pre- and post-QI. Overall, a higher proportion of all patients reported to community MTP post-QI.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mckenzie_randomized_2012,

title = {A randomized trial of methadone initiation prior to release from incarceration.},

author = {Michelle McKenzie and Nickolas Zaller and Samuel L. Dickman and Traci C. Green and Amisha Parihk and Peter D. Friedmann and Josiah D. Rich},

doi = {10.1080/08897077.2011.609446},

issn = {1547-0164 0889-7077},

year  = {2012},

date = {2012-01-01},

journal = {Substance abuse},

volume = {33},

number = {1},

pages = {19–29},

abstract = {Individuals who use heroin and illicit opioids are at high risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens, as well as incarceration. The purpose of the randomized trial reported here is to compare outcomes between participants who initiated methadone maintenance treatment (MMT) prior to release from incarceration, with those who were referred to treatment at the time of release. Participants who initiated MMT prior to release were significantly more likely to enter treatment postrelease (P < .001) and for participants who did enter treatment, those who received MMT prerelease did so within fewer days (P = .03). They also reported less heroin use (P = .008), other opiate use (P = .09), and injection drug use (P = .06) at 6 months. Initiating MMT in the weeks prior to release from incarceration is a feasible and effective way to improve MMT access postrelease and to decrease relapse to opioid use.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cohen_use_2012,

title = {Use of a pharmaceutically adulterated dietary supplement, Pai You Guo, among Brazilian-born women in the United States.},

author = {Pieter A. Cohen and Carly Benner and Danny McCormick},

doi = {10.1007/s11606-011-1828-0},

issn = {1525-1497 0884-8734},

year  = {2012},

date = {2012-01-01},

journal = {Journal of general internal medicine},

volume = {27},

number = {1},

pages = {51–56},

abstract = {BACKGROUND: Pai You Guo is a weight loss supplement manufactured in China and adulterated with the banned pharmaceutical products sibutramine and phenolphthalein. The US Food and Drug Administration (FDA) announced a voluntary recall of Pai You Guo in 2009, yet clinicians have noted its continued use among Brazilian-born women in Massachusetts. OBJECTIVE: To assess prevalence of Pai You Guo use, associated side effects, modes of acquisition, and impact of FDA regulatory action on these outcomes. DESIGN: Cross-sectional study using an anonymous questionnaire. PARTICIPANTS: Women ≤60 years of age, born in Brazil who attended one primary care clinic or one of six churches in Massachusetts. MAIN MEASURES: Prevalence of use, how users first heard about the product, location of purchase, associated side effects, patterns of use before and after the FDA recall. KEY RESULTS: Twenty-three percent (130/565) of respondents reported using Pai You Guo. In multivariate analysis, obesity (adj OR 3.7, p-value <0.001) and lack of insurance (adj OR 2.6, p-value 0.005) were associated with use. The majority of users (85%) reported at least one side effect. Dry mouth (59%), anxiety (29%), and insomnia (26%) were most commonly reported adverse effects. Nearly thirty-percent of users (38/130) purchased Pai You Guo from local stores and 9% (11/130) purchased it over the Internet. The majority of respondents (79/130; 61%) purchased Pai You Guo after the FDA recall. No respondent was aware of the FDA recall. CONCLUSIONS: Use of this pharmaceutically adulterated supplement is common among Brazilian-born women in Massachusetts. The FDA alerts and recall did not appear to decrease its use.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{rich_adverse_2011,

title = {An Adverse Reaction to Buprenorphine/Naloxone Induction in Prison: A Case Report.},

author = {Josiah D. Rich and Michelle McKenzie and Samuel Dickman and Jeffrey Bratberg and Joshua D. Lee and Robert P. Schwartz},

doi = {10.1097/ADT.0b013e3182133949},

issn = {1531-5754 1535-1122},

year  = {2011},

date = {2011-12-01},

journal = {Addictive disorders & their treatment},

volume = {10},

number = {4},

pages = {199–200},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_social_2011,

title = {Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia.},

author = {Amy Nunn and Samuel Dickman and Alexandra Cornwall and Cynthia Rosengard and Helena Kwakwa and Daniel Kim and George James and Kenneth H. Mayer},

doi = {10.1080/09540121.2011.565030},

issn = {1360-0451 0954-0121},

year  = {2011},

date = {2011-11-01},

journal = {AIDS care},

volume = {23},

number = {11},

pages = {1392–1399},

abstract = {African Americans face disproportionately higher risks of HIV infection. Concurrent sexual relationships, or sexual partnerships that overlap in time, are more common among African Americans than individuals of other races and may contribute to racial disparities in HIV infection. However, little is known about attitudes, norms and practices among individuals engaged in concurrent partnerships. Little is also known about the processes through which structural, behavioral, and social factors influence concurrent sexual relationships. We recruited 24 heterosexual African American men involved in concurrent sexual relationships from a public health clinic in Philadelphia. We conducted in-depth interviews exploring these men's sexual practices; social norms and individual attitudes about concurrency; perceived sexual health risks with main and non-main partners; and the social, structural, and behavioral factors contributing to concurrent sexual relationships. Twenty-two men reported having one main and one or more non-main partners; two reported having no main partners. Respondents generally perceived sexual relationships with non-main partners as riskier than relationships with main partners and used condoms far less frequently with main than non-main partners. Most participants commented that it is acceptable and often expected for men and women to engage in concurrent sexual relationships. Social factors influencing participants' concurrent partnerships included being unmarried and trusting neither main nor non-main partners. Structural factors influencing concurrent partnerships included economic dependence on one or more women, incarceration, unstable housing, and unemployment. Several men commented that individual behavioral factors such as alcohol and cocaine use contributed to their concurrent sexual partnerships. Future research and interventions related to sexual concurrency should address social and structural factors in addition to conventional HIV risk-taking behaviors.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hochman_endpoint_2011,

title = {Endpoint selection and relative (versus absolute) risk reporting in published medication trials.},

author = {Michael Hochman and Danny McCormick},

doi = {10.1007/s11606-011-1813-7},

issn = {1525-1497 0884-8734},

year  = {2011},

date = {2011-11-01},

journal = {Journal of general internal medicine},

volume = {26},

number = {11},

pages = {1246–1252},

abstract = {BACKGROUND: The use of surrogate and composite endpoints, disease-specific mortality as an endpoint, and relative (rather than absolute) risk reporting in clinical trials may produce results that are misleading or difficult to interpret. OBJECTIVE: To describe the prevalence of these endpoints and of relative risk reporting in medication trials. DESIGN AND MAIN MEASURES: We analyzed all randomized medication trials published in the six highest impact general medicine journals between June 1, 2008 and September 30, 2010 and determined the percentage using these endpoints and the percentage reporting results in the abstract exclusively in relative terms. KEY RESULTS: We identified 316 medication trials, of which 116 (37%) used a surrogate primary endpoint and 106 (34%) used a composite primary endpoint. Among 118 trials in which the primary endpoint involved mortality, 32 (27%) used disease-specific mortality rather than all-cause mortality. Among 157 trials with positive results, 69 (44%) reported these results in the abstract exclusively in relative terms. Trials using surrogate endpoints and disease-specific mortality as an endpoint were more likely to be exclusively commercially funded (45% vs. 29%, difference 15% [95% CI 5%-26%]},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{roelofs_qualitative_2011,

title = {A qualitative investigation of Hispanic construction worker perspectives on factors impacting worksite safety and risk.},

author = {Cora Roelofs and Linda Sprague-Martinez and Maria Brunette and Lenore Azaroff},

doi = {10.1186/1476-069X-10-84},

issn = {1476-069X},

year  = {2011},

date = {2011-09-01},

journal = {Environmental health : a global access science source},

volume = {10},

pages = {84},

abstract = {BACKGROUND: Hispanic workers have higher rates of injury and death on construction worksites than workers of other ethnicities. Language barriers and cultural differences have been hypothesized as reasons behind the disparate rates. METHODS: We conducted two series of focus groups with union and non-union Hispanic construction workers to ask them about their perceptions of the causes for the unequal rates. Spanish transcripts were translated and coded in QSR NVivo software for common themes. RESULTS: Workers reported a difficult work environment characterized by supervisor pressure, competition for jobs and intimidation with regard to raising safety concerns. Language barriers or cultural factors were not strongly represented as causative factors behind the rates. CONCLUSION: The results of this study have informed the development of an intervention trial that seeks to prevent falls and silica dust exposure by training contractors employing Hispanic construction workers in the elements of safety leadership, including building respect for their Hispanic workers and facilitating their participation in a safety program.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{boyd_crisis_2011,

title = {The crisis in mental health care: a preliminary study of access to psychiatric care in Boston.},

author = {J. Wesley Boyd and Andrew Linsenmeyer and Steffie Woolhandler and David U. Himmelstein and Rachel Nardin},

doi = {10.1016/j.annemergmed.2011.03.053},

issn = {1097-6760 0196-0644},

year  = {2011},

date = {2011-08-01},

journal = {Annals of emergency medicine},

volume = {58},

number = {2},

pages = {218–219},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_results_2011,

title = {Results of a community-university partnership to reduce deadly hazards in hardwood floor finishing.},

author = {Lenore S. Azaroff and Hoa Mai Nguyen and Tuan Do and Rebecca Gore and Marcy Goldstein-Gelb},

doi = {10.1007/s10900-011-9357-7},

issn = {1573-3610 0094-5145},

year  = {2011},

date = {2011-08-01},

journal = {Journal of community health},

volume = {36},

number = {4},

pages = {658–668},

abstract = {A community-university partnership used community-based participatory research (CBPR) to design, implement, and evaluate a multi-cultural public health campaign to eliminate flammable products and reduce use of products high in volatile organic compounds (VOCs) in hardwood floor finishing in Massachusetts. Leading participants were Vietnamese-American organizations and businesses. Following the public health campaign, a multi-lingual survey of self-reported experiences with fires, product use, exposure to outreach activities, and changes made, was conducted with floor finishers. One hundred nine floor finishers responded. Over 40% reported fires at their companies' jobs, mostly caused by lacquer sealers. Over one third had heard radio or TV shows about health and safety in floor finishing, and over half reported making changes as a result of outreach. Exposure to various outreach activities was associated with reducing use of flammable products, increasing use of low-VOC products, and greater knowledge about product flammability. However, most respondents still reported using flammable products. Outreach led by community partners reached large proportions of floor finishers, was associated with use of safer products, and adds to recent work on CBPR with immigrant workers. Continued use of flammable products supports the belief that an enforceable ban was ultimately necessary to eradicate them.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_low_2011,

title = {Low perceived risk and high HIV prevalence among a predominantly African American population participating in Philadelphia's Rapid HIV testing program.},

author = {Amy Nunn and Nickolas Zaller and Alexandra Cornwall and Kenneth H. Mayer and Elya Moore and Samuel Dickman and Curt Beckwith and Helena Kwakwa},

doi = {10.1089/apc.2010.0313},

issn = {1557-7449 1087-2914},

year  = {2011},

date = {2011-04-01},

journal = {AIDS patient care and STDs},

volume = {25},

number = {4},

pages = {229–235},

abstract = {African Americans are disproportionately infected with HIV/AIDS. Despite Centers for Disease Control and Prevention (CDC) guidelines recommending routine opt-out testing for HIV, most HIV screening is based on self-perceived HIV risks. Philadelphia launched a rapid HIV testing program in seven public health clinics in 2007. The program provides free rapid oral HIV tests to all patients presenting for health services who provide informed consent. We analyzed demographic, risk behavior, and HIV serostatus data collected during the program between September 2007 and January 2009. We used multivariable logistic regression to estimate the association between behavioral and demographic factors and newly diagnosed HIV infection. Of the 5871 individuals testing for HIV, 47% were male, 88% were African American, and the mean age was 34.7 years. Overall HIV prevalence was 1.1%. All positive tests represented new HIV diagnoses, and 72% of individuals reported testing previously. Approximately 90% of HIV-positive individuals and 92% of individuals with more than five recent sex partners never, or only sometimes, used condoms. Two thirds of individuals testing positive and 87% of individuals testing negative assessed their own HIV risk as zero or low. Individuals reporting cocaine use and ever having a same sex partner both had 2.6 times greater odds of testing positive. Condom use in this population was low, even among high-risk individuals. Philadelphia's program successfully provided HIV testing to many underserved African Americans who underestimate their HIV risk. Our results nevertheless suggest greater efforts are needed to encourage more individuals to undergo HIV testing in Philadelphia, particularly those who have never tested.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_getting_2010,

title = {Getting to Know You: Occupational Health Researchers Investigate Employee Assistance Professionals' Approaches to Workplace Stress.},

author = {Lenore S. Azaroff and Nicole J. Champagne and Suzanne Nobrega and Karishma Shetty and Laura Punnett},

doi = {10.1080/15555240.2010.520649},

issn = {1555-5240 1555-5259},

year  = {2010},

date = {2010-11-01},

journal = {Journal of workplace behavioral health},

volume = {25},

number = {4},

pages = {296–319},

abstract = {Workplace stress is strongly associated with health problems, including cardiovascular disease. The occupational health field is developing partnerships with a variety of health professions to prevent and address job stress at the organizational level. A review of literature for and about employee assistance professionals was conducted to explore their perspectives on these issues. Results show high awareness regarding the health effects of job stress and a wide range of approaches to address this problem. EAPs appear to be a potential strong partner in efforts to prevent workplace stress, but face obstacles to intervening at the level of the work environment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_improving_2010,

title = {Improving access to opiate addiction treatment for prisoners.},

author = {Amy Nunn and Nickolas Zaller and Samuel Dickman and Ank Nijhawan and Josiah D. Rich},

doi = {10.1111/j.1360-0443.2010.03000.x},

issn = {1360-0443 0965-2140},

year  = {2010},

date = {2010-07-01},

journal = {Addiction (Abingdon, England)},

volume = {105},

number = {7},

pages = {1312–1313},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mohan_life_2010,

title = {Life and health insurance industry investments in fast food.},

author = {Arun V. Mohan and Danny McCormick and Steffie Woolhandler and David U. Himmelstein and J. Wesley Boyd},

doi = {10.2105/AJPH.2009.178020},

issn = {1541-0048 0090-0036},

year  = {2010},

date = {2010-06-01},

journal = {American journal of public health},

volume = {100},

number = {6},

pages = {1029–1030},

abstract = {Previous research on health and life insurers' financial investments has highlighted the tension between profit maximization and the public good. We ascertained health and life insurance firms' holdings in the fast food industry, an industry that is increasingly understood to negatively impact public health. Insurers own $1.88 billion of stock in the 5 leading fast food companies. We argue that insurers ought to be held to a higher standard of corporate responsibility, and we offer potential solutions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_impact_2010,

title = {Impact of insurance status on migraine care in the United States: a population-based study.},

author = {Andrew Wilper and Steffie Woolhandler and David Himmelstein and Rachel Nardin},

doi = {10.1212/WNL.0b013e3181d8fff4},

issn = {1526-632X 0028-3878},

year  = {2010},

date = {2010-04-01},

journal = {Neurology},

volume = {74},

number = {15},

pages = {1178–1183},

abstract = {OBJECTIVE: To determine whether insurance status is associated with differential outpatient treatment of migraine in the United States. METHODS: We analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997-2007), which survey patient visits to doctors' offices, hospital outpatient departments, and emergency departments (EDs) in the United States. We used logistic regression to determine whether insurance status was associated with the prescription of standard migraine therapy, defined as 1) a triptan or dihydroergotamine and 2) a prophylactic agent. RESULTS: We identified 6,814 individual patient visits for migraine, representing 68.6 million visits nationally. After controlling for age, gender, race/ethnicity, geographic location, and year, migraineurs with no insurance or Medicaid were less likely than the privately insured to receive abortive therapy (odds ratio [OR] for failure to receive medication 2.0 [95% confidence interval (CI) 1.3, 3.0] and 1.6 [95% CI 1.1, 2.3]) and prophylactic therapy (OR 2.0 [95% CI 1.3, 2.9] and 1.5 [95% CI 1.0, 2.1]). Adding site of care to the regression model suggested that one mechanism for this discrepancy was the reliance of the uninsured on EDs for migraine care, a site where standard migraine care is often omitted (OR for failure to receive abortive and prophylactic medication in the ED relative to physicians' offices 4.8 [95% CI 3.6, 6.3] and 8.7 [95% CI 6.4, 11.7]). CONCLUSIONS: The uninsured, and those with Medicaid, receive substandard therapy for migraine, at least in part because they receive more care in emergency departments and less in physicians' offices.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hochman_characteristics_2010,

title = {Characteristics of published comparative effectiveness studies of medications.},

author = {Michael Hochman and Danny McCormick},

doi = {10.1001/jama.2010.240},

issn = {1538-3598 0098-7484},

year  = {2010},

date = {2010-03-01},

journal = {JAMA},

volume = {303},

number = {10},

pages = {951–958},

abstract = {CONTEXT: Policy makers and physician organizations have recently called for more comparative effectiveness (CE) research, yet little is known about existing CE studies. OBJECTIVE: To describe the characteristics of recently published CE studies evaluating medications. DESIGN, SETTING, AND PARTICIPANTS: Analysis of all randomized trials, observational studies, and meta-analyses involving medications published in the 6 general medicine and internal medicine journals with the highest impact factor between June 1, 2008, and September 30, 2009. MAIN OUTCOME MEASURES: The prevalence and characteristics of CE studies (those comparing existing, active treatments) and non-CE studies (those involving novel therapies or those using an inactive control). RESULTS: We identified 328 studies evaluating medications, 104 of which were CE studies. Among the CE studies, 45 (43%; 95% confidence interval [CI], 34%-53%) compared different medications, 11 (11%; 95% CI, 5%-18%) compared medications with nonpharmacologic interventions, 32 (31%; 95% CI, 22%-41%) compared different pharmacologic strategies, and 16 (15%; 95% CI, 9%-24%) compared different medication dosing schedules. Twenty (19%; 95% CI, 12%-28%) CE studies focused on safety and 2 (2%; 95% CI, 0%-7%) included cost-effectiveness analyses. Comparative effectiveness studies were less likely than non-CE studies to have been exclusively commercially funded: 13% (95% CI, 8%-22%) vs 45% (95% CI, 38%-52%), respectively (P < .001). In total, 90 (87%; 95% CI, 78%-92%) of the CE studies received noncommercial funding, including 66 that received government funding (63%; 95% CI, 53%-73%). Of 212 randomized trials, 97 (46%; 95% CI, 39%-63%) used an active comparator; the rest used an inactive control. Active-comparator trials were less likely than trials with inactive controls to report positive results: 44% (95% CI, 33%-55%) vs 66% (95% CI, 57%-75%), respectively (P = .002). CONCLUSIONS: In these high-impact general medicine journals, approximately one-third of studies evaluating medications were CE studies. Of these studies, only a minority compared pharmacologic and nonpharmacologic therapies, few focused on safety or cost, and most were funded by noncommercial funding sources.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nobrega_barriers_2010,

title = {Barriers to Workplace Stress Interventions in Employee Assistance Practice: EAP Perspectives.},

author = {Suzanne Nobrega and Nicole J. Champagne and Lenore S. Azaroff and Karishma Shetty and Laura Punnett},

doi = {10.1080/15555240.2010.518491},

issn = {1555-5240 1555-5259},

year  = {2010},

date = {2010-01-01},

journal = {Journal of workplace behavioral health},

volume = {25},

number = {4},

pages = {282–295},

abstract = {Occupational health literature links stressful working conditions with cardiovascular and other chronic diseases, injuries, and psychological distress. We conducted individual interviews with employee assistance professionals (EAPs) to understand opportunities and barriers for EAPs to address job stress through organization level interventions. EAPs described their primary role as assisting individual employees versus designing company wide interventions. The most salient barriers to organization level interventions cited were lack of access to company management and (for contracted EAPs) perceptions of contract vulnerability. Education about workplace stress interventions may be most effectively directed at EAPs who are already integrated with company level work groups.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_hospital_2010,

title = {Hospital computing and the costs and quality of care: a national study.},

author = {David U. Himmelstein and Adam Wright and Steffie Woolhandler},

doi = {10.1016/j.amjmed.2009.09.004},

issn = {1555-7162 0002-9343},

year  = {2010},

date = {2010-01-01},

journal = {The American journal of medicine},

volume = {123},

number = {1},

pages = {40–46},

abstract = {BACKGROUND: Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals. METHODS: We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others. RESULTS: More computerized hospitals had higher total costs in bivariate analyses (r=0.06},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_proposals_2009,

title = {Proposals for payment reform in Massachusetts.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.1056/NEJMc0910189},

issn = {1533-4406 0028-4793},

year  = {2009},

date = {2009-12-01},

journal = {The New England journal of medicine},

volume = {361},

number = {25},

pages = {2492; author reply 2492–2493},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_health_2009,

title = {Health insurance and mortality in US adults.},

author = {Andrew P. Wilper and Steffie Woolhandler and Karen E. Lasser and Danny McCormick and David H. Bor and David U. Himmelstein},

doi = {10.2105/AJPH.2008.157685},

issn = {1541-0048 0090-0036},

year  = {2009},

date = {2009-12-01},

journal = {American journal of public health},

volume = {99},

number = {12},

pages = {2289–2295},

abstract = {OBJECTIVES: A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data. METHODS: We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death. RESULTS: Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance. CONCLUSIONS: Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_hypertension_2009,

title = {Hypertension, diabetes, and elevated cholesterol among insured and uninsured UṠ. adults.},

author = {Andrew P. Wilper and Steffie Woolhandler and Karen E. Lasser and Danny McCormick and David H. Bor and David U. Himmelstein},

doi = {10.1377/hlthaff.28.6.w1151},

issn = {2694-233X 0278-2715},

year  = {2009},

date = {2009-12-01},

journal = {Health affairs (Project Hope)},

volume = {28},

number = {6},

pages = {w1151–1159},

abstract = {In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions. Undiagnosed and uncontrolled chronic illness, which is common among insured people, is even more frequent among the uninsured.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nunn_methadone_2009,

title = {Methadone and buprenorphine prescribing and referral practices in US prison systems: results from a nationwide survey.},

author = {Amy Nunn and Nickolas Zaller and Samuel Dickman and Catherine Trimbur and Ank Nijhawan and Josiah D. Rich},

doi = {10.1016/j.drugalcdep.2009.06.015},

issn = {1879-0046 0376-8716},

year  = {2009},

date = {2009-11-01},

journal = {Drug and alcohol dependence},

volume = {105},

number = {1-2},

pages = {83–88},

abstract = {BACKGROUND: More than 50% of incarcerated individuals have a history of substance use, and over 200,000 individuals with heroin addiction pass through American correctional facilities annually. Opiate replacement therapy (ORT) with methadone or buprenorphine is an effective treatment for opiate dependence and can reduce drug-related disease and recidivism for inmates. Provision of ORT is nevertheless a frequently neglected intervention in the correctional setting. OBJECTIVE AND METHODS: We surveyed the 50 state; Washington, District of Columbia (DC); and Federal Department of Corrections' medical directors or their equivalents about their facilities' ORT prescribing policies and referral programs for inmates leaving prison. RESULTS: We received responses from 51 of 52 prison systems nationwide. Twenty-eight prison systems (55%) offer methadone to inmates in some situations. Methadone use varies widely across states: over 50% of correctional facilities that offer methadone do so exclusively for pregnant women or for chronic pain management. Seven states' prison systems (14%) offer buprenorphine to some inmates. The most common reason cited for not offering ORT was that facilities "prefer drug-free detoxification over providing methadone or buprenorphine." Twenty-three states' prison systems (45%) provide referrals for some inmates to methadone maintenance programs after release, which increased from 8% in 2003; 15 states' prison systems (29%) provide some referrals to community buprenorphine providers. CONCLUSION: Despite demonstrated social, medical, and economic benefits of providing ORT to inmates during incarceration and linkage to ORT upon release, many prison systems nationwide still do not offer pharmacological treatment for opiate addiction or referrals for ORT upon release.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_regressivity_2009,

title = {The regressivity of taxing employer-paid health insurance.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.1056/NEJMopv0907478},

issn = {1533-4406 0028-4793},

year  = {2009},

date = {2009-09-01},

journal = {The New England journal of medicine},

volume = {361},

number = {10},

pages = {e101},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_medical_2009,

title = {Medical bankruptcy in the United States, 2007: results of a national study.},

author = {David U. Himmelstein and Deborah Thorne and Elizabeth Warren and Steffie Woolhandler},

doi = {10.1016/j.amjmed.2009.04.012},

issn = {1555-7162 0002-9343},

year  = {2009},

date = {2009-08-01},

journal = {The American journal of medicine},

volume = {122},

number = {8},

pages = {741–746},

abstract = {BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened. METHODS: We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as "medical" based on debtors' stated reasons for filing, income loss due to illness, and the magnitude of their medical debts. RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001. CONCLUSIONS: Illness and medical bills contribute to a large and increasing share of US bankruptcies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pechter_reducing_2009,

title = {Reducing hazardous cleaning product use: a collaborative effort.},

author = {Elise Pechter and Lenore S. Azaroff and Isabel López and Marcy Goldstein-Gelb},

doi = {10.1177/00333549091244S106},

issn = {0033-3549 1468-2877},

year  = {2009},

date = {2009-08-01},

journal = {Public health reports (Washington, D.C. : 1974)},

volume = {124 Suppl 1},

number = {Suppl 1},

pages = {45–52},

abstract = {Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts. This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health's Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP's history of public health practice regarding cleaning products enabled staff to respond promptly. MassCOSH's staff expertise and commitment to immigrant workers allowed it to play a vital role.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{herring_increasing_2009,

title = {Increasing length of stay among adult visits to UṠ. Emergency departments, 2001-2005.},

author = {Andrew Herring and Andrew Wilper and David U. Himmelstein and Steffie Woolhandler and Janice A. Espinola and David F. M. Brown and Carlos A. Jr Camargo},

doi = {10.1111/j.1553-2712.2009.00428.x},

issn = {1553-2712 1069-6563},

year  = {2009},

date = {2009-07-01},

journal = {Academic emergency medicine : official journal of the Society for Academic Emergency Medicine},

volume = {16},

number = {7},

pages = {609–616},

abstract = {BACKGROUND: Emergency departments (EDs) are traditionally designed to provide rapid evaluation and stabilization and are neither staffed nor equipped to provide prolonged care. Longer ED length of stay (LOS) may compromise quality of care and contribute to delays in the emergency evaluation of other patients. OBJECTIVES: The objective was to determine whether ED LOS increased between 2001 and 2005 and whether trends varied by patient and hospital factors. METHODS: This was a retrospective analysis of a nationally representative sample of 138,569 adult ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2001 to 2005. ED LOS was measured from registration to discharge. RESULTS: Median ED LOS increased 3.5% per year from 132 minutes in 2001 to 154 minutes in 2005 (p-value for trend < 0.001). There was a larger increase among critically ill patients for whom ED LOS increased 7.0% annually from 185 minutes in 2001 to 254 minutes in 2005 (p-value for trend < 0.01). ED LOS was persistently longer for black/African American, non-Hispanic patients (10.6% longer) and Hispanic patients (13.9% longer) than for non-Hispanic white patients, and these differences did not diminish over time. Among factors potentially associated with increasing ED LOS, a large increase was found (60.1%, p-value for trend < 0.001) in the use of advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MR], and ultrasound [US]) and in the proportion of ED visits at which five or more diagnostic or screening tests were ordered (17.6% increase, p-value for trend = 0.001). The proportion of uninsured patients was stable throughout the study period, and EDs with predominately privately insured patients experienced significant increases in ED LOS (4.0% per year from 2001 to 2005, p-value for trend < 0.01). CONCLUSIONS: Emergency department LOS in the United States is increasing, especially for critically ill patients for whom time-sensitive interventions are most important. The disparity of longer ED LOS for African Americans and Hispanics is not improving.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cohen_imported_2009,

title = {Imported compounded diet pill use among Brazilian women immigrants in the United States.},

author = {Pieter A. Cohen and Danny McCormick and Carolyn Casey and Glen F. Dawson and Karen A. Hacker},

doi = {10.1007/s10903-007-9099-x},

issn = {1557-1920 1557-1912},

year  = {2009},

date = {2009-06-01},

journal = {Journal of immigrant and minority health},

volume = {11},

number = {3},

pages = {229–236},

abstract = {In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18-50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{boyd_insurance-industry_2009,

title = {Insurance-industry investments in tobacco.},

author = {J. Wesley Boyd and David Himmelstein and Steffie Woolhandler},

doi = {10.1056/NEJMc0901817},

issn = {1533-4406 0028-4793},

year  = {2009},

date = {2009-06-01},

journal = {The New England journal of medicine},

volume = {360},

number = {23},

pages = {2483–2484},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_us_2009,

title = {UṠ. physicians' views on financing options to expand health insurance coverage: a national survey.},

author = {Danny McCormick and Steffie Woolhandler and Anjali Bose-Kolanu and Antonio Germann and David H. Bor and David U. Himmelstein},

doi = {10.1007/s11606-009-0916-x},

issn = {1525-1497 0884-8734},

year  = {2009},

date = {2009-04-01},

journal = {Journal of general internal medicine},

volume = {24},

number = {4},

pages = {526–531},

abstract = {BACKGROUND: Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. OBJECTIVE: To assess physician views on financing options for expanding health care coverage and on access to health care. DESIGN AND PARTICIPANTS: Nationally representative mail survey conducted between March 2007 and October 2007 of U.S. physicians engaged in direct patient care. MEASUREMENTS: Rated support for reform options including financial incentives to induce individuals to purchase health insurance and single-payer national health insurance; rated views of several dimensions of access to care. MAIN RESULTS: 1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance. CONCLUSIONS: The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_health_2009-1,

title = {The health and health care of US prisoners: results of a nationwide survey.},

author = {Andrew P. Wilper and Steffie Woolhandler and J. Wesley Boyd and Karen E. Lasser and Danny McCormick and David H. Bor and David U. Himmelstein},

doi = {10.2105/AJPH.2008.144279},

issn = {1541-0048 0090-0036},

year  = {2009},

date = {2009-04-01},

journal = {American journal of public health},

volume = {99},

number = {4},

pages = {666–672},

abstract = {OBJECTIVES: We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates. METHODS: We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates. RESULTS: Among inmates in federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition. Among inmates with a mental condition ever treated with a psychiatric medication, only 25.5% (SE = 7.5%) of federal, 29.6% (SE = 2.8%) of state, and 38.5% (SE = 1.5%) of local jail inmates were taking a psychiatric medication at the time of arrest, whereas 69.1% (SE = 4.8%), 68.6% (SE = 1.9%), and 45.5% (SE = 1.6%) were on a psychiatric medication after admission. CONCLUSIONS: Many inmates with a serious chronic physical illness fail to receive care while incarcerated. Among inmates with mental illness, most were off their treatments at the time of arrest. Improvements are needed both in correctional health care and in community mental health services that might prevent crime and incarceration.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cutrona_free_2008,

title = {Free drug samples in the United States: characteristics of pediatric recipients and safety concerns.},

author = {Sarah L. Cutrona and Steffie Woolhandler and Karen E. Lasser and David H. Bor and David U. Himmelstein and William H. Shrank and Neal S. LeLeiko},

doi = {10.1542/peds.2007-2928},

issn = {1098-4275 0031-4005},

year  = {2008},

date = {2008-10-01},

journal = {Pediatrics},

volume = {122},

number = {4},

pages = {736–742},

abstract = {OBJECTIVES: Free drug samples frequently are given to children. We sought to describe characteristics of free sample recipients, to determine whether samples are given primarily to poor and uninsured children, and to examine potential safety issues. METHODS: We analyzed data on 10295 US residents <18 years of age from the 2004 Medical Expenditure Panel Survey, a nationally representative survey that includes questions on receipt of free drug samples. We performed bivariate and multivariate analyses to evaluate characteristics associated with receipt of >or=1 free drug sample in 2004. We identified the most frequently reported sample medications and reviewed potential safety issues. RESULTS: Ten percent of children who received prescription medications and 4.9% of all children received >or=1 free drug sample in 2004. In bivariate analyses, poor children (family incomes of <200% of the federal poverty level) were no more likely to receive free samples than were those with incomes of >or=400% of the poverty level (3.8% vs 5.9%). Children who were uninsured for part or all of the year were no more likely to receive free samples than were those who were insured all year (4.5% vs 5.1%); 84.3% of all sample recipients were insured. In multivariate analyses, routine access to health care (>or=3 provider visits in 2004) was associated with free sample receipt. The 15 most frequently distributed pediatric free samples in 2004 included 2 schedule II controlled medication, Adderall (amphetamine/dextroamphetamine) [corrected] and 4 medications that received new or revised black box warnings between 2004 and 2007, Elidel (pimecrolimus), Advair (fluticasone/salmeterol), Strattera (atomoxetine), and Adderall (amphetamine/dextroamphetamine). CONCLUSIONS: Poor and uninsured children are not the main recipients of free drug samples. Free samples do not target the neediest children selectively, and they have significant safety considerations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hochman_news_2008,

title = {News media coverage of medication research: reporting pharmaceutical company funding and use of generic medication names.},

author = {Michael Hochman and Steven Hochman and David Bor and Danny McCormick},

doi = {10.1001/jama.300.13.1544},

issn = {1538-3598 0098-7484},

year  = {2008},

date = {2008-10-01},

journal = {JAMA},

volume = {300},

number = {13},

pages = {1544–1550},

abstract = {CONTEXT: The news media are an important source of information about medical research for patients and even some physicians. Little is known about how frequently news articles report when medication research has received funding from pharmaceutical companies or how frequently news articles use generic vs brand medication names. OBJECTIVES: To assess the reporting of pharmaceutical company funding and generic medication name use in news articles about medication studies and to determine the views of newspaper editors about these issues. DESIGN, SETTING, AND PARTICIPANTS: We reviewed US news articles from newspaper and online sources about all pharmaceutical company-funded medication studies published in the 5 most prominent general medical journals between April 1, 2004, and April 30, 2008. We also surveyed editors at the 100 most widely circulated newspapers in the United States. MAIN OUTCOME MEASURES: The percentage of news articles indicating when studies have been pharmaceutical company-funded and the percentage that refer to medications by their generic vs brand names. Also the percentage of newspaper editors who indicate that their articles report pharmaceutical company funding; the percentage of editors who indicate that their articles refer to medications by generic names; and the percentage of newspapers with policies about these issues. RESULTS: Of the 306 news articles about medication research identified,130 (42%; 95% confidence interval [CI], 37%-48%) did not report that the research had received company funding. Of the 277 of these articles reporting on medications with both generic and brand names, 186 (67%; 95% CI, 61%-73%) referred to the study medications by their brand names in at least half of the medication references. Eighty-two of the 93 (88%) newspaper editors who responded to our survey reported that articles from their publications always or often indicated when studies had received company funding (95% CI, 80%-94%), and 71 of 92 (77%) responding editors also reported that articles from their publications always or often referred to medications by the generic names (95% CI, 67%-85%). However, only 3 of 92 newspapers (3%) had written policies stating that company funding sources of medical studies be reported (95% CI 1%-9%), and 2 of 93 (2%) newspapers had written policies stating that medications should be referred to by their generic names (95% CI 1%-8%). CONCLUSION: News articles reporting on medication studies often fail to report pharmaceutical company funding and frequently refer to medications by their brand names despite newspaper editors' contention that this is not the case.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_sources_2008,

title = {Sources of UṠ. physician income: the contribution of government payments to the specialist-generalist income gap.},

author = {Karen E. Lasser and Steffie Woolhandler and David U. Himmelstein},

doi = {10.1007/s11606-008-0660-7},

issn = {1525-1497 0884-8734},

year  = {2008},

date = {2008-09-01},

journal = {Journal of general internal medicine},

volume = {23},

number = {9},

pages = {1477–1481},

abstract = {BACKGROUND: Physician income varies threefold among specialties. Lower incomes have produced shortages in primary care fields. OBJECTIVE: To investigate the impact of government policy on generating income differentials among specialties. DESIGN AND PARTICIPANTS: Cross-sectional analysis of the 2004 MEPS. MEASUREMENTS: For outpatient care, total payments made to 27 different types of specialists from five types of payers: Medicare, Medicaid, other government (the Veterans Administration and other state and local programs), private insurance, and out-of-pocket payments. For inpatient care, aggregate (i.e., all-specialty) inpatient physician reimbursement from the five payers. RESULTS: In 2004, physicians derived 78.6% of their practice income ($149,684 million, 95% CI, $140,784 million-$158,584 million) from outpatient sources and 21.4% of their income ($40,782 million, 95% CI, $36,839 million-$44,724 million) from inpatient sources. Government payers accounted for 32.7% of total physician income. Four specialties derived > 50% of their outpatient income from public sources, including both the lowest and highest paid specialties (geriatrics and hematology/oncology, respectively). CONCLUSIONS: Inter-specialty income differences result, in part, from government decisions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_national_2008,

title = {A national study of chronic disease prevalence and access to care in uninsured UṠ. adults.},

author = {Andrew P. Wilper and Steffie Woolhandler and Karen E. Lasser and Danny McCormick and David H. Bor and David U. Himmelstein},

doi = {10.7326/0003-4819-149-3-200808050-00006},

issn = {1539-3704 0003-4819},

year  = {2008},

date = {2008-08-01},

journal = {Annals of internal medicine},

volume = {149},

number = {3},

pages = {170–176},

abstract = {BACKGROUND: No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States. OBJECTIVE: To compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status. DESIGN: Population-based survey. SETTING: National Health and Nutritional Examination Survey (1999-2004). PARTICIPANTS: 12,486 patients age 18 to 64 years. MEASUREMENTS: Estimates of national rates of cardiovascular disease, hypertension, diabetes, hypercholesterolemia, active asthma or chronic obstructive pulmonary disease, previous cancer, and measures of access to care. RESULTS: On the basis of National Health and Nutrition Examination Survey (1999-2004) responses, an estimated 11.4 million (95% CI, 9.8 million to 13.0 million) working-age Americans with chronic conditions were uninsured, including 16.1% (CI, 12.6% to 19.6%) of the 7.8 million with cardiovascular disease, 15.5% (CI, 13.4% to 17.6%) of the 38.2 million with hypertension, and 16.6% (CI, 13.2% to 20.0%) of the 8.5 million with diabetes. After the authors controlled for age, sex, and race or ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%) but more likely to identify their standard site for care as an emergency department (7.1% vs. 1.1%) (P <0.001 for all comparisons). LIMITATION: The study was cross-sectional and used self-reported insurance and disease status. CONCLUSION: Millions of U.S. working-age adults with chronic conditions do not have insurance and have poorer access to medical care than their insured counterparts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{roelofs_results_2008,

title = {Results from a community-based occupational health survey of Vietnamese-American nail salon workers.},

author = {Cora Roelofs and Lenore S. Azaroff and Christina Holcroft and Huong Nguyen and Tam Doan},

doi = {10.1007/s10903-007-9084-4},

issn = {1557-1912},

year  = {2008},

date = {2008-08-01},

journal = {Journal of immigrant and minority health},

volume = {10},

number = {4},

pages = {353–361},

abstract = {A community-university collaborative partnership assessed self-reported work-related health effects and environmental factors in Boston's Vietnamese immigrant community via an interviewer-assisted survey. Seventy-one nail technicians responded. Musculoskeletal disorders, skin problems, respiratory irritation and headaches were commonly reported as work-related, as were poor air quality, dusts and offensive odors. The reporting of a work-related respiratory symptom was significantly associated with the reporting of exposure factors such as poorer air quality. Absence of skin disorders was associated with glove use and musculoskeletal symptoms were associated with years worked as a nail technician. Work-related health effects may be common in nail salon work. Chemical and musculoskeletal hazards should be reduced through product and equipment redesign.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{wilper_waits_2008,

title = {Waits to see an emergency department physician: UṠ. trends and predictors, 1997-2004.},

author = {Andrew P. Wilper and Steffie Woolhandler and Karen E. Lasser and Danny McCormick and Sarah L. Cutrona and David H. Bor and David U. Himmelstein},

doi = {10.1377/hlthaff.27.2.w84},

issn = {2694-233X 0278-2715},

year  = {2008},

date = {2008-04-01},

journal = {Health affairs (Project Hope)},

volume = {27},

number = {2},

pages = {w84–95},

abstract = {As emergency department (ED) patient volumes increase throughout the United States, are patients waiting longer to see an ED physician? We evaluated the change in wait time to see an ED physician from 1997 to 2004 for all adult ED patients, patients diagnosed with acute myocardial infarction (AMI), and patients whom triage personnel designated as needing "emergent" attention. Increases in wait times of 4.1 percent per year occurred for all patients but were especially pronounced for patients with AMI, for whom waits increased 11.2 percent per year. Blacks, Hispanics, women, and patients seen in urban EDs waited longer than other patients did.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cutrona_characteristics_2008,

title = {Characteristics of recipients of free prescription drug samples: a nationally representative analysis.},

author = {Sarah L. Cutrona and Steffie Woolhandler and Karen E. Lasser and David H. Bor and Danny McCormick and David U. Himmelstein},

doi = {10.2105/AJPH.2007.114249},

issn = {1541-0048 0090-0036},

year  = {2008},

date = {2008-02-01},

journal = {American journal of public health},

volume = {98},

number = {2},

pages = {284–289},

abstract = {OBJECTIVES: Free prescription drug samples are used widely in the United States. We sought to examine characteristics of free drug sample recipients nationwide. METHODS: We analyzed data on 32681 US residents from the 2003 Medical Expenditure Panel Survey (MEPS), a nationally representative survey. RESULTS: In 2003, 12% of Americans received at least 1 free sample. A higher proportion of persons who had continuous health insurance received a free sample (12.9%) than did persons who were uninsured for part or all of the year (9.9%; P<.001). The poorest third of respondents were less likely to receive free samples than were those with incomes at 400% of the federal poverty level or higher. After we controlled for demographic factors, we found that neither insurance status nor income were predictors of the receipt of drug samples. Persons who were uninsured all or part of the year were no more likely to receive free samples (odds ratio [OR]=0.98; 95% confidence interval [CI]=0.087, 1.11) than those who were continuously insured. CONCLUSIONS: Poor and uninsured Americans are less likely than wealthy or insured Americans to receive free drug samples. Our findings suggest that free drug samples serve as a marketing tool, not as a safety net.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_privatization_2008,

title = {Privatization in a publicly funded health care system: the UṠ. experience.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.2190/HS.38.3.a},

issn = {0020-7314},

year  = {2008},

date = {2008-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {38},

number = {3},

pages = {407–419},

abstract = {The United States has four decades of experience with the combination of public funding and private health care management and delivery, closely analogous to reforms recently enacted or proposed in many other nations. Extensive research, herein reviewed, shows that for-profit health institutions provide inferior care at inflated prices. The U.S. experience also demonstrates that market mechanisms nurture unscrupulous medical businesses and undermine medical institutions unable or unwilling to tailor care to profitability. The commercialization of care in the United States has driven up costs by diverting money to profits and by fueling a vast increase in management and financial bureaucracy, which now consumes 31 percent of total health spending. The Veterans Health Administration system–a network of government hospitals and clinics–has emerged as the leader in quality improvement and information technology, indicating the potential for public sector excellence and innovation. The poor performance of U.S. health care is directly attributable to reliance on market mechanisms and for-profit firms, and should warn other nations from this path.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{herring_insurance_2008,

title = {Insurance status of UṠ. organ donors and transplant recipients: the uninsured give, but rarely receive.},

author = {Andrew A. Herring and Steffie Woolhandler and David U. Himmelstein},

doi = {10.2190/HS.38.4.d},

issn = {0020-7314},

year  = {2008},

date = {2008-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {38},

number = {4},

pages = {641–652},

abstract = {Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81-4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06-0.12). Many uninsured Americans donate organs, but they rarely receive them.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_state_2008,

title = {State health reform flatlines.},

author = {Steffie Woolhandler and Benjamin Day and David U. Himmelstein},

doi = {10.2190/HS.38.3.k},

issn = {0020-7314},

year  = {2008},

date = {2008-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {38},

number = {3},

pages = {585–592},

abstract = {Massachusetts' recent health reform has generated laudatory headlines and a flurry of interest in state-based initiatives to achieve universal health insurance coverage. In 1988, a similar Massachusetts effort was also acclaimed and was imitated by several other states. Unfortunately, none of those efforts can be judged a success. The authors briefly review this earlier experience and caution against premature declaration of victory.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_lack_2007,

title = {Lack of health coverage among US veterans from 1987 to 2004.},

author = {David U. Himmelstein and Karen E. Lasser and Danny McCormick and David H. Bor and J. Wesley Boyd and Steffie Woolhandler},

doi = {10.2105/AJPH.2006.106302},

issn = {1541-0048 0090-0036},

year  = {2007},

date = {2007-12-01},

journal = {American journal of public health},

volume = {97},

number = {12},

pages = {2199–2203},

abstract = {OBJECTIVES: Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans' coverage, and whether uninsured veterans lacked access to medical care. METHODS: We analyzed annual data from 2 federal surveys, the Current Population Survey for the years 1988 to 2005 and the National Health Interview Survey for 2002 to 2004. RESULTS: Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004. The proportion of working-age veterans lacking coverage peaked in 1993 at 14.2%, fell to 9.9% in 2000, and rose steadily to 12.7% in 2004. Uninsured veterans had substantial access problems; 51.4% had no usual source of care (vs 8.9% of insured veterans), and 26.5% reported failing to get needed care because of the cost (vs 4.3% of insured veterans). CONCLUSIONS: Many US veterans are uninsured and lack adequate access to health care. Expanded funding for veterans' care is urgently needed; only national health insurance could guarantee coverage to both veterans and their family members.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_competition_2007,

title = {Competition in a publicly funded healthcare system.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1136/bmj.39400.549502.94},

issn = {1756-1833 0959-8138},

year  = {2007},

date = {2007-12-01},

journal = {BMJ (Clinical research ed.)},

volume = {335},

number = {7630},

pages = {1126–1129},

abstract = {Are the UK and other countries right to adopt a market based model for improving their health services? Steffie Woolhandler and David Himmelstein believe that the appropriate response to the US experience with such policies is quarantine, not replication},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_our_2007,

title = {Our health care system at the crossroads: single payer or market reform?},

author = {David U. Himmelstein and Steffie Woolhandler and John C. Goodman and Robert M. Sade},

doi = {10.1016/j.athoracsur.2007.07.082},

issn = {1552-6259 0003-4975},

year  = {2007},

date = {2007-11-01},

journal = {The Annals of thoracic surgery},

volume = {84},

number = {5},

pages = {1435–1446},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_double_2007,

title = {Double catastrophe: injury-related bankruptcies.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1097/MLR.0b013e3180f62b9f},

issn = {0025-7079},

year  = {2007},

date = {2007-08-01},

journal = {Medical care},

volume = {45},

number = {8},

pages = {699–701},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mintzer_treating_2007,

title = {Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings.},

author = {Ira L. Mintzer and Mark Eisenberg and Maria Terra and Casey MacVane and David U. Himmelstein and Steffie Woolhandler},

doi = {10.1370/afm.665},

issn = {1544-1717 1544-1709},

year  = {2007},

date = {2007-04-01},

journal = {Annals of family medicine},

volume = {5},

number = {2},

pages = {146–150},

abstract = {PURPOSE: Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in non-research clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings. METHODS: We studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use. RESULTS: Fifty-four percent of patients were sober at 6 months. There was no significant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings. CONCLUSIONS: Opioid-addicted patients can be safely and effectively treated in non-research primary care settings with limited on-site resources. Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{guyatt_systematic_2007,

title = {A systematic review of studies comparing health outcomes in Canada and the United States.},

author = {Gordon H. Guyatt and Pj Devereaux and Joel Lexchin and Samuel B. Stone and Armine Yalnizyan and David Himmelstein and Steffie Woolhandler and Qi Zhou and Laurie J. Goldsmith and Deborah J. Cook and Ted Haines and Christina Lacchetti and John N. Lavis and Terrence Sullivan and Ed Mills and Shelley Kraus and Neera Bhatnagar},

issn = {1911-2092},

year  = {2007},

date = {2007-04-01},

journal = {Open medicine : a peer-reviewed, independent, open-access journal},

volume = {1},

number = {1},

pages = {e27–36},

abstract = {BACKGROUND: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes. OBJECTIVES: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions. METHODS: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability. RESULTS: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{boyd_us_2007,

title = {UṠ. medical students' knowledge about the military draft, the Geneva Conventions, and military medical ethics.},

author = {J. Wesley Boyd and David U. Himmelstein and Karen Lasser and Danny McCormick and David H. Bor and Sarah L. Cutrona and Steffie Woolhandler},

doi = {10.2190/HS.37.4.d},

issn = {0020-7314},

year  = {2007},

date = {2007-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {37},

number = {4},

pages = {643–650},

abstract = {The objective of this study was to ascertain how much U.S. medical students are taught about and know about military medical ethics, the Geneva Conventions, and the laws governing conscription of medical personnel. The authors developed an Internet-based questionnaire on these matters, and e-mail invitations to participate were sent to approximately 5,000 medical students at eight U.S. medical schools. Thirty-five percent of e-mail recipients participated in the survey. Of those, 94 percent had received less than one hour of instruction about military medical ethics and only 3.5 percent were aware of legislation already passed making a "doctor's draft" possible; 37 percent knew the conditions under which the Geneva Conventions apply; 33.8 percent did not know that the Geneva Conventions state that physicians should "treat the sickest first, regardless of nationality;" 37 percent did not know that the Geneva Conventions prohibit ever threatening or demeaning prisoners or depriving them of food or water; and 33.9 percent could not state when they would be required to disobey an unethical order.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{moir_boston-area_2007,

title = {The Boston-area HASWIC Research Circle: an innovative participatory method for coloring in the picture of a special work environment.},

author = {Susan Moir and Lenore S. Azaroff},

doi = {10.2190/Q364-44T7-P7X8-3652},

issn = {1048-2911},

year  = {2007},

date = {2007-01-01},

journal = {New solutions : a journal of environmental and occupational health policy : NS},

volume = {17},

number = {1-2},

pages = {123–136},

abstract = {Recent qualitative studies have investigated some of the hazards affecting women in non-traditional trades such as construction. However, one-time interactions among researcher participants, and between researchers and participants, in standard settings such as focus groups and interviews, cannot provide the time, space, and relationships to fully explore tradeswomen's in-depth knowledge of their work environment. This study applied a Scandinavian method called the Research Circle to convene a group of experienced women construction workers repeatedly over a period of two years so they could collaborate with researchers in explaining workplace issues. The results both validated and expanded upon previous findings about health and safety for women in construction, including gender discrimination, lack of access to sanitary facilities, retaliation for reporting hazards and injuries, and inadequate training and equipment. Especially important, findings illustrate some of the complex hierarchical social structures involved in both female and male construction workers responding to hazardous conditions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_access_2006,

title = {Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.},

author = {Karen E. Lasser and David U. Himmelstein and Steffie Woolhandler},

doi = {10.2105/AJPH.2004.059402},

issn = {1541-0048 0090-0036},

year  = {2006},

date = {2006-07-01},

journal = {American journal of public health},

volume = {96},

number = {7},

pages = {1300–1307},

abstract = {OBJECTIVES: We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. METHODS: We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. RESULTS: In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. CONCLUSIONS: United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_discounting_2006,

title = {Discounting the debtors will not make medical bankruptcy disappear.},

author = {David U. Himmelstein and Elizabeth Warren and Deborah Thorne and Steffie Woolhandler},

doi = {10.1377/hlthaff.25.w84},

issn = {2694-233X 0278-2715},

year  = {2006},

date = {2006-04-01},

journal = {Health affairs (Project Hope)},

volume = {25},

number = {2},

pages = {w84–88; discussion w93},

abstract = {David Dranove and Michael Millenson seem determined to deny that financial fallout from illness pushes middle-class families into bankruptcy. Anxious to erase the headline that three-quarters of U.S. medical bankrupts had health insurance at the onset of their illnesses and the resulting spotlight on inadequate coverage and insurance cancellation practices, they ignore most of our data and misrepresent the rest. They dismiss families' explanations of their difficulties and blame those ruined by illness for their own problems. However, the data from the bankruptcy courts are undeniable. Bankruptcies affect mainly middle-class, privately insured families, and about half are triggered, at least in part, by illnesses.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{king_brief_2006,

title = {Brief report: Influenza vaccination and health care workers in the United States.},

author = {William D. King and Steffie J. Woolhandler and Arleen F. Brown and Luohua Jiang and Kristine Kevorkian and David U. Himmelstein and David H. Bor},

doi = {10.1111/j.1525-1497.2006.00325.x},

issn = {1525-1497 0884-8734},

year  = {2006},

date = {2006-02-01},

journal = {Journal of general internal medicine},

volume = {21},

number = {2},

pages = {181–184},

abstract = {OBJECTIVE: To determine influenza vaccination rates among U.S. health care workers (HCWs) by demographic and occupational categories. DESIGN AND PARTICIPANTS: We analyzed data from the 2000 National Health Interview Survey (NHIS). Weighted multivariable analyses were used to evaluate the association between HCW occupation and other variables potentially related to receipt of influenza vaccination. HCWs were categorized based on standard occupational classifications as health-diagnosing professions, health-assessing professions, health aides, health technicians; or health administrators. MAIN INDEPENDENT VARIABLES: Demographic characteristics and occupation category. MAIN OUTCOME VARIABLES: Receipt of influenza vaccination within 12 months of survey. ANALYSIS: Descriptive statistics and weighted multivariable logistic regression. RESULTS: There were 1,651 HCWs in the final sample. The overall influenza vaccination rate for HCWs was 38%. After weighted multivariable analyses, HCWs who were under 50 (odds ratio [OR] 0.67%, 95% confidence interval [CI]: 0.50 to 0.89, compared with HCWs 50 to 64), black (OR 0.57 95% CI: 0.42, 0.78, compared with white HCWs), or were health aides (OR 0.73%, 95% CI: 0.51, 1.04, compared with health care administrators and administrative support staff) had lower odds of having been vaccinated against influenza. CONCLUSIONS: The overall influenza vaccination rate among HCWs in the United States is low. Workers who are under 50, black, or health aides have the lowest rates of vaccinations. Interventions seeking to improve HCW vaccination rates may need to target these specific subgroups.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fulmer_factors_2006,

title = {Factors influencing ergonomic intervention in construction: trunkman case study.},

author = {Scott Fulmer and Lenore S. Azaroff and Susan Moir},

doi = {10.2190/1842-7382-9773-T673},

issn = {1048-2911},

year  = {2006},

date = {2006-01-01},

journal = {New solutions : a journal of environmental and occupational health policy : NS},

volume = {16},

number = {3},

pages = {235–247},

abstract = {This case study examines factors affecting the use of equipment designed to prevent lower back strain in laborers who pour concrete on major highway construction sites. Qualitative methods of organizational analysis were used to characterize factors identified from interviews and participant observation. The major obstacles to the use of the control on site were 1. Managers placing a low priority on ergonomics. 2. Safety officers' limited power in organizational hierarchies. 3. Rationalizing, rather than challenging, resistance to change. 4. Lack of a forum to share knowledge about interventions. Several organizational factors impeded the adoption of a technically effective, low-cost safety control on the site studied. The implementation of the control ultimately resulted from actions taken by the investigators, suggesting that safety programs present at the site are not always adequate to realize feasible interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_protecting_2006,

title = {Protecting workers and residents from wood floor-finishing hazards.},

author = {Lenore S. Azaroff and Tam Doan and Huong Nguyen and Marcy Goldstein-Gelb and Madeline Fraser-Cook and Supriya Kota},

doi = {10.2190/EYUH-QF8Y-5HGR-MN4E},

issn = {1048-2911},

year  = {2006},

date = {2006-01-01},

journal = {New solutions : a journal of environmental and occupational health policy : NS},

volume = {16},

number = {2},

pages = {119–138},

abstract = {The recent deaths of three hardwood floor finishers in the Boston area have highlighted the urgency of addressing hazards in this industry. Among other dangers to health and safety, fire is a constant threat in a work setting that combines highly flammable solvents, large quantities of airborne wood dust, electrical equipment, heat, and friction inside old homes. Immigrant workers, who perform a large proportion of this work, are at special risk. An Environmental Justice partnership of community-based organizations, community health centers, and environmental health researchers funded by the National Institute of Environmental Health Sciences (the "Dorchester Occupational Health Initiative") had been studying the occupational health of hardwood floor finishing when these workers died. This preparation enabled community, health, labor, business, and political leaders to mobilize a response and release recommendations within weeks of the second fatal fire. Their report, adapted below, contains important information for health and labor activists in all areas where wood flooring is common. Most notably, the use of less flammable (higher flash point) products can help reduce the risk of more fatal fires. For further information, please contact the Massachusetts Coalition for Occupational Safety and Health, masscosh.org.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mohanty_health_2005,

title = {Health care expenditures of immigrants in the United States: a nationally representative analysis.},

author = {Sarita A. Mohanty and Steffie Woolhandler and David U. Himmelstein and Susmita Pati and Olveen Carrasquillo and David H. Bor},

doi = {10.2105/AJPH.2004.044602},

issn = {0090-0036 1541-0048},

year  = {2005},

date = {2005-08-01},

journal = {American journal of public health},

volume = {95},

number = {8},

pages = {1431–1438},

abstract = {OBJECTIVES: We compared the health care expenditures of immigrants residing in the United States with health care expenditures of US-born persons. METHODS: We used the 1998 Medical Expenditure Panel Survey linked to the 1996-1997 National Health Interview Survey to analyze data on 18398 US-born persons and 2843 immigrants. Using a 2-part regression model, we estimated total health care expenditures, as well as expenditures for emergency department (ED) visits, office-based visits, hospital-based outpatient visits, inpatient visits, and prescription drugs. RESULTS: Immigrants accounted for $39.5 billion (SE=$4 billion) in health care expenditures. After multivariate adjustment, per capita total health care expenditures of immigrants were 55% lower than those of US-born persons ($1139 vs $2546). Similarly, expenditures for uninsured and publicly insured immigrants were approximately half those of their US-born counterparts. Immigrant children had 74% lower per capita health care expenditures than US-born children. However, ED expenditures were more than 3 times higher for immigrant children than for US-born children. CONCLUSIONS: Health care expenditures are substantially lower for immigrants than for US-born persons. Our study refutes the assumption that immigrants represent a disproportionate financial burden on the US health care system.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_illness_2005,

title = {Illness and injury as contributors to bankruptcy.},

author = {David U. Himmelstein and Elizabeth Warren and Deborah Thorne and Steffie Woolhandler},

doi = {10.1377/hlthaff.w5.63},

issn = {0278-2715},

year  = {2005},

date = {2005-06-01},

journal = {Health affairs (Project Hope)},

volume = {Suppl Web Exclusives},

pages = {W5–63–W5–73},

abstract = {In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged dollar 11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mohanty_diabetes_2005,

title = {Diabetes and cardiovascular disease among Asian Indians in the United States.},

author = {Sarita A. Mohanty and Steffie Woolhandler and David U. Himmelstein and David H. Bor},

doi = {10.1111/j.1525-1497.2005.40294.x},

issn = {1525-1497 0884-8734},

year  = {2005},

date = {2005-05-01},

journal = {Journal of general internal medicine},

volume = {20},

number = {5},

pages = {474–478},

abstract = {CONTEXT: Studies, mostly from outside the United States, have found high prevalence of diabetes, coronary heart disease (CHD), and hypertension among Asian Indians, despite low rates of associated risk factors. OBJECTIVE: To analyze the prevalence of obesity, diabetes, CHD, hypertension, and other associated risk factors among Asian Indians in the United States compared to non-Hispanic whites. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using data from the National Health Interview Survey (NHIS) for 1997, 1998, 1999, and 2000. We analyzed 87,846 non-Hispanic whites and 555 Asian Indians. MAIN OUTCOME MEASURES: Whether a subject reported having diabetes, CHD, or hypertension. RESULTS: Asian Indians had lower average body mass indices (BMIs) than non-Hispanic whites and lower rates of tobacco use, but were less physically active. In multivariate analysis controlling for age and BMI, Asian Indians had significantly higher odds of borderline or overt diabetes (adjusted OR [AOR], 2.70; 95% confidence interval [CI], 1.72 to 4.23). Multivariate analysis also showed that Asian Indians had nonsignificantly lower odds ratios for CHD (AOR, 0.58; 95% CI, 0.25 to 1.35) and significantly lower odds of reporting hypertension (AOR, 0.58; 95% CI, 0.42 to 0.82) compared to non-Hispanic whites. CONCLUSION: Asian Indians in the United States have higher odds of being diabetic despite lower rates of obesity. Unlike studies on Asian Indians in India and the United Kingdom, we found no evidence of an elevated risk of CHD or hypertension. We need more reliable national data on Asian Indians to understand their particular health behaviors and cardiovascular risks. Research and preventive efforts should focus on reducing diabetes among Asian Indians.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_americas_2005,

title = {America's neglected veterans: 1.7 million who served have no health coverage.},

author = {Steffie Woolhandler and David U. Himmelstein and Ronald Distajo and Karen E. Lasser and Danny McCormick and David H. Bor and Sidney M. Wolfe},

doi = {10.2190/UPBQ-C3RH-D367-5H9D},

issn = {0020-7314},

year  = {2005},

date = {2005-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {35},

number = {2},

pages = {313–323},

abstract = {Many U.S. military veterans lack health insurance and are ineligible for care in Veterans Administration health care facilities. Using two recently released national government surveys–the 2004 Current Population Survey and the 2002 National Health Interview Survey–the authors examined how many veterans are uninsured (lacking health insurance coverage and not receiving care from the VA) and whether uninsured veterans have problems in access to care. In 2003, 1.69 million military veterans neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals or clinics; the number of uninsured veterans increased by 235,159 since 2000. The proportion of nonelderly veterans who were uninsured rose from 9.9 percent in 2000 to 11.9 percent in 2003. An additional 3.90 million members of veterans' households were also uninsured and ineligible for VHA care. Medicare covered virtually all Korean War and World War II veterans, but 681,808 Vietnam-era veterans were uninsured (8.7 percent of the 7.85 million Vietnam-era vets). Among the 8.27 million veterans who served during "other eras" (including the Persian Gulf War), 12.1 percent (999,548) lacked health coverage. A disturbingly high number of veterans reported problems in obtaining needed medical care. By almost any measure, uninsured veterans had as much trouble getting medical care as other uninsured persons. Thus millions of U.S. veterans and their family members are uninsured and face grave difficulties in gaining access to even the most basic medical care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_occupational_2004,

title = {The occupational health of Southeast Asians in Lowell: a descriptive study.},

author = {Lenore S. Azaroff and Charles Levenstein and David H. Wegman},

doi = {10.1179/oeh.2004.10.1.47},

issn = {1077-3525},

year  = {2004},

date = {2004-03-01},

journal = {International journal of occupational and environmental health},

volume = {10},

number = {1},

pages = {47–54},

abstract = {To assess the occupational health of a group of vulnerable workers, Southeast Asians, in Lowell, Massachusetts, researchers surveyed 160 residents of Cambodian or Lao ethnicity regarding working conditions, health problems, and use of medical services. Over 40% reported work in electronics and computer assembly. A fourth of those currently employed held temporary jobs. Workplace hazards included soldering fumes; inadequate ventilation; prolonged sitting or standing; awkward postures; unguarded machinery; shift work; long hours; and pressure to produce quickly. Common work-related health problems included sprains and strains, headache, dizziness, and flu-like symptoms. Less than a third of the respondents knew about workers' compensation. Household surveys can provide otherwise unavailable occupational health data for defined populations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_administrative_2004,

title = {Administrative waste in the UṠ. health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings.},

author = {David U. Himmelstein and Steffie Woolhandler and Sidney M. Wolfe},

doi = {10.2190/D2BL-HUXY-RLF8-ULXA},

issn = {0020-7314},

year  = {2004},

date = {2004-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {34},

number = {1},

pages = {79–86},

abstract = {This report provides nationwide and state-specific estimates of U.S. health care administration spending and potential savings in 2003 were the United States to institute a Canadian-style national health insurance system. The United States wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured. Administrative expenses will consume at least dollar 399.4 billion of a total health expenditure of dollar 1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately dollar 286.0 billion in 2003, dollar 6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage. The cost of excess health bureaucracy in individual states is equally striking. For example, Massachusetts, with 560,000 uninsured state residents, could save about dollar 8,556 million in 2003 (dollar 16,453 per uninsured resident of that state) if it streamlined administration to Canadian levels. New Mexico, with 373,000 uninsured, could save dollar 1,500 million on health bureaucracy (dollar 4,022 per uninsured resident). Only a single-payer national health insurance system could garner these massive administrative savings, allowing universal coverage without any increase in total health spending. Because incremental reforms necessarily preserve the current fragmented and duplicative payment structure, they cannot achieve significant bureaucratic savings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_health_2004,

title = {Health care administration in the United States and Canada: micromanagement, macro costs.},

author = {Steffie Woolhandler and Terry Campbell and David U. Himmelstein},

doi = {10.2190/MJJW-GA0V-78KT-9RGX},

issn = {0020-7314},

year  = {2004},

date = {2004-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {34},

number = {1},

pages = {65–78},

abstract = {A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_costs_2003,

title = {Costs of health care administration in the United States and Canada.},

author = {Steffie Woolhandler and Terry Campbell and David U. Himmelstein},

doi = {10.1056/NEJMsa022033},

issn = {1533-4406 0028-4793},

year  = {2003},

date = {2003-08-01},

journal = {The New England journal of medicine},

volume = {349},

number = {8},

pages = {768–775},

abstract = {BACKGROUND: A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. METHODS: For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. RESULTS: In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.) CONCLUSIONS: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_occupational_2003,

title = {Occupational health of Southeast Asian immigrants in a US city: a comparison of data sources.},

author = {Lenore S. Azaroff and Charles Levenstein and David H. Wegman},

doi = {10.2105/ajph.93.4.593},

issn = {0090-0036 1541-0048},

year  = {2003},

date = {2003-04-01},

journal = {American journal of public health},

volume = {93},

number = {4},

pages = {593–598},

abstract = {OBJECTIVES: This study sought to characterize occupational injury and illness cases identified through 3 different sources of data on a population of immigrant workers. METHODS: Participants were Cambodian and Lao workers living in Lowell, Mass. A household survey allowed comparisons between characteristics of work-related cases documented in workers' compensation wage replacement records and hospital records and characteristics of self-reported cases. RESULTS: The household survey captured types of cases missing from existing data, particularly illnesses self-reported to be associated with chemical exposures. Injuries and illnesses affecting the study population appeared to be significantly underrepresented in workers' compensation wage replacement data. CONCLUSIONS: Community-based methods can supplement available occupational health data sources.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_relationship_2002,

title = {Relationship between low quality-of-care scores and HMOs' subsequent public disclosure of quality-of-care scores.},

author = {Danny McCormick and David U. Himmelstein and Steffie Woolhandler and Sidney M. Wolfe and David H. Bor},

doi = {10.1001/jama.288.12.1484},

issn = {0098-7484},

year  = {2002},

date = {2002-09-01},

journal = {JAMA},

volume = {288},

number = {12},

pages = {1484–1490},

abstract = {CONTEXT: Public disclosure of quality data on health maintenance organizations (HMOs) might improve public accountability, inform consumer decision making, and promote quality improvement. But, because disclosure is voluntary, some HMOs could subvert these objectives by refusing to release unfavorable data. OBJECTIVE: To determine the association between HMO quality of care and withdrawal from public disclosure of quality-of-care data the subsequent year. DESIGN AND SETTING: Retrospective cohort study of administrative and quality-of-care data on HMOs from the National Committee for Quality Assurance (NCQA) annual Quality Compass databases for 1997, 1998, and 1999, including Health Plan Employer Data and Information Set (HEDIS) quality scores. MAIN OUTCOME MEASURE: One-year rates of HMO withdrawal from public disclosure of HEDIS scores for plans in the highest and lowest tertiles of HEDIS scores, adjusted for method of data collection and plan model type. RESULTS: Of the 329 HMOs that publicly disclosed HEDIS scores in 1997, 161 plans (49%) withdrew from public disclosure in 1998. Of the 292 HMOs that disclosed their scores in 1998 (including 130 newly participating plans), 67 plans (23%) withdrew from public disclosure in 1999. Plans whose scores ranked in the lowest-quality tertile were much more likely than plans ranking in the highest-quality tertile to withdraw from public disclosure in 1998 (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.1-7.0) and 1999 (OR, 5.7; 95% CI, 2.7-17.7). CONCLUSION: Compared with HMOs receiving higher quality-of-care scores, lower-scoring plans are more likely to stop disclosing their quality data. Voluntary reporting of quality data by HMOs is ineffective; selective nondisclosure undermines both informed consumer decision making and public accountability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_occupational_2002,

title = {Occupational injury and illness surveillance: conceptual filters explain underreporting.},

author = {Lenore S. Azaroff and Charles Levenstein and David H. Wegman},

doi = {10.2105/ajph.92.9.1421},

issn = {0090-0036 1541-0048},

year  = {2002},

date = {2002-09-01},

journal = {American journal of public health},

volume = {92},

number = {9},

pages = {1421–1429},

abstract = {Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_timing_2002,

title = {Timing of new black box warnings and withdrawals for prescription medications.},

author = {Karen E. Lasser and Paul D. Allen and Steffie J. Woolhandler and David U. Himmelstein and Sidney M. Wolfe and David H. Bor},

doi = {10.1001/jama.287.17.2215},

issn = {0098-7484},

year  = {2002},

date = {2002-05-01},

journal = {JAMA},

volume = {287},

number = {17},

pages = {2215–2220},

abstract = {CONTEXT: Recently approved drugs may be more likely to have unrecognized adverse drug reactions (ADRs) than established drugs, but no recent studies have examined how frequently postmarketing surveillance identifies important ADRs. OBJECTIVE: To determine the frequency and timing of discovery of new ADRs described in black box warnings or necessitating withdrawal of the drug from the market. DESIGN AND SETTING: Examination of the Physicians' Desk Reference for all new chemical entities approved by the US Food and Drug Administration between 1975 and 1999, and all drugs withdrawn from the market between 1975 and 2000 (with or without a prior black box warning). MAIN OUTCOME MEASURES: Frequency of and time to a new black box warning or drug withdrawal. RESULTS: A total of 548 new chemical entities were approved in 1975-1999; 56 (10.2%) acquired a new black box warning or were withdrawn. Forty-five drugs (8.2%) acquired 1 or more black box warnings and 16 (2.9%) were withdrawn from the market. In Kaplan-Meier analyses, the estimated probability of acquiring a new black box warning or being withdrawn from the market over 25 years was 20%. Eighty-one major changes to drug labeling in the Physicians' Desk Reference occurred including the addition of 1 or more black box warnings per drug, or drug withdrawal. In Kaplan-Meier analyses, half of these changes occurred within 7 years of drug introduction; half of the withdrawals occurred within 2 years. CONCLUSIONS: Serious ADRs commonly emerge after Food and Drug Administration approval. The safety of new agents cannot be known with certainty until a drug has been on the market for many years.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{case_no_2002,

title = {No care for the caregivers: declining health insurance coverage for health care personnel and their children, 1988-1998.},

author = {Brady G. S. Case and David U. Himmelstein and Steffie Woolhandler},

doi = {10.2105/ajph.92.3.404},

issn = {0090-0036 1541-0048},

year  = {2002},

date = {2002-03-01},

journal = {American journal of public health},

volume = {92},

number = {3},

pages = {404–408},

abstract = {OBJECTIVES: This study examined trends in health insurance coverage for health care workers and their children between 1988 and 1998. METHODS: We analyzed data from the annual March supplements of the Current Population Survey (CPS), a Census Bureau survey that collects information about health insurance from a nationally representative sample of noninstitutionalized US residents. RESULTS: Of the health care personnel younger than 65 years, 1.36 million (90% confidence interval [CI] = 1.28 million, 1.45 million) were uninsured in 1998, up 83.4% from 1988; the proportion uninsured rose from 8.4% (90% CI = 7.8%, 9.1%) to 12.2% (90% CI = 11.5%, 12.9%). Declining coverage rates in the growing private-sector health care workforce—and declining health employment in the public sector, which provided health insurance benefits to more of its workers—accounted for the increases. Households with a health care worker included 1.12 million (90% CI = 1.05 million, 1.20 million) uninsured children, accounting for 10.1% (90% CI = 9.5%, 10.8%) of all uninsured children in the United States. CONCLUSIONS: Health care personnel are losing health insurance coverage more rapidly than are other workers. Increasingly, the health care sector is consigning its own workers and their children to the ranks of the uninsured.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_taking_2002,

title = {Taking care of business: HMOs that spend more on administration deliver lower-quality care.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.2190/JK74-14MB-YT5T-KUXQ},

issn = {0020-7314},

year  = {2002},

date = {2002-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {32},

number = {4},

pages = {657–667},

abstract = {The authors analyzed health maintenance organizations' administrative costs and quality measures from the National Committee for Quality Assurance's Quality Compass database for the years 1997-2000. HMOs with higher administrative overhead had consistently worse quality scores in univariate analysis. Multivariate analyses controlling for geographic region (all years) and HMO model type (1997 and 1998 analyses only) confirmed that higher administrative costs were associated with lower quality. Excess HMO bureaucracy is not only wasteful but harmful.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_minorities_2002,

title = {Do minorities in the United States receive fewer mental health services than whites?},

author = {Karen E. Lasser and David U. Himmelstein and Steffie J. Woolhandler and Danny McCormick and David H. Bor},

doi = {10.2190/UEXW-RARL-U46V-FU4P},

issn = {0020-7314},

year  = {2002},

date = {2002-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {32},

number = {3},

pages = {567–578},

abstract = {Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The authors calculated visit rates per 1,000 population to either primary care or psychiatric providers for mental health counseling, psychotherapy, and psychiatric drug therapy. In the primary care setting, Hispanics and blacks had lower visit rates (per 1,000 population) for drug therapy than whites (48.3 and 73.7 vs. 109.0; P <.0001 and P < .01, respectively). Blacks also had a lower visit rate for talk therapy (mental health counseling or psychotherapy) than whites (23.6 vs. 42.5; P < .01). In the psychiatric setting, Hispanics and blacks had lower visit rates than whites for talk therapy (38.4 and 33.6 vs. 85.1; P < .0001 for both comparisons) and drug therapy (38.3 and 29.1 vs. 71.8; P < .0001 for both comparisons). These results indicate that minorities receive about half as much outpatient mental health care as whites.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{harrington_does_2002,

title = {Does investor-ownership of nursing homes compromise the quality of care?},

author = {Charlene Harrington and Steffie Woolhandler and Joseph Mullan and Helen Carrillo and David U. Himmelstein},

doi = {10.2190/EBCN-WECV-C0NT-676R},

issn = {0020-7314},

year  = {2002},

date = {2002-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {32},

number = {2},

pages = {315–325},

abstract = {Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_hmo_2001,

title = {HMO profits and quality.},

author = {S. Woolhandler and D. U. Himmelstein and I. Hellander and S. M. Wolfe},

doi = {10.1377/hlthaff.20.5.302},

issn = {0278-2715},

year  = {2001},

date = {2001-10-01},

journal = {Health affairs (Project Hope)},

volume = {20},

number = {5},

pages = {302–303},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{harrington_does_2001,

title = {Does investor ownership of nursing homes compromise the quality of care?},

author = {C. Harrington and S. Woolhandler and J. Mullan and H. Carrillo and D. U. Himmelstein},

doi = {10.2105/ajph.91.9.1452},

issn = {0090-0036 1541-0048},

year  = {2001},

date = {2001-09-01},

journal = {American journal of public health},

volume = {91},

number = {9},

pages = {1452–1455},

abstract = {OBJECTIVES: Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. METHODS: We analyzed 1998 data from state inspections of 13,693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. RESULTS: Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. CONCLUSIONS: Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_smoking_2000,

title = {Smoking and mental illness: A population-based prevalence study.},

author = {K. Lasser and J. W. Boyd and S. Woolhandler and D. U. Himmelstein and D. McCormick and D. H. Bor},

doi = {10.1001/jama.284.20.2606},

issn = {0098-7484},

year  = {2000},

date = {2000-11-01},

journal = {JAMA},

volume = {284},

number = {20},

pages = {2606–2610},

abstract = {CONTEXT: Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking. OBJECTIVE: To assess rates of smoking and tobacco cessation in adults, with and without mental illness. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992. MAIN OUTCOME MEASURES: Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview. RESULTS: Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P =.04), and smokers with past-month mental illness had a self-reported quit rate of 30. 5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample. CONCLUSIONS: Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates. JAMA. 2000;284:2606-2610.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_investment_2000,

title = {Investment of health insurers and mutual funds in tobacco stocks.},

author = {D. U. Himmelstein and S. Woolhandler and J. W. Boyd},

doi = {10.1001/jama.284.6.697},

issn = {0098-7484},

year  = {2000},

date = {2000-08-01},

journal = {JAMA},

volume = {284},

number = {6},

pages = {697},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_quality_1999,

title = {Quality of care in investor-owned vs not-for-profit HMOs.},

author = {D. U. Himmelstein and S. Woolhandler and I. Hellander and S. M. Wolfe},

doi = {10.1001/jama.282.2.159},

issn = {0098-7484},

year  = {1999},

date = {1999-07-01},

journal = {JAMA},

volume = {282},

number = {2},

pages = {159–163},

abstract = {CONTEXT: The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. OBJECTIVE: To compare quality-of-care measures for investor-owned and not-for-profit HMOs. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. MAIN OUTCOME MEASURES: Rates for 14 HEDIS quality-of-care indicators. RESULTS: Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. CONCLUSIONS: Investor-owned HMOs deliver lower quality of care than not-for-profit plans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_ethical_1999,

title = {Ethical guidelines for physician payment based on capitation.},

author = {S. Woolhandler and D. U. Himmelstein},

issn = {0028-4793},

year  = {1999},

date = {1999-01-01},

journal = {The New England journal of medicine},

volume = {340},

number = {4},

pages = {321–2; author reply 322–323},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{carrasquillo_reappraisal_1999,

title = {A reappraisal of private employers' role in providing health insurance.},

author = {O. Carrasquillo and D. U. Himmelstein and S. Woolhandler and D. H. Bor},

doi = {10.1056/NEJM199901143400206},

issn = {0028-4793},

year  = {1999},

date = {1999-01-01},

journal = {The New England journal of medicine},

volume = {340},

number = {2},

pages = {109–114},

abstract = {BACKGROUND: In 1996, according to official figures, 61 percent of Americans received health insurance through employers. However, this estimate includes persons who relied primarily on government insurance such as Medicare, workers whose employers arranged their insurance but contributed nothing toward the premiums, and government employees whose private coverage was paid for by taxpayers. METHODS: To estimate the number of persons whose principal health insurance was paid for in whole or in part by employers in the private sector and the number receiving government-funded insurance, we analyzed data from the March 1997 Current Population Survey. Approximately 130,000 persons representative of the noninstitutionalized U.S. population were sampled. We considered people to be covered principally by health insurance paid for by private-sector employers if they had no public insurance coverage and were covered by insurance from a non-governmental employer who paid all or part of their premiums. Those who were covered by Medicaid, Medicare, insurance resulting from former or current military service, or the Indian Health Service were considered to be receiving government insurance. RESULTS: In 1996, 43.1 percent of the population (90 percent confidence interval, 42.7 to 43.5 percent) depended principally on health insurance paid for by private-sector employers, 34.2 percent (90 percent confidence interval, 33.8 to 34.6 percent) had publicly funded insurance, 7.1 percent (90 percent confidence interval, 6.8 to 7.6 percent) purchased their own coverage, and 15.6 percent (90 percent confidence interval, 15.3 to 15.9 percent) were uninsured. In only six states was more than half the population covered principally by health insurance paid for by private-sector employers. CONCLUSIONS: Current definitions of health insurance overemphasize the role of private employers and underestimate the extent to which government pays for health insurance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{carrasquillo_going_1999,

title = {Going bare: trends in health insurance coverage, 1989 through 1996.},

author = {O. Carrasquillo and D. U. Himmelstein and S. Woolhandler and D. H. Bor},

doi = {10.2105/ajph.89.1.36},

issn = {0090-0036 1541-0048},

year  = {1999},

date = {1999-01-01},

journal = {American journal of public health},

volume = {89},

number = {1},

pages = {36–42},

abstract = {OBJECTIVES: This study analyzed trends in health insurance coverage in the United States from 1989 through 1996. METHODS: Data from annual cross-sectional surveys by the US Census Bureau were analyzed. RESULTS: Between 1989 and 1996, the number of uninsured persons increased by 8.3 million (90% confidence interval [CI] = 7.7, 8.9 million). In 1996, 41.7 million (90% CI = 40.9, 42.5 million) lacked insurance. From 1989 to 1993, the proportion with Medicaid increased by 3.6 percentage points (90% CI = 3.1, 4.0), while the proportion with private insurance declined by 4.2 percentage points (90% CI = 3.7, 4.7). From 1993 to 1996 private coverage rates stabilized but did not reverse earlier declines. Consequently, the number uninsured continued to increase. The greatest increase in the population of uninsured [corrected] was among young adults aged 18 to 39 years; rates among children also rose steeply after 1992. While Blacks had the largest percentage increase, Hispanics accounted for 36.4% (90% CI = 32.3%, 40.5%) of the increase in the number uninsured. From 1989 to 1993, the majority of the increase was among poor families. Since then, middle-income families have incurred the largest increase. Northcentral and northeastern states had the largest increases in percent uninsured. CONCLUSIONS: Despite economic prosperity, the numbers and rates of the uninsured continued to rise. Principally affected were children and young adults, poor and middle income families, blacks, and Hispanics.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{carrasquillo_trends_1999,

title = {Trends in health insurance coverage, 1989-1997.},

author = {O. Carrasquillo and D. U. Himmelstein and S. Woolhandler and D. H. Bor},

doi = {10.2190/1AV3-E901-TN3D-3H38},

issn = {0020-7314},

year  = {1999},

date = {1999-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {29},

number = {3},

pages = {467–483},

abstract = {The authors analyze trends in health insurance coverage in the United States from 1989 through 1997, using cross-sectional surveys by the U.S. Census Bureau (Current Population Survey) of 160,000 persons representative of the non-institutionalized population. Between 1989 and 1997, the number of people without health insurance increased by 10.1 million to 43.4 million. From 1989 to 1993, the proportion covered by Medicaid increased by 3.6 percentage points while the proportion covered by private insurance declined by 4.2 percentage points. Since then, private coverage rates have stabilized and Medicaid coverage has decreased. Consequently, the number and percent uninsured continues to rise. Young adults age 18-39 had the largest increase in the proportion uninsured, and rates among children have also risen steeply since 1992. While blacks had the largest increase in the percent uninsured, Hispanics accounted for 35.6 percent of the increase in the number uninsured. Low-income families constituted over half of the increase in the number uninsured, but since 1993 the middle income group had the largest increase in the percent uninsured. Northeastern states had the largest increase in the percent uninsured. Thus, despite economic prosperity, the numbers and rates of the uninsured continue to rise. Principally affected are children and young adults, poor and middle-income families, blacks, and Hispanics.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{carrasquillo_can_1998,

title = {Can Medicaid managed care provide continuity of care to new Medicaid enrollees? An analysis of tenure on Medicaid.},

author = {O. Carrasquillo and D. U. Himmelstein and S. Woolhandler and D. H. Bor},

doi = {10.2105/ajph.88.3.464},

issn = {0090-0036 1541-0048},

year  = {1998},

date = {1998-03-01},

journal = {American journal of public health},

volume = {88},

number = {3},

pages = {464–466},

abstract = {OBJECTIVES: The purpose of this study was to analyze duration of coverage among new Medicaid enrollees. METHODS: The 1991 Survey of Income and Program Participation was used to examined the duration of coverage for individuals who did not have Medicaid in January 1991 and obtained coverage by May 1993. RESULTS: Of new Medicaid enrollees, 38% (90% confidence interval [CI] = 34%, 42%) remained covered 1 year later; 26% (90% CI = 21%, 31%) remained covered at 28 months. Of those older than 65 years, 54% (90% CI = 31%, 77%) retained Medicaid for 28 months, vs 20% (90% CI = 14%, 26%) of children. Of people who lost Medicaid, 54% (90% CI = 31%, 77%) had no insurance the following month. CONCLUSIONS: Almost two thirds of new Medicaid recipients lose coverage within 12 months. It is unlikely that Medicaid managed care will enhance continuity of care for new recipients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_oregon_1998,

title = {The Oregon Health Plan.},

author = {D. U. Himmelstein and S. Woolhandler},

issn = {0028-4793},

year  = {1998},

date = {1998-02-01},

journal = {The New England journal of medicine},

volume = {338},

number = {6},

pages = {395; author reply 396},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_costs_1997,

title = {Costs of care and administration at for-profit and other hospitals in the United States.},

author = {S. Woolhandler and D. U. Himmelstein},

doi = {10.1056/NEJM199703133361106},

issn = {0028-4793},

year  = {1997},

date = {1997-03-01},

journal = {The New England journal of medicine},

volume = {336},

number = {11},

pages = {769–774},

abstract = {BACKGROUND: In fiscal year 1990, administration accounted for 24.8 percent of total hospital costs in the United States - nearly twice the share in Canada. Studies from the 1970s and early 1980s found high costs, especially for administration, at for-profit hospitals. METHODS: We calculated administrative costs for 6227 nonfederal hospitals and the total costs of inpatient care for 5201 acute care hospitals in the United States for fiscal year 1994 on the basis of data the hospitals submitted to Medicare. We analyzed similar data for fiscal year 1990. Using multivariate analysis, we assessed the effect of hospital ownership (private not-for-profit, for-profit, and public) on administrative costs, controlling for hospital type, census region, hospital size, and the proportion of revenues derived from outpatient services. We adjusted inpatient costs for local wage levels, hospitals' reporting periods, and case mix. RESULTS: Administrative costs accounted for an average of 26.0 percent of total hospital costs in fiscal year 1994, up 1.2 percentage points from 1990. They increased by 2.2 percentage points, to 34.0 percent, for for-profit hospitals; by 1.2 percentage points, to 24.5 percent, for private not-for-profit hospitals; and by 0.6 percentage point, to 22.9 percent, for public hospitals. In 1994, administration accounted for 37.5 percent of total costs at psychiatric hospitals (44.4 percent at for-profit hospitals) and 33.0 percent of total costs at rehabilitation hospitals (37.7 percent at for-profit hospitals). In a multivariate analysis, for-profit ownership was associated with a 7.9 percent absolute (34 percent relative) increase in the proportion of hospital spending devoted to administration as compared with public hospitals and a 5.7 percent absolute (23 percent relative) increase as compared with private not-for-profit hospitals. Among acute care hospitals, for-profit institutions had higher adjusted costs per discharge ($8,115) than did private not-for-profit ($7,490) or public ($6,507) hospitals. Much of the difference was due to higher administrative costs ($2,289, $1,809, and $1,432 per discharge, respectively). CONCLUSIONS: Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals. Overall costs of care were also higher at for-profit hospitals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_medical_1996,

title = {Medical care employment in the United States, 1968 to 1993: The importance of health sector jobs for African Americans and women.},

author = {D. U. Himmelstein and J. P. Lewontin and S. Woolhandler},

doi = {10.2105/ajph.86.4.525},

issn = {0090-0036 1541-0048},

year  = {1996},

date = {1996-04-01},

journal = {American journal of public health},

volume = {86},

number = {4},

pages = {525–528},

abstract = {OBJECTIVES: The purpose of this study was to elucidate the social and economic impact of health sector employment. METHODS: US medical care employment was analyzed for each year between 1968 and 1993, with data from the March Current Population Survey. RESULTS: Between 1968 and 1993, medical care employment grew from 4.32 million to 11.40 million persons, accounting for 5.7% of all jobs in 1968 and 8.4% in 1993. Today, one seventh of employed women work in medical care; they hold 78% of medical care jobs. One fifth of all employed African-American women work in medical care. African-Americans hold 15.5% of jobs in the health sector: they hold 24.1% of the jobs in nursing homes, 15.9% of the jobs in hospitals, but only 5.6% of the jobs in practitioners' offices. Hispanics constitute 6.4% of medical care employees. Real wages rose 25% to 50% between 1968 and 1993 for most health occupations. Wages of registered nurses rose 86%; physicians' incomes rose 22%. Wages of nursing home workers were far lower than those of comparable hospital workers, and the gap has widened. In 1993, 11.7% of all medical care workers lacked health insurance and 597 000 lived in poverty. CONCLUSIONS: Hospital cuts and the continuing neglect of long-term care exacerbate unemployment and poverty among women and African Americans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_tenncare_1996,

title = {TennCare.},

author = {D. U. Himmelstein and S. Woolhandler},

doi = {10.1001/jama.275.9.683b},

issn = {0098-7484},

year  = {1996},

date = {1996-03-01},

journal = {JAMA},

volume = {275},

number = {9},

pages = {683; author reply 684},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_who_1996,

title = {Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.},

author = {D. U. Himmelstein and J. P. Lewontin and S. Woolhandler},

doi = {10.2105/ajph.86.2.172},

issn = {0090-0036 1541-0048},

year  = {1996},

date = {1996-02-01},

journal = {American journal of public health},

volume = {86},

number = {2},

pages = {172–178},

abstract = {OBJECTIVES: We compared US and Canadian health administration costs using national medical care employment data for both countries. METHODS: Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. RESULTS: Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33,666 health care full-time equivalent personnel per million population, and Canada deployed 31,529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. CONCLUSIONS: If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1,407,000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_care_1995,

title = {Care denied: US residents who are unable to obtain needed medical services.},

author = {D. U. Himmelstein and S. Woolhandler},

doi = {10.2105/ajph.85.3.341},

issn = {0090-0036 1541-0048},

year  = {1995},

date = {1995-03-01},

journal = {American journal of public health},

volume = {85},

number = {3},

pages = {341–344},

abstract = {OBJECTIVES: This study analyzed data on US residents reporting that they were unable to obtain needed care. Inadequately immunized children and women inadequately screened for breast or cervical cancer were also examined. METHODS: Data from the 1987 National Medical Expenditure Survey was analyzed. RESULTS: A total of 6,375,000 (90% confidence interval [CI] = 6,039,000, 6,711,000) people could not get hospitalization, prescription medications, medical equipment/supplies, or emergency, pediatric, mental health, or home care. Although the uninsured were more likely to forego care unavailable, three quarters of those unable to obtain services were insured, and 46% (90% CI = 42.4%, 49.6%) had private coverage. Of those reporting the reason why they failed to obtain care, 65.1% (90% CI = 61.7%, 68.6%) listed high costs or lack of insurance, including 60.7% (90% CI = 57.1%, 64.3%) of the privately insured. More than a third of women had not had a breast examination in the previous 2 years, a fifth had not had a Pap smear within the previous 4 years, and half had never had a mammogram (ages 50-69 only). Of children 2 to 5 years old, 35.1% (90% CI = 31.5%, 35.7%) were inadequately immunized. Medicaid recipients had measures of access to care similar to those of the uninsured. CONCLUSIONS: Many US residents–most of whom have insurance–are unable to obtain needed care, usually because of high costs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hellander_growing_1995,

title = {The growing epidemic of uninsurance: new data on the health insurance coverage of Americans.},

author = {I. Hellander and J. Moloo and D. U. Himmelstein and S. Woolhandler and S. M. Wolfe},

doi = {10.2190/AQTP-FLAQ-PWXN-DYMR},

issn = {0020-7314},

year  = {1995},

date = {1995-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {25},

number = {3},

pages = {377–392},

abstract = {Despite a massive expansion of Medicaid and an upswing in the economy, the total number of Americans uninsured in 1993 was 39.7 million, more than at any time since the passage of Medicaid and Medicare in the 1960s. Since 1989, the ranks of the uninsured have swelled by 6.3 million. Millions more would be uninsured if Medicaid enrollment had not risen dramatically, by 10.5 million people since 1989. Loss of health coverage is a growing problem for middle-income families, women, and children, as it has long been for low-income families. Even in Hawaii, whose employer mandate program is often cited as a model of universal coverage, there was a large increase in uninsurance. Nationwide, the sharp upswing in the number of Americans who are uninsured has coincided with government and corporate policies to encourage medical competition and push people into managed care plans. Republican proposals to limit AFDC benefits threaten to further increase uninsurance, particularly among women and children. Only a Canadian-style single-payer reform can assure universal coverage and simultaneously contain costs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}