29 CFR 1605.2 - Reasonable accommodation without undue hardship as required by section 701(j) of title VII of the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... BECAUSE OF RELIGION § 1605.2 Reasonable accommodation without undue hardship as required by section 701(j... address other obligations under title VII not to discriminate on grounds of religion, nor other provisions... intended to provide guidance for statutes which require accommodation on bases other than religion such as...

50 CFR 17.23 - Economic hardship permits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 2 2010-10-01 2010-10-01 false Economic hardship permits. 17.23 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... section in order to prevent undue economic hardship. The Director shall publish notice in the Federal...

50 CFR 17.63 - Economic hardship permits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 2 2010-10-01 2010-10-01 false Economic hardship permits. 17.63 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... issuance criteria of this section, in order to prevent undue economic hardship. No such exemption may be...

50 CFR 17.23 - Economic hardship permits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 2 2011-10-01 2011-10-01 false Economic hardship permits. 17.23 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... section in order to prevent undue economic hardship. The Director shall publish notice in the Federal...

50 CFR 17.63 - Economic hardship permits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 2 2013-10-01 2013-10-01 false Economic hardship permits. 17.63 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... issuance criteria of this section, in order to prevent undue economic hardship. No such exemption may be...

50 CFR 17.63 - Economic hardship permits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 2 2012-10-01 2012-10-01 false Economic hardship permits. 17.63 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... issuance criteria of this section, in order to prevent undue economic hardship. No such exemption may be...

50 CFR 17.23 - Economic hardship permits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 2 2013-10-01 2013-10-01 false Economic hardship permits. 17.23 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... section in order to prevent undue economic hardship. The Director shall publish notice in the Federal...

50 CFR 17.63 - Economic hardship permits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 2 2011-10-01 2011-10-01 false Economic hardship permits. 17.63 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... issuance criteria of this section, in order to prevent undue economic hardship. No such exemption may be...

50 CFR 17.23 - Economic hardship permits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 2 2014-10-01 2014-10-01 false Economic hardship permits. 17.23 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... section in order to prevent undue economic hardship. The Director shall publish notice in the Federal...

50 CFR 17.23 - Economic hardship permits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 2 2012-10-01 2012-10-01 false Economic hardship permits. 17.23 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... section in order to prevent undue economic hardship. The Director shall publish notice in the Federal...

50 CFR 17.63 - Economic hardship permits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 2 2014-10-01 2014-10-01 false Economic hardship permits. 17.63 Section... Economic hardship permits. Upon receipt of a complete application, the Director may issue a permit... issuance criteria of this section, in order to prevent undue economic hardship. No such exemption may be...

24 CFR 8.11 - Reasonable accommodation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... make reasonable accommodation to the known physical or mental limitations of an otherwise qualified... accommodation would impose an undue hardship on the operation of its program. (b) Reasonable accommodation may... hardship on the operation of a recipient's program, factors to be considered include: (1) The overall size...

Monitoring progress towards universal health coverage at country and global levels.

PubMed

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-09-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.

Monitoring Progress towards Universal Health Coverage at Country and Global Levels

PubMed Central

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-01-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries. PMID:25243899

9 CFR 381.132 - Labeling approval.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; (iii) Denial of the request would create undue economic hardship; and (iv) An unfair competitive advantage would not result from the granting of the temporary approval. (2) Extensions of temporary...

31 CFR 29.524 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Financial hardship. 29.524 Section 29... Waiver of Overpayments § 29.524 Financial hardship. Financial hardship may be deemed to exist when the.... Financial hardship will not be found to exist when the debtor merely establishes that the repayment causes a...

45 CFR 32.9 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-10-01

... § 32.9 Financial hardship. (a) A debtor whose wages are subject to a withholding order may, at any time... financial hardship is found, the Secretary shall downwardly adjust, by an amount and for a period of time... 45 Public Welfare 1 2010-10-01 2010-10-01 false Financial hardship. 32.9 Section 32.9 Public...

34 CFR 34.24 - Claim of financial hardship by debtor subject to garnishment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Claim of financial hardship by debtor subject to... WAGE GARNISHMENT § 34.24 Claim of financial hardship by debtor subject to garnishment. (a) You may... notice of garnishment would cause financial hardship to you and your dependents. (See § 34.7) (b) You may...

26 CFR 1.6045-1T - Returns of information of brokers and barter exchanges (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

..., see § 1.6045-1 (a) through (k). (l) Use of magnetic media. For information returns filed after... magnetic media and for rules relating to waivers granted for undue hardship. For information returns filed...

Handbook of Reasonable Accommodation.

ERIC Educational Resources Information Center

Heaton, Sandra M.; And Others

The booklet discusses a basic concept in affirmative action and nondiscrimination for the handicapped, which requires federal agencies to make reasonable accommodation to the physical or mental limitations of a qualified handicapped applicant or employee unless the accommodation would impose an undue hardship on the agency. Reasonable…

26 CFR 1.6045-1T - Returns of information of brokers and barter exchanges (temporary).

Code of Federal Regulations, 2011 CFR

2011-04-01

... guidance, see § 1.6045-1 (a) through (k). (l) Use of magnetic media. For information returns filed after... magnetic media and for rules relating to waivers granted for undue hardship. For information returns filed...

Financial hardship and psychological distress: Exploring the buffering effects of religion

PubMed Central

Bradshaw, Matt; Ellison, Christopher G.

2013-01-01

Despite ample precedent in theology and social theory, few studies have systematically examined the role of religion in mitigating the harmful effects of socioeconomic deprivation on mental health. The present study outlines several arguments linking objective and subjective measures of financial hardship, as well as multiple aspects of religious life, with psychological distress. Relevant hypotheses are then tested using data on adults aged 18–59 from the 1998 US NORC General Social Survey. Findings confirm that both types of financial hardship are positively associated with distress, and that several different aspects of religious life buffer against these deleterious influences. Specifically, religious attendance and the belief in an afterlife moderate the deleterious effects of financial hardship on both objective and subjective financial hardship, while meditation serves this function only for objective hardship. No interactive relationships were found between frequency of prayer and financial hardship. A number of implications, study limitations, and directions for future research are identified. PMID:20556889

Family Financial Hardship and Adolescent Girls' Adjustment: The Role of Maternal Disclosure of Financial Concerns.

ERIC Educational Resources Information Center

Lehman, Stephanie Jacobs; Koerner, Susan Silverberg

2002-01-01

A study of 62 adolescent girls and their recently divorced mothers examined the relationship between maternal disclosure of financial concerns and difficulties in adolescent daughters' adjustment. Findings revealed a positive direct relationship between family financial hardship and girls' psychological distress, and that financial hardship was…

A New Key Unlocks Dormitory Financing.

ERIC Educational Resources Information Center

Ransdell, Gary A.

2000-01-01

Describes how one university creatively financed its dormitory renovation without imposing undue hardships on students (and with approval from of the university's governing board and elected state leaders). Planners developed a nonprofit foundation to fund the recapitalization and renovation of the dormitories. The foundation owned the…

24 CFR 7.15 - Responsibilities of managers and supervisors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Opportunity Without Regard to Race, Color Religion, Sex, National Origin, Age, Disability or Reprisal... sound management and personnel practices; (g) Resolving complaints of discrimination early in the EEO... accommodations can be made without undue hardship on the business of the Department; (i) Attending mandatory...

10 CFR 4.123 - Reasonable accommodation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... shall make reasonable accommodation to the known physical or mental limitations of an otherwise... would impose an undue hardship on the operation of its program or activity. (b) Reasonable accommodation... on the operation of a recipient's program or activity, factors to be considered include: (1) The...

7 CFR 12.23 - Conservation plans and conservation systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... to produce agricultural commodities prior to December 23, 1985, the applicable conservation systems... available conservation technology; cost-effective; and shall not cause undue economic hardship on the person... containing highly erodible cropland which was used to produce an agricultural commodity prior to December 23...

Financial hardship and drug use among men who have sex with men.

PubMed

Park, Su Hyun; Al-Ajlouni, Yazan; Palamar, Joseph J; Goedel, William C; Estreet, Anthony; Elbel, Brian; Sherman, Scott E; Duncan, Dustin T

2018-05-24

Little is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM. We conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs). In our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05-1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19-1.78), marijuana (aRR = 1.48; 95% CI =1.03-2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03-1.50). Financial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.

22 CFR 17.5 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-04-01

... as follows: (i) The individual's financial ability to pay at the time collection is scheduled to be... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Financial hardship. 17.5 Section 17.5 Foreign... SYSTEM (FSPS) § 17.5 Financial hardship. (a) Waiver of overpayment will not be allowed in any case prior...

The role of hardship in the association between socio-economic position and depression.

PubMed

Butterworth, Peter; Olesen, Sarah C; Leach, Liana S

2012-04-01

It is well established that socio-economic position is associated with depression. The experience of financial hardship, having to go without the essentials of daily living due to limited financial resources, may explain the effect. However, there are few studies examining the link between financial hardship and diagnosable depression at a population level. The current paper addresses this gap and also evaluates the moderating effect of age. Data were from 8841 participants aged 16-85 years in Australia's 2007 National Survey of Mental Health and Wellbeing. The 12-month prevalence of depressive episode was assessed using the Composite International Diagnostic Interview. Measures of socio-economic position included: financial hardship, education, labour-force status, occupational skill, household income, main source of income, and area-level disadvantage. Financial hardship was more strongly associated with depression than other socio-economic variables. Hardship was more strongly associated with current depression than with prior history of depression. The relative effect of hardship was strongest in late adulthood but the absolute effect of hardship was greatest in middle age. The results demonstrate the critical role of financial hardship in the association between socio-economic disadvantage and 12-month depressive episode, and suggest that social and economic policies that address inequalities in living standards may be an appropriate way to reduce the burden attributable to depression.

12 CFR 268.102 - Board program for equal employment opportunity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Commission's Management Directives; (3) Conduct a continuing campaign to eradicate every form of prejudice or... candidates without regard to race, color, religion, sex, national origin, age or disability, and solicit... when those accommodations can be made without undue hardship on the business of the Board; (8) Make...

22 CFR 126.3 - Exceptions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Exceptions. 126.3 Section 126.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS GENERAL POLICIES AND PROVISIONS § 126.3 Exceptions. In a case of exceptional or undue hardship, or when it is otherwise in the interest...

22 CFR 126.3 - Exceptions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Exceptions. 126.3 Section 126.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS GENERAL POLICIES AND PROVISIONS § 126.3 Exceptions. In a case of exceptional or undue hardship, or when it is otherwise in the interest...

22 CFR 126.3 - Exceptions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Exceptions. 126.3 Section 126.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS GENERAL POLICIES AND PROVISIONS § 126.3 Exceptions. In a case of exceptional or undue hardship, or when it is otherwise in the interest...

22 CFR 126.3 - Exceptions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Exceptions. 126.3 Section 126.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS GENERAL POLICIES AND PROVISIONS § 126.3 Exceptions. In a case of exceptional or undue hardship, or when it is otherwise in the interest...

Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis.

PubMed

Shankaran, Veena; Jolly, Sanjay; Blough, David; Ramsey, Scott D

2012-05-10

Characteristics that predispose patients to financial hardship during cancer treatment are poorly understood. We therefore conducted a population-based exploratory analysis of potential factors associated with financial hardship and treatment nonadherence during and following adjuvant chemotherapy for colon cancer. Patients diagnosed with stage III colon cancer between 2008 and 2010 were identified from a population-based cancer registry representing 13 counties in Washington state. Patients were asked to complete a comprehensive survey on treatment-related costs. Patients were considered to have experienced financial hardship if they accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a 20% or greater decline in their annual income as a result of treatment-related expenses. Logistic regression analysis was used to investigate factors associated with financial hardship and treatment nonadherence. A total of 284 responses were obtained from 555 eligible patients (response rate, 51.2%). Nearly all patients in the final sample were insured during treatment. In this sample, 38% of patients reported one or more financial hardships as a result of treatment. The factors most closely associated with treatment-related financial hardship were younger age and lower annual household income. Younger age, lower income, and unemployment or disability (which occurred in most instances following diagnosis) were most closely associated with treatment nonadherence. A significant proportion of patients undergoing adjuvant chemotherapy for stage III colon cancer may experience financial hardship, despite having health insurance coverage. Interventions to help at-risk patients early on during therapy may prevent long-term financial adverse effects.

49 CFR 37.155 - Factors in decision to grant an undue financial burden waiver.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Service § 37.155 Factors in decision to grant an undue financial burden waiver. (a) In making an undue... reduction in service, measured by service miles; (2) Average number of trips made by the entity's general... and quality of available resources for complementary paratransit service; and (10) Unique...

How financial hardship is associated with the onset of mental health problems over time.

PubMed

Kiely, Kim M; Leach, Liana S; Olesen, Sarah C; Butterworth, Peter

2015-06-01

Poor mental health has been consistently linked with the experience of financial hardship and poverty. However, the temporal association between these factors must be clarified before hardship alleviation can be considered as an effective mental health promotion and prevention strategy. We examined whether the longitudinal associations between financial hardship and mental health problems are best explained by an individual's current or prior experience of hardship, or their underlying vulnerability. We analysed nine waves (years: 2001-2010) of nationally representative panel data from the Household, Income, and Labour Dynamics in Australia survey (n = 11,134). Two components of financial hardship (deprivation and cash-flow problems) and income poverty were coded into time-varying and time-invariant variables reflecting the contemporaneous experience of hardship (i.e., current), the prior experience of hardship (lagged/12 months), and any experience of hardship during the study period (vulnerability). Multilevel, mixed-effect logistic regression models tested the associations between these measures and mental health. Respondents who reported deprivation and cash-flow problems had greater risk of mental health problems than those who did not. Individuals vulnerable to hardship had greater risk of mental health problems, even at the times they did not report hardship. However, their risk of mental health problems was greater on occasions when they did experience hardship. The results are consistent with the argument that economic and social programmes that address and prevent hardship may promote community mental health.

Financial hardship and the intensity of medical care received near death.

PubMed

Tucker-Seeley, Reginald D; Abel, Gregory A; Uno, Hajime; Prigerson, Holly

2015-05-01

Although end-of-life (EOL) care can present a substantial financial burden for the household, the influence of this burden on the intensity of care received at the EOL remains unknown. The goal of this study was to determine the association between financial hardship and intensive care in the last week of life. The Coping with Cancer (CwC) Study is a longitudinal, multisite cohort study of terminally ill cancer patients and their informal caregivers, September 2002-February 2008. Patients (N = 281) were followed from baseline to death, a median of 4.4 months after baseline assessment. Intensive care was defined as the use of resuscitation and/or ventilation in the patient's last week of life. Financial hardship was measured at study baseline as a positive response to whether the household had to use all or most of their savings because of the family member's illness. Twenty-nine percent reported financial hardship, and 9% received intensive EOL care. Patients reporting financial hardship had a 3.22 (95% CI: 1.38, 7.53) higher likelihood of receiving intensive EOL care compared with patients not reporting financial hardship. After adjusting for sociodemographic characteristics and patient preferences, patients reporting financial hardship had a 3.05 (95% CI: 1.22, 7.62) higher likelihood of receiving intensive EOL care. The depletion of a family's financial resources is a significant predictor of intensive EOL care, over and above the influence of sociodemographic characteristics and patient preferences. Copyright © 2014 John Wiley & Sons, Ltd.

Financial hardship and self-rated health among low-income housing residents.

PubMed

Tucker-Seeley, Reginald D; Harley, Amy E; Stoddard, Anne M; Sorensen, Glorian G

2013-08-01

Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. We analyzed cross-sectional data from the Health in Common Study (N = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population.

Rural Disparities in Treatment-Related Financial Hardship and Adherence to Surveillance Colonoscopy in Diverse Colorectal Cancer Survivors.

PubMed

McDougall, Jean A; Banegas, Matthew P; Wiggins, Charles L; Chiu, Vi K; Rajput, Ashwani; Kinney, Anita Y

2018-03-28

Cancer survivors increasingly report financial hardship as a consequence of the high cost of cancer care, yet the financial experience of rural cancer survivors remains largely unstudied. The purpose of this study was to investigate potential rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy. Individuals diagnosed with localized or regional colorectal cancer (CRC) between 2004-2012 were ascertained by the population-based New Mexico Tumor Registry. Participants completed a mailed questionnaire or telephone survey about their CRC survivorship experience, including treatment-related financial hardship and receipt of surveillance colonoscopy. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to urban CRC survivors (n=168), rural CRC survivors (n=109) were slightly older, more likely to be married (65% v. 59%) and have an annual income <$30,000 (37% v. 27%), less likely to be employed (35% v. 41%), have a college degree (28% v. 38%) or a high level of health literacy (39% v. 51%). Rural survivors were twice as likely as urban survivors to report treatment-related financial hardship (OR 1.86, 95% CI 1.06-3.28) and nonadherence to surveillance colonoscopy guidelines (OR 2.28, 95% CI 1.07-4.85). In addition, financial hardship was independently associated with nonadherence to surveillance colonoscopy (OR 2.17, 95% CI 1.01-4.85). Substantial rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy exist. Treatment-related financial hardship among rural CRC survivors may negatively impact adherence to guideline recommended follow-up care. Copyright ©2018, American Association for Cancer Research.

12 CFR 313.97 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Financial hardship. 313.97 Section 313.97 Banks... CORPORATE DEBT COLLECTION Administrative Wage Garnishment § 313.97 Financial hardship. (a) A debtor whose wages are subject to a wage withholding order under this section, may, at any time, request a review by...

41 CFR 105-57.010 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Financial hardship. 105... Administration 57-ADMINISTRATION WAGE GARNISHMENT § 105-57.010 Financial hardship. (a) A debtor whose wages are subject to a wage withholding order under this part, may, at any time, request a review by GSA of the...

Association of financial hardship with poor sleep health outcomes among men who have sex with men.

PubMed

Duncan, Dustin T; Hyun Park, Su; Al-Ajlouni, Yazan A; Hale, Lauren; Jean-Louis, Girardin; Goedel, William C; Chaix, Basile; Elbel, Brian

2017-12-01

Previous studies have identified an association between socioeconomic status and sleep health. While some research has studied this association among sexual minority groups, including men who have sex with men (MSM), they exclusively focused on US-based populations. The interplay between the two in shaping sleep health has not been previously examined on populations residing outside the US. This study considers both determinants, by investigating whether financial hardship is associated with sleep health among a sample of MSM in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users in Paris to a web-based survey measuring financial hardship and five dimensions of sleep health as well as socio-demographic characteristics. Modified Poisson models with robust error variance were computed to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between financial hardship and the following self-reported outcomes: 1) poor sleep quality, 2) short sleep duration; and 3) sleep problems. In total, 580 respondents completed the survey. In this sample, both financial hardship and poor sleep health were common - 45.5% reported that it was extremely, very, or somewhat difficult for them to meet their monthly payments on bills (referred to as "high financial hardship") and 30.1% rated their sleep as fairly bad or very bad (referred to as "poor sleep quality"). Multivariate models revealed that, compared to participants who reported low financial hardship, those who reported high financial hardship were more likely to report poor sleep quality (aRR: 1.35, 95% CI: 1.04, 1.77), to report problems falling asleep (aRR: 1.23, 95% CI: 1.02, 1.49), and to report problems staying awake in the daytime (aRR: 3.12, 95% CI: 1.83, 5.31). Future research should investigate whether this relationship is causal and determine whether interventions to reduce financial hardships could promote sleep health among MSM.

Impact of Economic Hardship and Financial Threat on Suicide Ideation and Confusion.

PubMed

Fiksenbaum, Lisa; Marjanovic, Zdravko; Greenglass, Esther; Garcia-Santos, Francisco

2017-07-04

The present study tested the extent to which perceived economic hardship is associated with psychological distress (suicide ideation and confusion) after controlling for personal characteristics. It also explored whether perceived financial threat (i.e., fearful anxious-uncertainty about the stability and security of one's personal financial situation) mediates the relationship between economic hardship and psychological distress outcomes. The theoretical model was tested in a sample of Canadian students (n = 211) and was validated in a community sample of employed Portuguese adults (n = 161). In both samples, the fit of the model was good. Parameter estimates indicated that greater experience of economic hardship increased with financial threat, which in turn increased with levels of suicide ideation and confusion. We discuss the practical implications of these results, such as for programs aimed at alleviating the burden of financial hardship, in our concluding remarks.

29 CFR 1605.2 - Reasonable accommodation without undue hardship as required by section 701(j) of title VII of the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION GUIDELINES ON DISCRIMINATION... address other obligations under title VII not to discriminate on grounds of religion, nor other provisions... to discrimination prohibited by title VII on the bases of race, color, sex, and national origin also...

29 CFR 1605.2 - Reasonable accommodation without undue hardship as required by section 701(j) of title VII of the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION GUIDELINES ON DISCRIMINATION... address other obligations under title VII not to discriminate on grounds of religion, nor other provisions... to discrimination prohibited by title VII on the bases of race, color, sex, and national origin also...

29 CFR 1605.2 - Reasonable accommodation without undue hardship as required by section 701(j) of title VII of the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION GUIDELINES ON DISCRIMINATION... address other obligations under title VII not to discriminate on grounds of religion, nor other provisions... to discrimination prohibited by title VII on the bases of race, color, sex, and national origin also...

29 CFR 1605.2 - Reasonable accommodation without undue hardship as required by section 701(j) of title VII of the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION GUIDELINES ON DISCRIMINATION... address other obligations under title VII not to discriminate on grounds of religion, nor other provisions... to discrimination prohibited by title VII on the bases of race, color, sex, and national origin also...

41 CFR Appendix A to Part 60 - 300-Guidelines on a Contractor's Duty To Provide Reasonable Accommodation

Code of Federal Regulations, 2014 CFR

2014-07-01

... privileges of employment as are enjoyed by employees without disabilities. 4. The term “undue hardship...)), the Job Accommodation Network (JAN) operated by the Office of Disability Employment Policy in the U.S... privileges of employment as are enjoyed by employees who do not have disabilities. 8. Another of the...

26 CFR 35a.3406-2 - Imposition of backup withholding for notified payee underreporting of reportable interest or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... withholding causes undue hardship include, but are not limited to, the following: (i) Whether estimated tax..., and (2) The payments of estimated tax which are considered payments on account of such taxes. (C... Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT TAXES AND COLLECTION...

Improved Financial Capability Can Reduce Material Hardship among Mothers.

PubMed

Huang, Jin; Nam, Yunju; Sherraden, Michael; Clancy, Margaret M

2016-10-01

This study draws on the theoretical framework of financial capability in investigating whether financial access (that is, availability of financial products and services) and financial knowledge (that is, understanding of basic financial concepts) can influence the risk of material hardship. Authors examine the possibility of direct associations as well as of indirect ones in which financial management (that is, individual financial behaviors) serves as a mediator. The probability sample of mothers with young children born in Oklahoma during 2007 (N = 2,529) was selected from Oklahoma birth certificates. Results from structural equation modeling analyses show that financial access is positively associated with financial management (p < 0.001) but that financial knowledge is not; both financial access (p < 0.001) and financial management (p < 0.001) are negatively correlated with material hardship. Similar results are obtained from analyses with a subsample of low-income mothers. Findings suggest that financial capability, particularly the financial access component, is critical for improving financial management and reducing the risk of material hardship among mothers with young children, including low-income mothers. Efforts to promote financial capability offer social workers an important strategy for improving their clients’ economic well-being.

Financial Hardship and Patient-Reported Outcomes after Hematopoietic Cell Transplantation

PubMed Central

Abel, Gregory A.; Albelda, Randy; Khera, Nandita; Hahn, Theresa; Salas Coronado, Diana Y.; Odejide, Oreofe O.; Bona, Kira; Tucker-Seeley, Reginald; Soiffer, Robert

2016-01-01

Although hematopoietic cell transplantation (HCT) is the only curative therapy for many advanced hematologic cancers, little is known about the financial hardship experienced by HCT patients, nor the association of hardship with patient-reported outcomes. We mailed a 43-item survey to adult patients approximately 180 days post first autologous or allogeneic HCT at three high-volume centers. We assessed decreases in household income, difficulty with HCT-related costs such as need to relocate or travel, and two types of hardship: “hardship_1” (reporting one or two of the following: dissatisfaction with present finances, difficulty meeting monthly bill payments, or not having enough money at the end of the month), and “hardship_2” (reporting all three). Patient-reported stress was measured with the Perceived Stress Scale (PSS-4), and seven-point scales were provided for perceptions of overall quality of life (QOL) and health. 325 of 499 surveys (65.1%) were received. The median days since HCT was 173; 47% underwent an allogeneic HCT, 60% were male, 51% were > 60 years old, and 92% were white. Overall, 46% reported income decline post-HCT, 56% reported “hardship_1” and 15% “hardship 2.” In multivariable models controlling for income, those reporting difficulty paying for HCT-related costs were more likely to report financial hardship (OR 6.9 [3.8, 12.3]). “Hardship_1” was associated with QOL below the median (OR 2.9 [1.7, 4.9]), health status below the median (OR 2.2 [1.3, 3.6]), and stress above the median (OR 2.1 [1.3, 3.5]). In this sizable cohort of HCT patients, financial hardship was prevalent, and associated with worse QOL and higher levels of perceived stress. Interventions to address patient financial hardship—especially those that ameliorate HCT-specific costs—are likely to improve patient-reported outcomes. PMID:27184627

29 CFR 18.28 - Continuances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... cases of prior judicial commitments or undue hardship, or a showing of other good cause. (b) Time limit... shall be in writing. At least 3″ x 3 1/2″ of blank space shall be provided on the last page of the... 29 Labor 1 2011-07-01 2011-07-01 false Continuances. 18.28 Section 18.28 Labor Office of the...

29 CFR 18.28 - Continuances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... cases of prior judicial commitments or undue hardship, or a showing of other good cause. (b) Time limit... shall be in writing. At least 3″x31/2″ of blank space shall be provided on the last page of the motion... 29 Labor 1 2010-07-01 2010-07-01 true Continuances. 18.28 Section 18.28 Labor Office of the...

Financial Hardship and Patient-Reported Outcomes after Hematopoietic Cell Transplantation.

PubMed

Abel, Gregory A; Albelda, Randy; Khera, Nandita; Hahn, Theresa; Salas Coronado, Diana Y; Odejide, Oreofe O; Bona, Kira; Tucker-Seeley, Reginald; Soiffer, Robert

2016-08-01

Although hematopoietic cell transplantation (HCT) is the only curative therapy for many advanced hematologic cancers, little is known about the financial hardship experienced by HCT patients nor the association of hardship with patient-reported outcomes. We mailed a 43-item survey to adult patients approximately 180 days after their first autologous or allogeneic HCT at 3 high-volume centers. We assessed decreases in household income; difficulty with HCT-related costs, such as need to relocate or travel; and 2 types of hardship: hardship_1 (reporting 1 or 2 of the following: dissatisfaction with present finances, difficulty meeting monthly bill payments, or not having enough money at the end of the month) and "hardship_2" (reporting all 3). Patient-reported stress was measured with the Perceived Stress Scale-4, and 7-point scales were provided for perceptions of overall quality of life (QOL) and health. In total, 325 of 499 surveys (65.1%) were received. The median days since HCT was 173; 47% underwent an allogeneic HCT, 60% were male, 51% were > 60 years old, and 92% were white. Overall, 46% reported income decline after HCT, 56% reported hardship_1, and 15% reported hardship_2. In multivariable models controlling for income, those reporting difficulty paying for HCT-related costs were more likely to report financial hardship (odds ratio, 6.9; 95% confidence interval, 3.8 to 12.3). Hardship_1 was associated with QOL below the median (odds ratio, 2.9; 95% confidence interval, 1.7 to 4.9), health status below the median (odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6), and stress above the median (odds ratio, 2.1; 95% confidence interval, 1.3 to 3.5). In this sizable cohort of HCT patients, financial hardship was prevalent and associated with worse QOL and higher levels of perceived stress. Interventions to address patient financial hardship-especially those that ameliorate HCT-specific costs-are likely to improve patient-reported outcomes. Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Financial hardship, unmet medical need, and health self-efficacy among African American men.

PubMed

Tucker-Seeley, Reginald D; Mitchell, Jamie A; Shires, Deirdre A; Modlin, Charles S

2015-06-01

Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p < .05), more likely to report low health self-efficacy. When unmet medical need due to cost was added to the model, the association between financial hardship and low health self-efficacy was no longer statistically significant. Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy. © 2014 Society for Public Health Education.

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men.

PubMed

Duncan, Dustin T; Park, Su Hyun; Schneider, John A; Al-Ajlouni, Yazan A; Goedel, William C; Elbel, Brian; Morganstein, Jace G; Ransome, Yusuf; Mayer, Kenneth H

2017-12-01

The objective of this study was to examine the association between financial hardship, condomless anal intercourse and HIV risk among a sample of men who have sex with men (MSM). Users of a popular geosocial networking application in Paris were shown an advertisement with text encouraging them to complete a anonymous web-based survey (n = 580). In adjusted multivariate models, high financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse (aRR 1.28; 95% CI 1.08-1.52), engagement in condomless receptive anal intercourse (aRR 1.34; 95% CI 1.07-1.67), engagement in condomless insertive anal intercourse (aRR 1.30; 95% CI 1.01-1.67), engagement in transactional sex (aRR 2.36; 95% CI 1.47-3.79) and infection with non-HIV STIs (aRR 1.50; 95% CI 1.07-2.10). This study suggests that interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviors in MSM.

12 CFR 608.808 - Right to offer to repay claim.

Code of Federal Regulations, 2010 CFR

2010-01-01

... explanation. The statement shall recite that the written explanation was read and understood before execution... would create a financial hardship, the FCA shall analyze the debtor's financial condition. The FCA may... financial hardship for the debtor. The written agreement shall set forth the amount and frequency of...

Reduced employment and financial hardship among middle-aged individuals with colorectal cancer.

PubMed

Gordon, Louisa G; Beesley, Vanessa L; Mihala, Gabor; Koczwara, Bogda; Lynch, Brigid M

2017-09-01

Financial hardship may affect up to 30% of cancer survivors, however, little research has addressed the effect of employment change on financial hardship. This study compared the self-reported financial hardship of middle-aged (45-64 years) colorectal cancer survivors (n = 187) at 6 and 12 months following diagnosis with that of a matched general population group (n = 355). Colorectal cancer survivors were recruited through the Queensland Cancer Registry, Australia; data from the Household Income and Labour Dynamics in Australia (HILDA) Survey were used for the general population group. Pearson chi-square tests were used to assess the differences in proportions between the two groups and McNemar tests to assess differences across time among the same group. Generalised linear modelling was performed to produce prevalence ratios. A higher proportion of workers with colorectal cancer reported financial strain (money shortage for living essentials) at 6 months (15%) but eased and was comparable to the comparison group at 12 months (7%). Middle-aged working cancer survivors who ceased or reduced work were more likely to report not being financially comfortable, compared with those who had continued work (adjusted prevalence ratio 1.66, 95%CI: 1.12, 2.44) at 12 months. Health professionals, employers and government services should address the impact of impaired employment on financial hardship among cancer survivors. © 2017 John Wiley & Sons Ltd.

5 CFR 1650.42 - How to obtain a financial hardship withdrawal.

Code of Federal Regulations, 2010 CFR

2010-01-01

... form or use the TSP Web site to initiate a request. A participant's ability to complete a financial hardship withdrawal on the Web will depend on his or her retirement system coverage and marital status. (b...

Experiences of Material Hardships among TANF Leavers

ERIC Educational Resources Information Center

Hunter, Tamara; Santhiveeran, Janaki

2005-01-01

Experiences of food insufficiencies, inadequate access to health care, and housing-related hardships represent how financial strain negatively impacts the entire family. The purpose of this study was to examine experiences of material hardships by TANF leavers and to understand factors that are associated with experiences of material hardship.…

The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors.

PubMed

Davidoff, Amy J; Hill, Steven C; Bernard, Didem; Yabroff, K Robin

2015-09-01

Cancer survivors may face barriers to accessing health insurance and experience financial hardship because of medical expenditures. We examined potential improvements in access to insurance for cancer survivors through adult Medicaid expansions and premium tax credits in the new insurance marketplaces under the Affordable Care Act (ACA). Eligibility for Medicaid and premium tax credits was simulated for cancer survivors age 18 to 64 years in the 2008 to 2010 Medical Expenditure Panel Survey using a detailed deterministic model. Financial hardship was determined as: 1) delays or unmet need for medical, prescription, or dental care because of cost or insurance issues and/or 2) family out-of-pocket medical spending that was 20% or more of gross income. Descriptive analyses were stratified by whether the state of residence chose to expand Medicaid by January 2015. All statistical tests were two-sided. Overall, 14.7% of 9.44 million cancer survivors were uninsured, with 18% reporting financial hardship. Under the ACA, 19% overall, 30% of the uninsured, and 39% of those reporting financial hardship would be Medicaid eligible. An additional 10% would be eligible for premium tax credits, with the remainder able to participate in the Marketplace without tax credits. However, 21% of uninsured cancer survivors in states not expanding Medicaid would be ineligible for assistance with coverage. Under the ACA, many of the uninsured and a larger proportion of survivors facing financial hardship will be eligible for Medicaid or premium tax credits in the Marketplaces. ACA implementation will dramatically enhance insurance availability and is likely to reduce financial hardship for vulnerable cancer survivors. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors

PubMed Central

Hill, Steven C.; Bernard, Didem; Yabroff, K. Robin

2015-01-01

Background: Cancer survivors may face barriers to accessing health insurance and experience financial hardship because of medical expenditures. We examined potential improvements in access to insurance for cancer survivors through adult Medicaid expansions and premium tax credits in the new insurance marketplaces under the Affordable Care Act (ACA). Methods: Eligibility for Medicaid and premium tax credits was simulated for cancer survivors age 18 to 64 years in the 2008 to 2010 Medical Expenditure Panel Survey using a detailed deterministic model. Financial hardship was determined as: 1) delays or unmet need for medical, prescription, or dental care because of cost or insurance issues and/or 2) family out-of-pocket medical spending that was 20% or more of gross income. Descriptive analyses were stratified by whether the state of residence chose to expand Medicaid by January 2015. All statistical tests were two-sided. Results: Overall, 14.7% of 9.44 million cancer survivors were uninsured, with 18% reporting financial hardship. Under the ACA, 19% overall, 30% of the uninsured, and 39% of those reporting financial hardship would be Medicaid eligible. An additional 10% would be eligible for premium tax credits, with the remainder able to participate in the Marketplace without tax credits. However, 21% of uninsured cancer survivors in states not expanding Medicaid would be ineligible for assistance with coverage. Conclusions: Under the ACA, many of the uninsured and a larger proportion of survivors facing financial hardship will be eligible for Medicaid or premium tax credits in the Marketplaces. ACA implementation will dramatically enhance insurance availability and is likely to reduce financial hardship for vulnerable cancer survivors. PMID:26134034

Financial hardship after traumatic brain injury: a brief scale for family caregivers.

PubMed

Sabella, Scott A; Andrzejewski, Joshua H; Wallgren, Alexandrea

2018-05-02

Financial hardship is frequently posited as a significant factor influencing family health and adjustment after brain injury, though traditional methods of measurement have shown limited usefulness. The purpose of this study was to adapt and test the utility of a brief scale of financial hardship (BSFH-BI) for use with family caregivers after TBI. The researchers constructed the BSFH-BI using financial well-being items adapted from three survey instruments. The BSFH-BI questionnaire was completed by 136 family caregivers of individuals with TBIs. Scale utility was evaluated through reliability analysis, factor analysis, and correlations with a measure of life satisfaction. The factor analysis revealed that the BSFH-BI had a meaningful two factor structure consisting of items related to (a) meeting essential living expenses and (b) financial changes after the injury. The scale showed high internal consistency (α = 0.92) and moderate negative correlations with life satisfaction (r s  = -0.58). The preliminary findings indicate that the BSFH-BI can be a reliable and valid scale for use with family caregivers after TBI. The authors recommend further study of financial hardship within models of adaptation to TBI using psychometrically validated instruments such as the BSFH-BI.

31 CFR 29.524 - Financial hardship.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Financial hardship. 29.524 Section 29.524 Money and Finance: Treasury Office of the Secretary of the Treasury FEDERAL BENEFIT PAYMENTS UNDER... may suspend collection action until a future date. (a) Considerations. Pertinent considerations in...

34 CFR 32.9 - Written decision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... stating the facts supporting the nature and origin of the debt and the hearing official's analysis... determination of the existence and the amount of the overpayment or the extreme financial hardship caused by the... decides the issue of extreme financial hardship caused by the involuntary repayment schedule only where...

Does financial compensation for living kidney donation change willingness to donate?

PubMed

Gordon, E J; Patel, C H; Sohn, M-W; Hippen, B; Sherman, L A

2015-01-01

The potential use of financial compensation to increase living kidney donation rates remains controversial in potentially introducing undue inducement of vulnerable populations to donate. This cross-sectional study assessed amounts of financial compensation that would generate motivation and an undue inducement to donate to family/friends or strangers. Individuals leaving six Departments of Motor Vehicles were surveyed. Of the 210 participants who provided verbal consent (94% participation rate), respondents' willingness to donate would not change (70%), or would increase (29%) with compensation. Median lowest amounts of financial compensation for which participants would begin to consider donating a kidney were $5000 for family/friends, and $10,000 for strangers; respondents reporting $0 for family/friends (52%) or strangers (26%) were excluded from analysis. Median lowest amounts of financial compensation for which participants could no longer decline (perceive an undue inducement) were $50,000 for family/friends, and $100,000 for strangers; respondents reporting $0 for family/friends (44%) or strangers (23%) were excluded from analysis. The two most preferred forms of compensation included: direct payment of money (61%) and paid leave (21%). The two most preferred uses of compensation included: paying off debt (38%) and paying nonmedical expenses associated with the transplant (29%). Findings suggest tolerance for, but little practical impact of, financial compensation. Certain compensation amounts could motivate the public to donate without being perceived as an undue inducement. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.

Financial Hardship and Self-Rated Health among Low-Income Housing Residents

ERIC Educational Resources Information Center

Tucker-Seeley, Reginald D.; Harley, Amy E.; Stoddard, Anne M.; Sorensen, Glorian G.

2013-01-01

Background: Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among…

A trauma-informed examination of the hardships experienced by abortion fund patients in the United States.

PubMed

Ely, Gretchen E; Hales, Travis; Jackson, D Lynn; Bowen, Elizabeth A; Maguin, Eugene; Hamilton, Greer

2017-11-01

Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.

Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland.

PubMed

Fekete, Christine; Siegrist, Johannes; Reinhardt, Jan D; Brinkhof, Martin W G

2014-01-01

To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland. Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions. Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18-5.21), comorbidities (OR 2.88, 95% CI 1.83-4.53) and pain (OR 3.32, 95% CI 2.21-4.99), whereas mental health (OR 0.23, 95% CI 0.15-0.36), participation (OR 0.30, 95% CI 0.21-0.43) and quality of life (OR 0.22, 95% CI 0.15-0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00-1.07) and higher quality of life (OR 1.06, 95% CI 1.02-1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship. Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.

Financial Hardship, Unmet Medical Need, and Health Self-Efficacy among African American Men

ERIC Educational Resources Information Center

Tucker-Seeley, Reginald D.; Mitchell, Jamie A.; Shires, Deirdre A.; Modlin, Charles S., Jr.

2015-01-01

Background: Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet…

Family Adjustment to Relocation

DTIC Science & Technology

1992-11-01

multi-method research program designed to provide needed information about the partnership between the Army and the families of the men and women who...hardships associated with relocation, including financial and emotional difficulties (Styles et al., 1988). Family members can no longer be...assignments compounded with the emotional , financial, and geographic hardships of a PCS can add up to a very difficult move. The number and severity

Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men.

PubMed

Ayala, George; Bingham, Trista; Kim, Junyeop; Wheeler, Darrell P; Millett, Gregorio A

2012-05-01

We examined the impact of social discrimination and financial hardship on unprotected anal intercourse with a male sex partner of serodiscordant or unknown HIV status in the past 3 months among 1081 Latino and 1154 Black men who have sex with men (MSM; n = 2235) residing in Los Angeles County, California; New York, New York; and Philadelphia, Pennsylvania. We administered HIV testing and a questionnaire assessing 6 explanatory variables. We combined traditional mediation analysis with the results of a path analysis to simultaneously examine the direct, indirect, and total effects of these variables on the outcome variable. Bivariate analysis showed that homophobia, racism, financial hardship, and lack of social support were associated with unprotected anal intercourse with a serodiscordant or sero-unknown partner. Path analysis determined that these relations were mediated by participation in risky sexual situations and lack of social support. However, paths between the explanatory variable and 2 mediating variables varied by participants' serostatus. Future prevention research and program designs should specifically address the differential impact of social discrimination and financial hardship on lack of social support and risky sexual situations among Latino and Black MSM.

For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships.

PubMed

Banegas, Matthew P; Guy, Gery P; de Moor, Janet S; Ekwueme, Donatus U; Virgo, Katherine S; Kent, Erin E; Nutt, Stephanie; Zheng, Zhiyuan; Rechis, Ruth; Yabroff, K Robin

2016-01-01

The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719 cancer survivors ages 18-64, we examined the proportions of survivors who reported going into debt or filing for bankruptcy as a result of cancer, as well as the amount of debt incurred. Approximately one-third of the survivors had gone into debt, and 3 percent had filed for bankruptcy. Of those who had gone into debt, 55 percent incurred obligations of $10,000 or more. Cancer survivors who were younger, had lower incomes, and had public health insurance were more likely to go into debt or file for bankruptcy, compared to those who were older, had higher incomes, and had private insurance, respectively. Future longitudinal population-based studies are needed to improve understanding of financial hardship among US working-age cancer survivors throughout the cancer care trajectory and, ultimately, to help stakeholders develop evidence-based interventions and policies to reduce the financial hardship of cancer. Project HOPE—The People-to-People Health Foundation, Inc.

The Impact of Financial Hardship on Single Parents: An Exploration of the Journey From Social Distress to Seeking Help.

PubMed

Stack, Rebecca Jayne; Meredith, Alex

2018-01-01

Single parent families are at high risk of financial hardship which may impact on psychological wellbeing. This study explored the impact of financial hardship on wellbeing on 15 single parents. Semi-structured interviews were conducted and analysed using constructivist thematic analysis. Participants described food and fuel poverty, and the need to make sacrifices to ensure that children's basic needs were met. In some cases, participants went without food and struggled to pay bills. Isolation, anxiety, depression, paranoia, and suicidal thoughts were described. However, participants reported that psychological services not able to take the needs of single parents in to account. Support for single parents must acknowledge the impact of social circumstances and give more consideration economic drivers of distress.

How are patients managing with the costs of care for chronic kidney disease in Australia? A cross-sectional study

PubMed Central

2013-01-01

Background Chronic kidney disease (CKD) poses a financial burden on patients and their households. This descriptive study measures the prevalence of economic hardship and out-of-pocket costs in an Australian CKD population. Methods A cross-sectional study of patients receiving care for CKD (stage III-V) in Western Sydney, Australia using a structured questionnaire. Data collection occurred between November 2010 and April 2011. Multivariate analyses assessed the relationships between economic hardship and individual, household and health system characteristics. Results The study included 247 prevalent CKD patients. A mean of AUD$907 per three months was paid out-of-pocket resulting in 71% (n=153) of participants experiencing financial catastrophe (out-of-pocket costs exceeding 10% of household income). Fifty-seven percent (n=140) of households reported economic hardship. The adjusted risk factors that decreased the likelihood of hardship included: home ownership (OR: 0.32, 95% CI: 0.14-0.71), access to financial resources (OR: 0.24, 95% CI: 0.11-0.50) and quality of life (OR: 0.12, 95% CI: 0.02-0.56). The factors that increased the likelihood of hardship included if income was negatively impacted by CKD (OR: 4.80, 95% CI: 2.17-10.62) and concessional status (i.e. receiving government support) (OR: 3.09, 95% CI: 1.38-6.91). Out-of-pocket costs and financial catastrophe were not found to be significantly associated with hardship in this analysis. Conclusions This study describes the poorer economic circumstances of households affected by CKD and reinforces the inter-relationships between chronic illness, economic well-being and quality of life for this patient population. PMID:23305212

Financial Hardship from Purchasing Medications for Senior Citizens Before and After the Medicare Modernization Act of 2003 and the Patient Protection and Affordable Care Act of 2010: Findings from 1998, 2001, and 2015.

PubMed

Olson, Anthony W; Schommer, Jon C; Mott, David A; Brown, Lawrence M

2016-10-01

The Medicare Modernization Act of 2003 (Medicare Part D) added prescription drug coverage for senior citizens aged 65 years and older and applied managed care approaches to contain costs. The Patient Protection and Affordable Care Act of 2010 (ACA) had the goals of expanding health care insurance coverage and slowing growth in health care expenditures. To (a) describe the proportion of senior citizens who had prescription drug insurance coverage and the proportion who experienced financial hardship from purchasing medications in 2015, and (b) compare the findings with those collected in 1998 and 2001. Data were obtained in 1998 and 2001 via surveys mailed to national random samples of seniors. Of 2,434 deliverable surveys, 946 (39%) were returned, and 700 (29%) provided usable data. Data were collected in 2015 via an online survey sent to a national sample of adults. Of 26,173 usable responses, 3,933 were aged 65 years or older. Descriptive statistics and logistic regression analyses described relationships among study variables. Results showed that the proportion of seniors without prescription coverage was 9% in 2015, a decrease from 29% in 2001 and 32% in 1998. The proportion of senior citizens reporting financial hardship from medication purchases was 36% in 2015, a rise from 31% in 2001 and 19% in 1998. For those without prescription drug coverage, 34%, 55%, and 49% reported financial hardship in 1998, 2001, and 2015, respectively. For those with drug coverage, 12%, 22%, and 35% reported financial hardship in 1998, 2001, and 2015, respectively. After implementation of Medicare Part D and the ACA, the proportion of seniors without prescription drug coverage decreased. However, self-reported financial hardship from purchasing medications increased. Senior citizens with prescription drug insurance may be experiencing financial hardship from increasing out-of-pocket costs for insurance premiums, cost sharing, and full-cost obligation for some medications. Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, and the Peters Endowment for Pharmacy Practice Innovation. The authors have no conflicts of interest to declare. Schommer, Mott, and Brown contributed to study design and collected the data, with assistance from Olson. Data interpretation was performed by Olson, Schommer, Mott, and Brown. The manuscript was written and revised by Olson, Schommer, Mott, and Brown.

Hardship financing of healthcare among rural poor in Orissa, India

PubMed Central

2012-01-01

Background This study examines health-related "hardship financing" in order to get better insights on how poor households finance their out-of-pocket healthcare costs. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare costs. Methods Using survey data of 5,383 low-income households in Orissa, one of the poorest states of India, we investigate factors influencing the risk of hardship financing with the use of a logistic regression. Results Overall, about 25% of the households (that had any healthcare cost) reported hardship financing during the year preceding the survey. Among households that experienced a hospitalization, this percentage was nearly 40%, but even among households with outpatient or maternity-related care around 25% experienced hardship financing. Hardship financing is explained not merely by the wealth of the household (measured by assets) or how much is spent out-of-pocket on healthcare costs, but also by when the payment occurs, its frequency and its duration (e.g. more severe in cases of chronic illnesses). The location where a household resides remains a major predictor of the likelihood to have hardship financing despite all other household features included in the model. Conclusions Rural poor households are subjected to considerable and protracted financial hardship due to the indirect and longer-term deleterious effects of how they cope with out-of-pocket healthcare costs. The social network that households can access influences exposure to hardship financing. Our findings point to the need to develop a policy solution that would limit that exposure both in quantum and in time. We therefore conclude that policy interventions aiming to ensure health-related financial protection would have to demonstrate that they have reduced the frequency and the volume of hardship financing. PMID:22284934

Hardship financing of healthcare among rural poor in Orissa, India.

PubMed

Binnendijk, Erika; Koren, Ruth; Dror, David M

2012-01-27

This study examines health-related "hardship financing" in order to get better insights on how poor households finance their out-of-pocket healthcare costs. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare costs. Using survey data of 5,383 low-income households in Orissa, one of the poorest states of India, we investigate factors influencing the risk of hardship financing with the use of a logistic regression. Overall, about 25% of the households (that had any healthcare cost) reported hardship financing during the year preceding the survey. Among households that experienced a hospitalization, this percentage was nearly 40%, but even among households with outpatient or maternity-related care around 25% experienced hardship financing.Hardship financing is explained not merely by the wealth of the household (measured by assets) or how much is spent out-of-pocket on healthcare costs, but also by when the payment occurs, its frequency and its duration (e.g. more severe in cases of chronic illnesses). The location where a household resides remains a major predictor of the likelihood to have hardship financing despite all other household features included in the model. Rural poor households are subjected to considerable and protracted financial hardship due to the indirect and longer-term deleterious effects of how they cope with out-of-pocket healthcare costs. The social network that households can access influences exposure to hardship financing. Our findings point to the need to develop a policy solution that would limit that exposure both in quantum and in time. We therefore conclude that policy interventions aiming to ensure health-related financial protection would have to demonstrate that they have reduced the frequency and the volume of hardship financing.

Modeling the Impact of Social Discrimination and Financial Hardship on the Sexual Risk of HIV Among Latino and Black Men Who Have Sex With Men

PubMed Central

Bingham, Trista; Kim, Junyeop; Wheeler, Darrell P.; Millett, Gregorio A.

2012-01-01

Objectives. We examined the impact of social discrimination and financial hardship on unprotected anal intercourse with a male sex partner of serodiscordant or unknown HIV status in the past 3 months among 1081 Latino and 1154 Black men who have sex with men (MSM; n = 2235) residing in Los Angeles County, California; New York, New York; and Philadelphia, Pennsylvania. Methods. We administered HIV testing and a questionnaire assessing 6 explanatory variables. We combined traditional mediation analysis with the results of a path analysis to simultaneously examine the direct, indirect, and total effects of these variables on the outcome variable. Results. Bivariate analysis showed that homophobia, racism, financial hardship, and lack of social support were associated with unprotected anal intercourse with a serodiscordant or sero-unknown partner. Path analysis determined that these relations were mediated by participation in risky sexual situations and lack of social support. However, paths between the explanatory variable and 2 mediating variables varied by participants’ serostatus. Conclusions. Future prevention research and program designs should specifically address the differential impact of social discrimination and financial hardship on lack of social support and risky sexual situations among Latino and Black MSM. PMID:22401516

The association between hardship and self-rated health: does the choice of indicator matter?

PubMed

Marshall, Gillian L; Tucker-Seeley, Reginald

2018-07-01

The purpose of this study was to investigate the association between four specific forms of hardship (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) and self-rated health among older men and women. Cross-sectional logistic regression analysis was conducted using the 2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N = 7619) to determine the association between four hardship indicators and self-rated health. Hardship indicators (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) were dichotomized (0 = no hardship, 1 = yes hardship) for this analysis. After adjusting for sociodemographic factors, participants reporting difficulty paying bills had an 1.8 higher odds of reporting poor self-rated health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking less medication due to cost had a 2.5 times higher odds of poor self-rated health (95% CI: 1.97, 3.09) compared to those not reporting these hardships. When stratified by gender, and adjusting for sociodemographic factors, men who took less medication due to cost had a 1.93 higher odds of low self-rated health (95% CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women not reporting these hardships. Research in this area can provide greater conceptual and measurement clarity on the hardship experience and further elucidate the pathway between specific hardships and poor health outcomes to inform intervention development. Copyright © 2018 Elsevier Inc. All rights reserved.

Food Hardship and Obesity in a Sample of Low-Income Immigrants.

PubMed

Caspi, Caitlin E; Tucker-Seeley, Reginald D; Adamkiewicz, Gary; Roberto, Christina A; Stoddard, Anne M; Sorensen, Glorian C

2017-02-01

Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.

Financial hardship, mastery and social support: Explaining poor mental health amongst the inadequately employed using data from the HILDA survey.

PubMed

Crowe, Laura; Butterworth, Peter; Leach, Liana

2016-12-01

This study analysed data from the Household Income and Labour Dynamics in Australia (HILDA) Survey to examine the relationship between employment status and mental health, and the mediating effects of financial hardship, mastery and social support. In addition, the study sought to explore the effects of duration of unemployment on mental health. The primary analysis used three waves of data from the HILDA Survey with 4965 young adult respondents. Longitudinal population-averaged logistic regression models assessed the association of employment status and mental health, including the contribution of mastery, financial hardship and social support in explaining this association between employment groups (unemployed vs. employed; under employed vs. employed). Sensitivity analyses utilised a fixed-effects approach and also considered the full-range of working-age respondents. Regression analysis was used to explore the effect of duration of unemployment on mental health. Respondents' who identified as unemployed or underemployed were at higher risk of poor mental health outcomes when compared to their employed counterparts. This association was ameliorated when accounting for mastery, financial hardship and social support for the unemployed, and was fully mediated for the underemployed. The fixed-effects models showed the transition to unemployment was associated with a decline in mental health and that mastery in particular contributed to that change. The same results were found with a broader age range of respondents. Finally, the relationship between duration of unemployment and mental health was not linear, with mental health showing marked decline across the first 9 weeks of unemployment. Mastery, social support and financial hardship are important factors in understanding the association of poor mental health with both unemployment and underemployment. Furthermore, the results suggest that the most deleterious effects on mental health may occur in the first two months of unemployment before plateauing. In order to prevent deterioration in mental health, these findings suggest intervention should commence immediately following job loss.

What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India.

PubMed

Madan, Jason; Lönnroth, Knut; Laokri, Samia; Squire, Stephen Bertel

2015-10-22

Tuberculosis (TB) is a major global public health problem which affects poorest individuals the worst. A high proportion of patients incur 'catastrophic costs' which have been shown to result in severe financial hardship and adverse health outcomes. Data on catastrophic cost incidence is not routinely collected, and current definitions of this indicator involve several practical and conceptual barriers to doing so. We analysed data from TB programmes in India (Bangalore), Bangladesh and Tanzania to determine whether dissaving (the sale of assets or uptake of loans) is a useful indicator of financial hardship. Data were obtained from prior studies of TB patient costs in Bangladesh (N = 96), Tanzania (N = 94) and Bangalore (N = 891). These data were analysed using logistic and linear multivariate regression to determine the association between costs (absolute and relative to income) and both the presence of dissaving and the amounts dissaved. After adjusting for covariates such as age, sex and rural/urban location, we found a significant positive association between the occurrence of dissaving and total costs incurred in Tanzania and Bangalore. We further found that, for patients in Bangalore an increase in dissaving of $10 USD was associated with an increase in the cost-income ratio of 0.10 (p < 0.001). For low-income patients in Bangladesh, an increase in dissaving of $10 USD was associated with an increase in total costs of $7 USD (p <0.001). Dissaving is potentially a convenient proxy for catastrophic costs that does not require usage of complex patient cost questionnaires. It also offers an informative indicator of financial hardship in its own right, and could therefore play an important role as an indicator to monitor and evaluate the impact of financial protection and service delivery interventions in reducing hardship and facilitating universal health coverage. Further research is required to understand the patterns and types of dissaving that have the strongest relationship with financial hardship and clinical outcomes in order to move toward evidence-based policy making.

Material hardship and children's social-emotional development: Testing mitigating effects of Child Development Accounts in a randomized experiment.

PubMed

Huang, J; Kim, Y; Sherraden, M

2017-01-01

Research has established a negative association between household material hardship and children's mental health. This study examines whether Child Development Accounts (CDAs), an economic intervention that encourages families to accumulate assets for children's long-term development, mitigate the association between material hardship and children's social-emotional development. Researchers conducted a randomized experiment of CDAs in Oklahoma, USA, with a probability sample (N = 7328) of all infants born in two 3-month periods in 2007. After agreeing to participate in the experiment, caregivers of 2704 infants completed a baseline survey and were assigned randomly to the treatment (n = 1358) or control group (n = 1346). The intervention exposed the treatment group to a CDA, which consisted of an Oklahoma 529 College Savings Plan account, financial incentives and financial information. Material hardship has a negative association with the social-emotional development of children around the age of 4 years. Estimates from regression analysis indicate that CDAs mitigate about 50% of the negative association between material hardship and children's social-emotional development. Although they do not provide direct support for consumption in households experiencing material hardship, CDAs may improve child development by influencing parenting practices and parents' expectations for their children. We discuss the implications of using asset-building programmes to improve child development. © 2016 John Wiley & Sons Ltd.

Does financial hardship account for elevated psychological distress in lone mothers?

PubMed

Hope, S; Power, C; Rodgers, B

1999-12-01

Lone mothers have been shown to have higher levels of psychological distress than married mothers, but it is not clear how this difference arises. Using data from the 1958 British birth cohort followed to age 33, we investigated alternative explanations for the excess distress of lone mothers. Logistic regression models were used to estimate odds ratios for distress (measured using the Malaise Inventory) in lone vs married mothers. Odds ratios were adjusted to assess the contribution of explanatory factors. At age 33, psychological distress was greater among lone than married mothers (OR 2.59, 95% CI 1.97, 3.41). The odds ratio decreased to 1.43 (95% CI 1.02, 2.01) after adjustment for all explanatory factors (prior psychological distress, age of youngest child and number of children in the household, and contemporary measures of financial hardship, employment, and social support). Attenuation of the odds ratio was most marked after taking account of financial hardship. Psychological distress was greater among divorced mothers than never married mothers, though not significantly (OR = 1.70, 95% CI 0.88, 3.28). This difference was not explained by the factors examined, and was not due to the immediate distress associated with a recent divorce. Elevated psychological distress of lone mothers appears to be related to financial hardship, while other explanations, including social support and selection, have a more modest impact. Not all of the elevated psychological distress among lone mothers was accounted for, particularly among divorced lone mothers.

Income, Poverty, and Material Hardship Among Older Americans

PubMed Central

LEVY, HELEN

2016-01-01

Using data from the 2008 and 2010 waves of the Health and Retirement Study to analyze the determinants of material hardship among individuals ages sixty-five and older, I look at five self-reported hardships: food insecurity, skipped meals, medication cutbacks, difficulty paying bills, and dissatisfaction with one’s financial situation. One-fifth of the elderly report one or more of these hardships. Although hardship is more likely for those with low incomes, most older Americans experiencing hardship are not poor. I analyze whether alternative measures of resources do a better job of predicting hardship than does income relative to the federal poverty threshold. I find that spending relative to the poverty threshold does a worse job predicting hardship than does income relative to poverty. Subtracting out-of-pocket medical spending from income yields a measure that is an even better predictor of hardship. In multivariate models, I find that self-reported health, activity limitations, and disability are significant predictors of hardship. Having reliable children (as assessed by the respondent) or an able-bodied spouse reduces the likelihood of hardship. Poor health increases hardship through three channels: by lowering income, by increasing out-of-pocket medical spending, and through its direct effect on hardship. The first two of these—lower income and higher medical spending—are much less quantitatively important than the third; in a nutshell, poor health makes it harder to get by with less. PMID:27857982

Student Parents, Hardship and Debt: A Qualitative Study

ERIC Educational Resources Information Center

Gerrard, Eve; Roberts, Ron

2006-01-01

To date little is known about the effects of financial hardship on student parents, who remain a significant although largely unrecognized proportion of the student population. The objective of this study was to gain an insight into their concerns and illuminate issues which may have far-reaching consequences not only for the mental and physical…

A global country-level comparison of the financial burden of surgery.

PubMed

Shrime, M G; Dare, A; Alkire, B C; Meara, J G

2016-10-01

Approximately 30 per cent of the global burden of disease is surgical, and nearly one-quarter of individuals who undergo surgery each year face financial hardship because of its cost. The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgery by 2030, but no country-level estimates exist of the financial burden of surgical access. Using publicly available data, the incidence and risk of financial hardship owing to surgery was estimated for each country. Four measures of financial catastrophe were examined: catastrophic expenditure, and impoverishment at the national poverty line, at 2 international dollars (I$) per day and at I$1·25 per day. Stochastic models of income and surgical costs were built for each country. Results were validated against available primary data. Direct medical costs of surgery put 43·9 (95 per cent posterior credible interval 2·2 to 87·1) per cent of the examined population at risk of catastrophic expenditure, and 57·0 (21·8 to 85·1) per cent at risk of being pushed below I$2 per day. The risk of financial hardship from surgery was highest in sub-Saharan Africa. Correlations were found between the risk of financial catastrophe and external financing of healthcare (positive correlation), national measures of well-being (negative correlation) and the percentage of a country's gross domestic product spent on healthcare (negative correlation). The model performed well against primary data on the costs of surgery. Country-specific estimates of financial catastrophe owing to surgical care are presented. The economic benefits projected to occur with the scale-up of surgery are placed at risk if the financial burden of accessing surgery is not addressed in national policies. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Unmeasured costs of a child's death: perceived financial burden, work disruptions, and economic coping strategies used by American and Australian families who lost children to cancer.

PubMed

Dussel, Veronica; Bona, Kira; Heath, John A; Hilden, Joanne M; Weeks, Jane C; Wolfe, Joanne

2011-03-10

Financial concerns represent a major stressor for families of children with cancer but remain poorly understood among those with terminally ill children. We describe the financial hardship, work disruptions, income loss, and coping strategies of families who lost children to cancer. Retrospective cross-sectional survey of 141 American and 89 Australian bereaved parents whose children died between 1990 and 1999 and 1996 to 2004, respectively, at three tertiary-care pediatric hospitals (two American, one Australian). Response rate: 63%. Thirty-four (24%) of 141 families from US centers and 34 (39%) of 88 families from the Australian center reported a great deal of financial hardship resulting from their children's illness. Work disruptions were substantial (84% in the United States, 88% in Australia). Australian families were more likely to report quitting a job (49% in Australia v 35% in the United States; P = .037). Sixty percent of families lost more than 10% of their annual income as a result of work disruptions. Australians were more likely to lose more than 40% of their income (34% in Australia v 19% in the United States; P = .035). Poor families experienced the greatest income loss. After accounting for income loss, 16% of American and 22% of Australian families dropped below the poverty line. Financial hardship was associated with poverty and income loss in all centers. Fundraising was the most common financial coping strategy (52% in the United States v 33% in Australia), followed by reduced spending. In these US and Australian centers, significant household-level financial effects of a child's death as a result of cancer were observed, especially for poor families. Interventions aimed at reducing the effects of income loss may ease financial distress.

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

PubMed Central

Frenz, Patricia; Grabenhenrich, Linus; Keil, Thomas; Tinnemann, Peter

2016-01-01

Abstract Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. PMID:27034521

Stress spillover, African Americans' couple and health outcomes, and the stress-buffering effect of family-centered prevention.

PubMed

Barton, Allen W; Beach, Steven R H; Bryant, Chalandra M; Lavner, Justin A; Brody, Gene H

2018-03-01

This study investigated (a) the stress spillover pathways linking contextual stressors, changes in couple relationship functioning and depressive symptoms, and changes in individuals' physical health, and (b) the stress-buffering effect of participation in an efficacious, family centered prevention program designed to protect couples from the deleterious effects of stressors. The sample consisted of 346 rural African American couples (63% married) who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program. Participants were assessed at three time points across 17 months. Results examining stress spillover within the control group indicated that elevated current, but not prior, financial hardship was associated with decreased effective communication, relationship satisfaction, and relationship confidence as well as increased depressive symptoms; current levels of racial discrimination also predicted greater depressive symptoms. Relationship confidence and relationship satisfaction, but not communication or depressive symptoms, in turn predicted declines in self-reported physical health. Results examining stress-buffering effects suggested that participation in ProSAAF protected individuals' relationship confidence from declines associated with elevated financial hardship. In addition, the indirect effect linking financial hardship to declines in physical health through relationship confidence that emerged among participants in the control group was no longer evident for ProSAAF couples. Results highlight the effect of contextual stressors on African Americans' couple and individual well-being and the potential for the ProSAAF program to provide a constructed resilience resource, protecting couple's confidence in their relationship from the negative effects of financial hardship and, consequently, promoting physical health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Adlerian Marital Therapy Strategies with Middle Income Couples Facing Financial Stress.

ERIC Educational Resources Information Center

Freeman, Criswell; And Others

1993-01-01

Describes the impact of economic stressors on marriage. Discusses how Adlerian marital therapy strategies can be tailored to help middle-income couples deal with such stressors. Identifies problems facing middle income families experiencing financial hardship, describes Adlerian counseling for financial conflict in marriage, and delineates…

Exploring the financial impact of breast cancer for African American medically underserved women: a qualitative study.

PubMed

Darby, Kathleen; Davis, Cindy; Likes, Wendy; Bell, John

2009-08-01

In addition to the physical suffering experienced by cancer survivors, there are considerable financial hardships and access barriers to quality health care. The current study explored the financial burden of breast cancer on African American medically underserved women. Four focus groups were conducted in three major cities across Tennessee. Research participants (N=36) were recruited by the staff of cancer support and treatment programs in the area. Findings revealed that participants' lack of insurance or inadequate insurance resulted in missed, delayed, or fewer treatment opportunities. The financial burden of cancer was not limited to the acute treatment phase. The women in the current study reported extreme economic hardship resulting from this disease into long-term survivorship. This exploratory study confirms the importance of providing care across the continuum to address the complex needs of low-income cancer survivors.

Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh

PubMed Central

Ali, Nazia Binte; Siddique, Md. Abu Bakkar; Ahmed, Sameen; Rahman, Mubashshira; Islam, Sajia; Rahman, Md. Mezanur; Amena, Bushra; Hoque, D. M. Emdadul; Huda, Tanvir M.; Arifeen, Shams El

2018-01-01

Background Around 63% of total health care expenditure in Bangladesh is mitigated through out of pocket payment (OOP). Heavy reliance on OOP at the time of care seeking poses great threat for financial impoverishment of the households. Households employ different strategies to cope with the associated financial hardship. Objective The aim of this paper is to understand the determinants of hardship financing in coping with OOP adopted for health care seeking of under five childhood illnesses in rural setting of Bangladesh. Methods A community based cross sectional survey was conducted during August to October, 2014 in 15 low performing sub-districts of northern and north-east regions of Bangladesh. Of the 7039 mothers of under five children surveyed, 1895 children who suffered from illness and sought care for their illness episodes were reported in this study. Descriptive statistics and ordinal regression analysis were conducted. Results A total number of 7,039 under five children reported to have suffered illness by their mothers. Among these children 37% suffered from priority illness. Care was sought for 88% children suffering from illnesses. Among them 26% went to a public or private sector medically trained provider. 5% of households incurred illness cost more than 10% of the household’s monthly expenditure. The need for assistance was higher among those compared to others (31% vs 13%). Different financing mechanisms adopted to meet OOP are loan with interest (6%), loan without interest (9%) and financial help from relatives (6%) Need for financial assistance varied from 19% among households in the lowest quintile to 9% in the highest wealth. Ordinal regression analysis revealed that burden of hardship financing increases by 2.17 times when care is sought from a private trained provider compared to care seeking from untrained provider (CI: 1.49, 3.17). Similarly, for families that incur a health care expenditure that is more than 10% of their total monthly expenditure (CI:1.46, 3.88), the probability of falling into more severe financial burden increases by 2.4 times. We also found severity of the hardship financing to be around half for households with monthly income of more than BDT 7500 (OR = 0.56, CI: 0.37, 0.86). The burden increased by 2.10 times for households with a deficit (CI: 1.53, 2.88) between their monthly income and expenditure. The interaction between family income and severity of illness showed to significantly affect the scale of hardship financing. Children suffering from priority illness belonging to poor households were found have two times (CI: 1.09, 3.47) higher risks of suffering from hardship financing. Conclusion and policy implications Findings from this study will help the policy makers to identify the target groups and thereby design effective health financing programs. PMID:29758022

Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh.

PubMed

Tahsina, Tazeen; Ali, Nazia Binte; Siddique, Md Abu Bakkar; Ahmed, Sameen; Rahman, Mubashshira; Islam, Sajia; Rahman, Md Mezanur; Amena, Bushra; Hoque, D M Emdadul; Huda, Tanvir M; Arifeen, Shams El

2018-01-01

Around 63% of total health care expenditure in Bangladesh is mitigated through out of pocket payment (OOP). Heavy reliance on OOP at the time of care seeking poses great threat for financial impoverishment of the households. Households employ different strategies to cope with the associated financial hardship. The aim of this paper is to understand the determinants of hardship financing in coping with OOP adopted for health care seeking of under five childhood illnesses in rural setting of Bangladesh. A community based cross sectional survey was conducted during August to October, 2014 in 15 low performing sub-districts of northern and north-east regions of Bangladesh. Of the 7039 mothers of under five children surveyed, 1895 children who suffered from illness and sought care for their illness episodes were reported in this study. Descriptive statistics and ordinal regression analysis were conducted. A total number of 7,039 under five children reported to have suffered illness by their mothers. Among these children 37% suffered from priority illness. Care was sought for 88% children suffering from illnesses. Among them 26% went to a public or private sector medically trained provider. 5% of households incurred illness cost more than 10% of the household's monthly expenditure. The need for assistance was higher among those compared to others (31% vs 13%). Different financing mechanisms adopted to meet OOP are loan with interest (6%), loan without interest (9%) and financial help from relatives (6%) Need for financial assistance varied from 19% among households in the lowest quintile to 9% in the highest wealth. Ordinal regression analysis revealed that burden of hardship financing increases by 2.17 times when care is sought from a private trained provider compared to care seeking from untrained provider (CI: 1.49, 3.17). Similarly, for families that incur a health care expenditure that is more than 10% of their total monthly expenditure (CI:1.46, 3.88), the probability of falling into more severe financial burden increases by 2.4 times. We also found severity of the hardship financing to be around half for households with monthly income of more than BDT 7500 (OR = 0.56, CI: 0.37, 0.86). The burden increased by 2.10 times for households with a deficit (CI: 1.53, 2.88) between their monthly income and expenditure. The interaction between family income and severity of illness showed to significantly affect the scale of hardship financing. Children suffering from priority illness belonging to poor households were found have two times (CI: 1.09, 3.47) higher risks of suffering from hardship financing. Findings from this study will help the policy makers to identify the target groups and thereby design effective health financing programs.

Bioethical Issues in Providing Financial Incentives to Research Participants

PubMed Central

Resnik, David B.

2015-01-01

Offering research subjects financial incentives for their participation is a common practice that boosts recruitment but also raises ethical concerns, such as undue inducement, exploitation, and biased enrollment. This article reviews the arguments for providing participants with financial incentives, ethical concerns about payment, and approaches to establishing appropriate compensation levels. It also makes recommendations for investigators, institutions, and oversight committees. PMID:26807399

New EEOC guidance details responsibilities for job accommodation.

PubMed

1999-04-02

The Equal Employment Opportunity Commission (EEOC) released new guidelines on how employers should accommodate the needs of workers with disabilities. Guidelines address using leave as an accommodation, the duty of offering reassignment as a form of reasonable accommodation, and an employer's cost of accommodation. Among the clarifications, the EEOC states that employers do not have to provide more paid leave than workers in similar situations receive. Employees must be qualified for reassignments, and the employer is not obligated to provide training for the new position. The EEOC disagrees with the Americans with Disabilities Act reasoning that employers should not be forced to accommodate if a cost-benefit analysis reveals undue hardship on the employer. Contact information is provided.

Handicap discrimination considerations in treating the impaired worker: drugs, alcohol, pregnancy, and AIDS in the workplace.

PubMed

Postol, L P

1988-04-01

In dealing with applicants and employees, administrators must comply with handicap and pregnancy discrimination statutes, any union collective bargaining agreement, and any state or local statutes specifically directed at protecting certain classes of handicapped persons. The employer must make reasonable accommodations which allow the disabled worker to perform the job, although the employer need not implement accommodations which are an undue hardship. Similarly, if the impaired employee cannot safely perform the essential functions of the job, he or she need not be hired or retained. Employers must also recognize their responsibilities and liability under their health benefit plans and other liability statutes, and attempt to minimize their exposure.

Serial Migration and the Assessment of "Extreme and Unusual Psychological Hardship" with Undocumented Latina/o Families

ERIC Educational Resources Information Center

Cervantes, Joseph M.; Mejia, Olga L.; Mena, Amalia Guerrero

2010-01-01

There has been a significant trend among families from Mexico and Central America to immigrate to the United States due to difficult living conditions, financial hardship, and the lack of opportunity. This article addresses the role of serial migration, where one family member immigrates first and then brings the rest of the family at a later…

Stress and Unemployment in Rural Nonfarm Couples: A Study of Hardships and Coping Resources.

ERIC Educational Resources Information Center

Wilhelm, Mari S.; Ridley, Carl A.

1988-01-01

Explored effects of unemployment on stress with 44 rural nonfarm families. Results revealed that increases in financial arguments were more predictive of stress than were actual changes in financial management, especially for wives. Avoidance coping was predictive of stress and mediated relationship between financial arguments and stress for both…

Financial hardship associated with colorectal cancer survivorship: the role of asset depletion and debt accumulation.

PubMed

Hanly, Paul; Maguire, Rebecca; Ceilleachair, Alan O; Sharp, Linda

2018-05-31

To estimate the prevalence of financial objective stress and subjective strain among colorectal cancer survivors and assess associated financial coping factors in Ireland which has a mixed public-private healthcare system. Colorectal cancer survivors were identified from the National Cancer Registry and a sample of 496 respondents were included in the analysis. A postal survey collected information on survivor demographics, socio-economic background, medical characteristics, cancer-related financial hardship, debt accumulation and asset depletion. Cancer-related financial objective stress and subjective strain were employed as dependent variables in logistic regression analysis. Approximately two in five survivors experienced objective stress (40.9%) or subjective strain (39.4%). Depletion of savings (49.1%) was the most prevalent form of financial coping strategy. Factors significantly associated with increased objective stress were having a stoma (OR=2.1, 95% CI 1.1-3.9), using savings (OR=9.4, 95% CI 4.9-18.0), formally borrowing money (OR=3.1, 95% CI 1.0-9.6) and loans from family members/friends (OR=3.8, 95% CI 1.9-7.8). Not working (excluding retirees) (OR=0.44, 95% CI 0.20-0.96) was associated with decreased objective stress. Significant predictors of subjective strain included having dependents, a stoma, using savings (OR=5.3 95% CI 2.9-9.5) and loans from family members/friends (OR=2.0, 95% CI 1.1-3.9), but excluded borrowing money. Cancer-related financial objective stress and subjective strain are common in colorectal cancer survivors, even where all citizens are entitled to publicly-funded care, but the financial coping strategies significantly associated with these two measures differed. These findings will help inform targeted measures across disparate health care systems, and survivor groups, to alleviate financial hardship. This article is protected by copyright. All rights reserved.

Medicalization of global health 4: The universal health coverage campaign and the medicalization of global health.

PubMed

Clark, Jocalyn

2014-01-01

Universal health coverage (UHC) has emerged as the leading and recommended overarching health goal on the post-2015 development agenda, and is promoted with fervour. UHC has the backing of major medical and health institutions, and is designed to provide patients with universal access to needed health services without financial hardship, but is also projected to have 'a transformative effect on poverty, hunger, and disease'. Multiple reports and resolutions support UHC and few offer critical analyses; but among these are concerns with imprecise definitions and the ability to implement UHC at the country level. A medicalization lens enriches these early critiques and identifies concerns that the UHC campaign contributes to the medicalization of global health. UHC conflates health with health care, thus assigning undue importance to (biomedical) health services and downgrading the social and structural determinants of health. There is poor evidence that UHC or health care alone improves population health outcomes, and in fact health care may worsen inequities. UHC is reductionistic because it focuses on preventative and curative actions delivered at the individual level, and ignores the social and political determinants of health and right to health that have been supported by decades of international work and commitments. UHC risks commodifying health care, which threatens the underlying principles of UHC of equity in access and of health care as a collective good.

25 CFR 115.616 - What information will be included in BIA's final decision?

Code of Federal Regulations, 2012 CFR

2012-04-01

...? 115.616 Section 115.616 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS IIM Accounts: Hearing Process for Restricting an IIM... applicable; (d) Any provision to allow for distributions to the account holder because of an undue financial...

25 CFR 115.616 - What information will be included in BIA's final decision?

Code of Federal Regulations, 2013 CFR

2013-04-01

...? 115.616 Section 115.616 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS IIM Accounts: Hearing Process for Restricting an IIM... applicable; (d) Any provision to allow for distributions to the account holder because of an undue financial...

25 CFR 115.616 - What information will be included in BIA's final decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

...? 115.616 Section 115.616 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS IIM Accounts: Hearing Process for Restricting an IIM... applicable; (d) Any provision to allow for distributions to the account holder because of an undue financial...

25 CFR 115.616 - What information will be included in BIA's final decision?

Code of Federal Regulations, 2014 CFR

2014-04-01

...? 115.616 Section 115.616 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS IIM Accounts: Hearing Process for Restricting an IIM... applicable; (d) Any provision to allow for distributions to the account holder because of an undue financial...

25 CFR 115.616 - What information will be included in BIA's final decision?

Code of Federal Regulations, 2011 CFR

2011-04-01

...? 115.616 Section 115.616 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS IIM Accounts: Hearing Process for Restricting an IIM... applicable; (d) Any provision to allow for distributions to the account holder because of an undue financial...

Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care.

PubMed

Katz, Jennifer; Crean, Hugh F; Cerulli, Catherine; Poleshuck, Ellen L

2018-03-14

Introduction Although poverty is an established correlate of poorer mental health for pregnant women, limited research has examined the mental health effects of material hardship (i.e., difficulties meeting basic needs such as for food, transportation, or stable housing) during pregnancy. Methods The current research examined rates of material hardship among pregnant women seeking prenatal care and the relationships of both income and material hardship with depression and anxiety during pregnancy. Pregnant women (N = 892) responded to self-report measures of mental health symptoms, annual household income, and current material hardship in the waiting areas of community-based obstetrics/gynecology practices serving primarily financially disadvantaged patients. Results About 56% of the sample reported some form of material hardship. About 19% of the sample reported elevated depression, and 17% reported elevated anxiety. Both depression and anxiety were uniquely associated with lower income and greater material hardship, even after controlling for age, race/ethnicity, relationship status, and number of children in the home. Furthermore, material hardship partially mediated the effect of income on mental health symptoms. Discussion The physical, emotional, and social effects of deprivation of basic daily needs may contribute to pregnant women's experiences of mental health symptoms. These results converge with the broader literature focused on the social determinants of physical and mental health. When symptoms of depression and anxiety reflect distress related to material hardship, addressing unmet social needs may be more effective than mental health treatment.

Unmeasured Costs of a Child's Death: Perceived Financial Burden, Work Disruptions, and Economic Coping Strategies Used by American and Australian Families Who Lost Children to Cancer

PubMed Central

Dussel, Veronica; Bona, Kira; Heath, John A.; Hilden, Joanne M.; Weeks, Jane C.; Wolfe, Joanne

2011-01-01

Purpose Financial concerns represent a major stressor for families of children with cancer but remain poorly understood among those with terminally ill children. We describe the financial hardship, work disruptions, income loss, and coping strategies of families who lost children to cancer. Methods Retrospective cross-sectional survey of 141 American and 89 Australian bereaved parents whose children died between 1990 and 1999 and 1996 to 2004, respectively, at three tertiary-care pediatric hospitals (two American, one Australian). Response rate: 63%. Results Thirty-four (24%) of 141 families from US centers and 34 (39%) of 88 families from the Australian center reported a great deal of financial hardship resulting from their children's illness. Work disruptions were substantial (84% in the United States, 88% in Australia). Australian families were more likely to report quitting a job (49% in Australia v 35% in the United States; P = .037). Sixty percent of families lost more than 10% of their annual income as a result of work disruptions. Australians were more likely to lose more than 40% of their income (34% in Australia v 19% in the United States; P = .035). Poor families experienced the greatest income loss. After accounting for income loss, 16% of American and 22% of Australian families dropped below the poverty line. Financial hardship was associated with poverty and income loss in all centers. Fundraising was the most common financial coping strategy (52% in the United States v 33% in Australia), followed by reduced spending. Conclusion In these US and Australian centers, significant household-level financial effects of a child's death as a result of cancer were observed, especially for poor families. Interventions aimed at reducing the effects of income loss may ease financial distress. PMID:21205758

Poverty, near-poverty, and hardship around the time of pregnancy.

PubMed

Braveman, Paula; Marchi, Kristen; Egerter, Susan; Kim, Soowon; Metzler, Marilyn; Stancil, Tonya; Libet, Moreen

2010-01-01

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income 400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.

Neuronal nitric oxide synthase (NOS1) polymorphisms interact with financial hardship to affect depression risk.

PubMed

Sarginson, Jane E; Deakin, J F William; Anderson, Ian M; Downey, Darragh; Thomas, Emma; Elliott, Rebecca; Juhasz, Gabriella

2014-11-01

There is increasing evidence that genetic factors have a role in differential susceptibility to depression in response to severe or chronic adversity. Studies in animals suggest that nitric oxide (NO) signalling has a key role in depression-like behavioural responses to stress. This study investigated whether genetic variation in the brain-expressed nitric oxide synthase gene NOS1 modifies the relationship between psychosocial stress and current depression score. We recruited a population sample of 1222 individuals who provided DNA and questionnaire data on symptoms and stress. Scores on the List of Life-Threatening Experiences (LTE) questionnaire for the last year and self-rated current financial hardship were used as measures of recent/ongoing psychosocial stress. Twenty SNPs were genotyped. Significant associations between eight NOS1 SNPs, comprising two regional haplotypes, and current depression score were identified that survived correction for multiple testing when current financial hardship was used as the interaction term. A smaller three-SNP haplotypes (rs10507279, rs1004356 and rs3782218) located in a regulatory region of NOS1 showed one of the strongest effects, with the A-C-T haplotype associating with higher depression scores at low adversity levels but lower depression scores at higher adversity levels (p=2.3E-05). These results suggest that NOS1 SNPs interact with exposure to economic and psychosocial stressors to alter individual's susceptibility to depression.

Neuronal Nitric Oxide Synthase (NOS1) Polymorphisms Interact with Financial Hardship to Affect Depression Risk

PubMed Central

Sarginson, Jane E; Deakin, JF William; Anderson, Ian M; Downey, Darragh; Thomas, Emma; Elliott, Rebecca; Juhasz, Gabriella

2014-01-01

There is increasing evidence that genetic factors have a role in differential susceptibility to depression in response to severe or chronic adversity. Studies in animals suggest that nitric oxide (NO) signalling has a key role in depression-like behavioural responses to stress. This study investigated whether genetic variation in the brain-expressed nitric oxide synthase gene NOS1 modifies the relationship between psychosocial stress and current depression score. We recruited a population sample of 1222 individuals who provided DNA and questionnaire data on symptoms and stress. Scores on the List of Life-Threatening Experiences (LTE) questionnaire for the last year and self-rated current financial hardship were used as measures of recent/ongoing psychosocial stress. Twenty SNPs were genotyped. Significant associations between eight NOS1 SNPs, comprising two regional haplotypes, and current depression score were identified that survived correction for multiple testing when current financial hardship was used as the interaction term. A smaller three-SNP haplotypes (rs10507279, rs1004356 and rs3782218) located in a regulatory region of NOS1 showed one of the strongest effects, with the A-C-T haplotype associating with higher depression scores at low adversity levels but lower depression scores at higher adversity levels (p=2.3E-05). These results suggest that NOS1 SNPs interact with exposure to economic and psychosocial stressors to alter individual's susceptibility to depression. PMID:24917196

49 CFR 37.151 - Waiver for undue financial burden.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... (b) At the time of its annual plan update submission, if the entity believes that circumstances have changed since its last submission, and it is no longer able to comply by January 26, 1997, or make...

49 CFR 37.151 - Waiver for undue financial burden.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... (b) At the time of its annual plan update submission, if the entity believes that circumstances have changed since its last submission, and it is no longer able to comply by January 26, 1997, or make...

49 CFR 37.151 - Waiver for undue financial burden.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... (b) At the time of its annual plan update submission, if the entity believes that circumstances have changed since its last submission, and it is no longer able to comply by January 26, 1997, or make...

49 CFR 37.151 - Waiver for undue financial burden.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... (b) At the time of its annual plan update submission, if the entity believes that circumstances have changed since its last submission, and it is no longer able to comply by January 26, 1997, or make...

49 CFR 37.151 - Waiver for undue financial burden.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (b) At the time of its annual plan update submission, if the entity believes that circumstances have changed since its last submission, and it is no longer able to comply by January 26, 1997, or make...

Elementary Schools, Teaching, and Social Studies in Texas: Facing the Great Depression

ERIC Educational Resources Information Center

Bellows, M. Elizabeth; Baumi, Michelle; Field, Sherry L.

2013-01-01

Across the United States, the Great Depression was a period of tremendous upheaval. Economic, family, political, and educational institutions shook mightily as the tremors of widespread financial downturn were felt. Public schools faced increasing hardships, which included financial problems such as a weakened tax base due to the non-payment of…

Order in the Home: Family Routines Moderate the Impact of Financial Hardship

ERIC Educational Resources Information Center

Budescu, Mia; Taylor, Ronald D.

2013-01-01

The study examined whether frequency of adolescent reported family routines moderated the relation between caregivers' perceptions of financial resources and adolescents' behavioral and academic outcomes among a sample of inner-city African American families. The sample consisted of 115 adolescents (average age = 15.95) and their female caregivers…

Educational Financing and Budgeting in Kyrgyzstan. Financial Management of Education Systems. Working Document.

ERIC Educational Resources Information Center

Rysalieva, Symbat Dj.; Ibraeva, Gulmira A.

This book provides an indepth description and analysis of financial management and budgetary procedures for education in Kyrgyzstan. The case of this country is interesting for practitioners and researchers due to its policy of accelerated transition to a market economy, with associated hardships for educational finance and budgeting. Kyrgyzstan…

Student Loan Debt in Kentucky: An Analysis of Debt Levels and Their Relationship to Earnings for Baccalaureate Degree Holders of Public Universities, 2010-2013

ERIC Educational Resources Information Center

Kentucky Council on Postsecondary Education, 2015

2015-01-01

Student loans can be a good investment in an individual's future, providing financial access to higher education and improved chances of economic success after college. However, avoiding undue financial obligations and maximizing the return on investment require careful planning and prudent borrowing. Estimating whether the student loan debt…

The Implications of Grandparent Coresidence for Economic Hardship among Children in Mother-Only Families

PubMed Central

Mutchler, Jan E.; Baker, Lindsey A.

2014-01-01

Estimates suggest that more than 6 million children live with at least one grandparent. Despite evidence establishing the growing prevalence of this arrangement, limited research has focused on estimating the implications of co-residence for the economic well-being of grandchildren. Using data from the 2001 panel of the Survey of Income and Program Participation, this paper examines levels of financial hardship among a particularly vulnerable group of children – those living in mother-only families. Findings suggest that children living in mother-only families that include a grandparent are substantially less likely to be living below or near the poverty level, compared to children living in mother-only families without a grandparent present. The financial security of children in these three-generation households is enhanced through significant economic contributions of the grandparents, and from household receipt of a wide range of financial resources, including means-tested cash transfers and other income such as Social Security. PMID:25750469

7 CFR 1714.56 - Fund advance period.

Code of Federal Regulations, 2010 CFR

2010-01-01

... certain mergers, consolidations, and transfers of systems substantially in their entirety are set forth in... date for completion of construction. (2) In the case of financial hardship, as determined by the...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

7 CFR 1710.109 - Reimbursement of general funds and interim financing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... be limited, except in cases of extreme financial hardship as determined by the Administrator, to the...) Policies for reimbursement of general funds and interim financing following certain mergers, consolidations...

Variety more than quantity of fruit and vegetable intake varies by socioeconomic status and financial hardship. Findings from older adults in the EPIC cohort.

PubMed

Conklin, Annalijn I; Forouhi, Nita G; Suhrcke, Marc; Surtees, Paul; Wareham, Nicholas J; Monsivais, Pablo

2014-12-01

Beyond quantity, variety of fruit and vegetable (FV) intake prevents chronic conditions and is widely recommended as critical to healthful eating. FV consumption is socially patterned, especially for women, but little is known about multiple economic determinants of variety or whether they differ from those of quantity. To examine socioeconomic status and financial hardships in relation to variety and quantity of FV intakes among older British women and men. Cross-sectional study of 9580 adults (50-79 years) in the nationally representative EPIC cohort who responded to a postal Health and Life Experiences Questionnaire (1996-2000) and Food Frequency Questionnaire (1998-2002). Variety counted unique items consumed (items/month) and quantity measured total intake (g/day). No consistent differences by any economic factor were observed for quantity of fruits or vegetables, except education in men. Lower education, lower social class and renting were independently associated with lower fruit variety and vegetable variety (p-trend < 0.001), with differences stronger in men. Mean vegetable variety differed between top and bottom social classes by 2.9 items/month for men and 2.5 for women. Greater financial hardships were also independently associated with lower variety, with differences stronger in women for fruits and in men for vegetables. British older adults reporting greater economic disadvantage consistently consumed fewer different fruits or vegetables, but not lower amounts. Further nutrition studies of the protective effects, and underlying mechanisms, of FV variety are warranted for addressing social inequalities in older adults' diet quality. Dietary guidance should separately emphasise variety, and interventions should aim to address financial barriers to older adults' consumption of diverse FV. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

5 CFR 1636.160 - Communications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE FEDERAL RETIREMENT THRIFT INVESTMENT BOARD... would result in a fundamental alteration in the nature of a program or activity or in undue financial...

22 CFR 711.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

....150 Section 711.150 Foreign Relations OVERSEAS PRIVATE INVESTMENT CORPORATION ADMINISTRATIVE... THE OVERSEAS PRIVATE INVESTMENT CORPORATION § 711.150 Program accessibility: Existing facilities. (a... result in a fundamental alteration in the nature of a program or activity or in undue financial and...

5 CFR 1636.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... facilities. 1636.150 Section 1636.150 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD... RETIREMENT THRIFT INVESTMENT BOARD § 1636.150 Program accessibility: Existing facilities. (a) General. The... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review.

PubMed

Valtorta, Nicole K; Hanratty, Barbara

2013-04-01

Chronic disease has financial consequences for older adults, but it is unclear how this varies between conditions with different disease trajectories. The aim of this study was to review evidence on the financial burden associated with cancer, heart failure or stroke in older people, to identify those most at risk of financial adversity. We systematically searched nine databases for studies with data on the illness-related financial burden (objective), or on the perception of financial hardship (subjective), of older patients and/or their informal caregivers in high-income countries. We identified thirty-eight papers published in English between 1984 and 2012. Studies fell into three categories: those reporting direct, out of pocket, costs (medical and/or non-medical); studies of the indirect costs associated with illness (such as wage or income loss); and papers reporting general financial or economic burdens secondary to illness. Three out of four studies focused on people with cancer. More affluent people had greater out of pocket costs, but were less financially burdened by illness, compared with older adults from lower socioeconomic backgrounds. Disadvantaged patients and families were more likely to report experiences of financial hardship, and spend a higher proportion of their income on all expenses related to their diagnoses. This review illustrates how little is known about the financial adversity experienced by patients with some common chronic conditions. It raises the possibility that higher expenditure by more affluent older people may be creating inequalities in how chronic illness is experienced. The development of effective strategies for financial protection at older ages will require more information on who is affected and at which point in their illness trajectory. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

5 CFR 723.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... facilities. 723.150 Section 723.150 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... ACTIVITIES CONDUCTED BY THE OFFICE OF PERSONNEL MANAGEMENT § 723.150 Program accessibility: Existing... would result in a fundamental alteration in the nature of a program or activity or in undue financial...

41 CFR 105-8.160 - Communications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Communications. 105-8.160 Section 105-8.160 Public Contracts and Property Management Federal Property Management Regulations... would result in a fundamental alteration in the nature of a program or activity or in undue financial...

22 CFR 530.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE BROADCASTING BOARD OF GOVERNORS... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where Board personnel...

46 CFR 507.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE FEDERAL MARITIME COMMISSION... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where agency personnel...

1 CFR 500.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE NATIONAL COMMISSION FOR EMPLOYMENT POLICY... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where agency personnel...

49 CFR 1014.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE SURFACE TRANSPORTATION BOARD... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where agency personnel...

How much downside? Quantifying the relative harm from tobacco taxation

PubMed Central

Wilson, N; Thomson, G; Tobias, M; Blakely, T

2004-01-01

Objective: To estimate the loss of life expectancy attributable to tobacco taxation (via financial hardship and flow-on health effect) in New Zealand. Design: Data were used on the gradients in life expectancy and smoking by neighbourhood socioeconomic deprivation and survey data on tobacco expenditure. Three estimates were modelled of the percentage of the crude association of neighbourhood deprivation with life expectancy that might be mediated via financial hardship: 100%, 50%, and 25% (best estimate). From this information the impact of tobacco taxation on life expectancy was estimated. Main results: For the total population, the estimated loss of life expectancy due to tobacco tax ranged from 0.005 years to 0.027 years. For people living in the most deprived 30% of neighbourhoods, the range was 0.009 to 0.044 years (that is, 3 to 16 days of lost life expectancy). For the total population the loss of life expectancy attributable to tobacco tax ranged from 119 to 460 times less than that attributable to deprivation. The loss of life expectancy attributable to tobacco tax was 42 to 257 times less than that attributable to smoking. Conclusions: The estimated harm to life expectancy from tobacco taxation (via financial hardship) is orders of magnitude smaller than the harm from smoking. Although the analyses involve a number of simplistic assumptions, this conclusion is likely to be robust. Policy makers should be reassured that tobacco taxation is likely to be achieving far more benefit than harm in the general population and in socioeconomically deprived populations. PMID:15143110

Influence of subjective economic hardship on new onset of neck pain (so-called: katakori) in the chronic phase of the Great East Japan Earthquake: A prospective cohort study.

PubMed

Sekiguchi, Takuya; Hagiwara, Yoshihiro; Sugawara, Yumi; Tomata, Yasutake; Tanji, Fumiya; Watanabe, Takashi; Yabe, Yutaka; Koide, Masashi; Itaya, Nobuyuki; Itoi, Eiji; Tsuji, Ichiro

2018-06-19

Studies have suggested that musculoskeletal symptoms increase after natural disasters. The Great East Japan Earthquake (GEJE) and accompanying tsunami placed a huge financial burden on the local population. This study determined whether subjective economic hardship influenced the new onset of neck pain (katakori) in the chronic phase after the GEJE. This study used longitudinal data from 1359 adults who had responded to the self-report questionnaire at 2 and 3 years after the GEJE. New-onset neck pain was defined as neck pain absent at 2 years and present at 3 years. Subjective economic hardship at 2 years after the GEJE was categorized into 4 groups: "normal," "a little bit hard," "hard," and "very hard." Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) in order to examine the association between subjective economic hardship and new-onset neck pain. Among the participants, 12.9% (n = 175) reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who considered their subjective economic hardship to be "hard" (OR = 2.10, 95% CI = 1.34-3.30) or "very hard" (OR = 3.26, 95% CI = 1.83-5.46; p for trend <0.001) compared with those who considered their hardship to be "normal." Subjective economic hardship was significantly associated with new-onset neck pain in the chronic phase of the GEJE. (228/300). Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Information to be Submitted with 2016 Renewable Fuel Standard (RFS) Small Refinery Hardship Exemption Requests

EPA Pesticide Factsheets

This December 6, 2016 letter from EPA provides information about the petition submission process for small refineries seeking exemptions from their 2016 RFS obligations, including financial and other information necessary for evaluation.

41 CFR 51-10.160 - Communications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Communications. 51-10.160 Section 51-10.160 Public Contracts and Property Management Other Provisions Relating to Public Contracts... would result in a fundamental alteration in the nature of a program or activity or in undue financial...

28 CFR 0.19 - Associate Attorney General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Director, Office of Attorney Recruitment and Management. (c) The Associate Attorney General is the Attorney... can achieve the purpose of a program without fundamental changes in its nature, and whether an action would result in a fundamental alteration in the nature of a program or activity or in undue financial...

41 CFR 51-10.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Program accessibility: Existing facilities. 51-10.150 Section 51-10.150 Public Contracts and Property Management Other Provisions... result in a fundamental alteration in the nature of a program or activity or in undue financial and...

17 CFR 200.650 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the Basis of Handicap in Programs or Activities Conducted by the Securities and Exchange Commission... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

45 CFR 1175.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE NATIONAL ENDOWMENT FOR THE... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... of a program or activity or in undue financial and administrative burdens. In those circumstances...

7 CFR 15e.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE UNITED STATES DEPARTMENT OF AGRICULTURE... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

6 CFR 15.50 - Program accessibility; existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF DISABILITY IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE... Department shall operate each program or activity so that the program or activity, when viewed in its... result in a fundamental alteration in the nature of a program or activity or in undue financial and...

25 CFR 720.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE NAVAJO AND HOPI INDIAN RELOCATION... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where agency personnel...

38 CFR 15.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AFFAIRS ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY.... The agency shall operate each program or activity so that the program or activity, when viewed in its... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

22 CFR 219.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY INTERNATIONAL DEVELOPMENT.... (a) General. The agency shall operate each program or activity so that the program or activity, when... result in a fundamental alteration in the nature of a program or activity or in undue financial and...

22 CFR 1510.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE AFRICAN DEVELOPMENT FOUNDATION... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

22 CFR 144.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE UNITED STATES DEPARTMENT OF... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... activity or in undue financial and administrative burdens. In those circumstances where agency personnel...

24 CFR 9.150 - Program accessibility: existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ACTIVITIES CONDUCTED BY THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.150 Program accessibility... shall operate each program or activity so that the program or activity, when viewed in its entirety, is... nature of a program or activity or in undue financial and administrative burdens. In those circumstances...

5 CFR 1850.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE OFFICE OF SPECIAL COUNSEL... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

49 CFR 28.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF TRANSPORTATION § 28... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

36 CFR 812.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... HISTORIC PRESERVATION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES... facilities. (a) General. The agency shall operate each program or activity so that the program or activity... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

12 CFR 606.650 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE FARM CREDIT... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

3 CFR 102.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE EXECUTIVE OFFICE OF THE PRESIDENT... or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

18 CFR 1313.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITY ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY... agency shall operate each program or activity so that the program or activity, when viewed in its... the nature of a program or activity or in undue financial and administrative burdens. In those...

29 CFR 2205.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COMMISSION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY... facilities. (a) General. The agency shall operate each program or activity so that the program or activity... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

45 CFR 606.51 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOUNDATION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY... Foundation shall operate each program or activity so that the program or activity, when viewed in its... result in a fundamental alteration in the nature of a program or activity or in undue financial and...

29 CFR 100.550 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities Conducted by the National... shall operate each program or activity so that the program or activity, when viewed in its entirety, is... the nature of a program or activity or in undue financial and administrative burdens. In those...

40 CFR 12.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE ENVIRONMENTAL PROTECTION... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

45 CFR 1214.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ACTIVITIES CONDUCTED BY ACTION § 1214.150 Program accessibility: Existing facilities. (a) General. The agency shall operate each program or activity so that the program or activity, when viewed in its entirety, is... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

29 CFR 2706.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COMMISSION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY... facilities. (a) General. The agency shall operate each program or activity so that the program or activity... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

22 CFR 1701.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE UNITED STATES INSTITUTE OF... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

36 CFR 909.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DEVELOPMENT CORPORATION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES... facilities. (a) General. The agency shall operate each program or activity so that the program or activity... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

5 CFR 2416.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE FEDERAL... shall operate each program or activity so that the program or activity, when viewed in its entirety, is... fundamental alteration in the nature of a program or activity or in undue financial and administrative burdens...

17 CFR 149.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... COMMISSION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY...) General. The agency shall operate each program or activity so that the program or activity, when viewed in... the nature of a program or activity or in undue financial and administrative burdens. In those...

45 CFR 1181.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE INSTITUTE OF MUSEUM AND... operate each program or activity so that the program or activity, when viewed in its entirety, is readily... the nature of a program or activity or in undue financial and administrative burdens. In those...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2010 CFR

2010-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2011 CFR

2011-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2014 CFR

2014-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

78 FR 15040 - Renewal of Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... authorized by the mining laws, and in obtaining financial guarantees for the reclamation of public lands. The... the General Mining Law (43 CFR subpart 3809). Forms: Form 3809-1, Surface Management Surety Bond; Form... whether operators and mining claimants are meeting their responsibility to prevent unnecessary or undue...

Financial woes of the Canada Pension Plan hold implications for physicians

PubMed Central

Gray, Charlotte

1995-01-01

Although it is unlikely that many Canadian physicians are relying on the Canada Pension Plan (CPP) for retirement security, a forecast that the program is in financial trouble has implications for the medical profession. One is the prospect of a generation of poverty-stricken seniors who could put undue stress on the health care system; another is that as the number of CPP disability claims continues to skyrocket, there may have to be more rigorous scrutiny of hard-to-define medical conditions.

Role of financial and social hardships in asthma racial disparities.

PubMed

Beck, Andrew F; Huang, Bin; Simmons, Jeffrey M; Moncrief, Terri; Sauers, Hadley S; Chen, Chen; Ryan, Patrick H; Newman, Nicholas C; Kahn, Robert S

2014-03-01

Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.

Role of Financial and Social Hardships in Asthma Racial Disparities

PubMed Central

Huang, Bin; Simmons, Jeffrey M.; Moncrief, Terri; Sauers, Hadley S.; Chen, Chen; Ryan, Patrick H.; Newman, Nicholas C.; Kahn, Robert S.

2014-01-01

BACKGROUND AND OBJECTIVES: Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS: We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS: The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS: African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity. PMID:24488745

Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey.

PubMed

Stewart, Barclay T; Lafta, Riyadh; Esa Al Shatari, Sahar A; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2016-02-01

Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Burns in Baghdad from 2003–2014: results of a randomized household cluster survey

PubMed Central

Stewart, Barclay T; Lafta, Riyadh; Shatari, Sahar A Esa Al; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2015-01-01

Purpose Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Results Nine-hundred households, totaling 5,148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2,340 serious burn injures (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burn injuries generally increased post-invasion to 8,780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn injury than children aged less than 13 years (aOR 2.42; 95%CI 1.08 – 5.44). Nineteen burns (35%) involved ≥20% body surface area. Death (16% of burn injuries), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn injury. Conclusion Civilian burn injury in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn injury. Ongoing conflict will directly and indirectly generate more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. PMID:26526376

5 CFR 831.1404 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-01-01

... may be deemed to exist in—but not limited to—those situations where the annuitant from whom collection is sought needs substantially all of his/her current income and liquid assets to meet current... the annuitant's liquid assets and current income in making such determinations. ...

43 CFR 17.550 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... on the Basis of Handicap in Programs or Activities Conducted by the Department of the Interior § 17... activity so that the program or activity, when viewed in its entirety, is readily accessible to and usable... the nature of a program or activity or in undue financial and administrative burdens. In those...

45 CFR 85.42 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF HEALTH AND HUMAN... program or activity so that the program or activity, when viewed in its entirety, is readily accessible to... the nature of a program or activity or in undue financial and administrative burdens. In those...

Financial hardship on the path to Universal Health Coverage in the Gulf States.

PubMed

Alshamsan, Riyadh; Leslie, Hannah; Majeed, Azeem; Kruk, Margaret

2017-03-01

Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship. Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors. We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001). In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage. Copyright © 2017 Elsevier B.V. All rights reserved.

Dyadic effects of gender minority stressors in substance use behaviors among transgender women and their non-transgender male partners

PubMed Central

Reisner, Sari L.; Gamarel, Kristi E.; Nemoto, Tooru; Operario, Don

2014-01-01

Background Despite evidence that interpersonal processes shape health behaviors, research concerning the dyadic effects of gender minority stressors on substance use behaviors of transgender people is scarce. The objective of this study was to use dyadic analysis to examine whether transgender discrimination was associated with substance use among transgender women and their male partners. Methods Transgender women and their male partners (N=191 couples; N=382 individuals) completed questionnaires. Participants’ mean age was 37.1; 79.1% were racial/ethnic minority; 61.3% earned <$500 per-month. The mean relationship duration was 37.9 months. Actor-Partner Interdependence Models were used to examine the associations between transgender-related discrimination and past 30-day non-marijuana illicit drug use adjusting for age, relationship length, financial hardship, and depressive distress among partners in these dyads. Results Illicit drug use was reported by 31.4% of transgender women and 25.1% of their male partners. Perceived transgender discrimination was independently associated with increased odds of illicit drug use for transgender women (actor effect) but not for their male partners. Financial hardship statistically predicted drug use for both partners (actor effects). There were no partner effects for financial hardship on drug use. Overall, 34.5% of dyads had discrepant substance use. Discrimination scores of male partners differentiated dyads who reported discrepant substance use. Discussion Gender minority stressors are critical to understanding substance use among transgender women and their male partners. Integrating socioeconomic status into gender minority stress frameworks is essential. Results have implications for substance use prevention and treatment, including the need to incorporate gender minority stressors into interventions. PMID:25642440

Dyadic effects of gender minority stressors in substance use behaviors among transgender women and their non-transgender male partners.

PubMed

Reisner, Sari L; Gamarel, Kristi E; Nemoto, Tooru; Operario, Don

2014-03-01

Despite evidence that interpersonal processes shape health behaviors, research concerning the dyadic effects of gender minority stressors on substance use behaviors of transgender people is scarce. The objective of this study was to use dyadic analysis to examine whether transgender discrimination was associated with substance use among transgender women and their male partners. Transgender women and their male partners ( N =191 couples; N =382 individuals) completed questionnaires. Participants' mean age was 37.1; 79.1% were racial/ethnic minority; 61.3% earned <$500 per-month. The mean relationship duration was 37.9 months. Actor-Partner Interdependence Models were used to examine the associations between transgender-related discrimination and past 30-day non-marijuana illicit drug use adjusting for age, relationship length, financial hardship, and depressive distress among partners in these dyads. Illicit drug use was reported by 31.4% of transgender women and 25.1% of their male partners. Perceived transgender discrimination was independently associated with increased odds of illicit drug use for transgender women (actor effect) but not for their male partners. Financial hardship statistically predicted drug use for both partners (actor effects). There were no partner effects for financial hardship on drug use. Overall, 34.5% of dyads had discrepant substance use. Discrimination scores of male partners differentiated dyads who reported discrepant substance use. Gender minority stressors are critical to understanding substance use among transgender women and their male partners. Integrating socioeconomic status into gender minority stress frameworks is essential. Results have implications for substance use prevention and treatment, including the need to incorporate gender minority stressors into interventions.

Becoming disabled: The association between disability onset in younger adults and subsequent changes in productive engagement, social support, financial hardship and subjective wellbeing.

PubMed

Emerson, Eric; Kariuki, Maina; Honey, Anne; Llewellyn, Gwynnyth

2014-10-01

Very few population-based studies have investigated the association between the onset of health conditions/impairments associated with disability and subsequent well-being. To examine the association between the onset of disability and four indicators of well-being (full-time engagement in employment or education, financial hardship, social support, subjective well-being) among a nationally representative sample of Australian adolescents and young adults. Secondary analysis of the first eight waves (2001-2008) of the survey of Household Income and Labour Dynamics in Australia. For financial hardship and subjective well-being, the majority of participants belonged to trajectory classes for which there was no evidence that the onset of disability was associated with a subsequent lowering of well-being. For participation in employment and education, the majority of participants belonged to trajectory classes for which there was evidence of a modest immediate reduction in participation rates followed by subsequent stability. For social support, the majority of participants belonged to trajectory classes for which there was evidence of a modest temporary reduction in support followed by rebound back to initial levels. Membership of classes associated with poorer outcomes was associated with a number of covariates including: male gender; younger age of disability onset; being born overseas; not living with both parents at age 14; lower proficiency in the English language; and parental education being year 12 or below. The results of our analyses illustrate the existence of clear empirically defined trajectory classes following the onset of disability across a range of indicators of well-being. Copyright © 2014 Elsevier Inc. All rights reserved.

Financial Decision-making Abilities and Financial Exploitation in Older African Americans: Preliminary Validity Evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS)

PubMed Central

Ficker, Lisa J.; Rahman-Filipiak, Annalise

2015-01-01

This study examines preliminary evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS), a new person-centered approach to assessing capacity to make financial decisions, and its relationship to self-reported cases of financial exploitation in 69 older African Americans. More than one third of individuals reporting financial exploitation also had questionable decisional abilities. Overall, decisional ability score and current decision total were significantly associated with cognitive screening test and financial ability scores, demonstrating good criterion validity. Financially exploited individuals, and non-exploited individuals, showed mean group differences on the Mini Mental State Exam, Financial Situational Awareness, Psychological Vulnerability, Current Decisional Ability, and Susceptibility to undue influence subscales, and Total Lichtenberg Financial Decision Rating Scale Score. Study findings suggest that impaired decisional abilities may render older adults more vulnerable to financial exploitation, and that the LFDRS is a valid tool for measuring both decisional abilities and financial exploitation. PMID:26285038

7 CFR 1710.110 - Supplemental financing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and Basic Policies § 1710.110 Supplemental financing. (a) Except in the case of financial hardship as determined by the Administrator, and following certain mergers, consolidations, and transfers of systems... merger, consolidation, or transfer of system substantially in its entirety, and the provisions of 7 CFR...

Harassment, discrimination, violence, and illicit drug use among young men who have sex with men.

PubMed

Wong, Carolyn F; Weiss, George; Ayala, George; Kipke, Michele D

2010-08-01

We examined the relationship among social discrimination, violence, and illicit drug use among an ethnically diverse cohort of young men who have sex with men (YMSM) residing in Los Angeles. Five Hundred twenty-six YMSM (aged 18-24 years) were recruited using a venue-based, stratified probability sampling design. Surveys assessed childhood financial hardship, violence (physical assault, sexual assault, intimate partner violence), social discrimination (homophobia and racism), and illicit drug use in the past 3 months. Analyses examined main and interaction effects of key variables on drug use. Experiences of financial hardship, physical intimate partner violence and homophobia predicted drug use. Although African American participants were less likely to report drug use than their Caucasian peers, those who experienced greater sexual racism were at significantly greater risk for drug use. Racial/ethnic minority YMSM were at increased risk for experiencing various forms of social discrimination and violence that place them at increased risk for drug use.

State health care financing strategies for children with intellectual and developmental disabilities.

PubMed

Bachman, Sara S; Comeau, Margaret; Tobias, Carol; Allen, Deborah; Epstein, Susan; Jantz, Kathryn; Honberg, Lynda

2012-06-01

We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were identified through interviews with family advocacy, Title V, and Medicaid organizational representatives. Results showed that states use myriad strategies to pay for care and maximize supports, including benefits counseling, consumer- and family-directed care, flexible funding, mandated benefits, Medicaid buy-in programs, and Tax Equity and Fiscal Responsibility Act of 1982 funding. Although health reform may reduce variation among states, its impact on families of children with intellectual and developmental disabilities is not yet clear. As health reform is implemented, state strategies to ameliorate financial hardship among families of children with intellectual and developmental disabilities show promise for immediate use. However, further analysis and evaluation are required to understand their impact on family and child well-being.

Harassment, Discrimination, Violence and Illicit Drug Use among Young Men Who Have Sex with Men

PubMed Central

Wong, Carolyn F.; Weiss, George; Ayala, George; Kipke, Michele D.

2010-01-01

We examined the relationship between social discrimination, violence, and illicit drug use among an ethnically diverse cohort of young men who have sex with men (YMSM) residing in Los Angeles. 526 YMSM (ages 18–24 years) were recruited using a venue-based, stratified probability sampling design. Surveys assessed childhood financial hardship, violence (physical assault, sexual assault, intimate partner violence), social discrimination (homophobia and racism), and illicit drug use in the past 3 months. Analyses examined main and interaction effects of key variables on drug use. Experiences of financial hardship, physical intimate partner violence and homophobia predicted drug use. Although African American participants were less likely to report drug use than their Caucasian peers, those who experienced greater sexual racism were at significantly greater risk for drug use. Racial/ethnic minority YMSM were at increased risk for experiencing various forms of social discrimination and violence that place them at increased risk for drug use. PMID:20707690

The impact of the European financial crisis on clinical research within the European union or "when life gives you lemons, make lemonade".

PubMed

Tsoulfas, G

2012-01-01

The European Union (EU) and the world are faced with unprecedented economic challenges, which if allowed to persist could threaten its continued existence in its current form as a union. Furthermore, these same financial challenges can easily translate into societal hardship. The biomedical and pharmaceutical industries of the U.S. and Europe have been in the midst of severe financial constraints over the last few years, which will worsen in the coming years. A critical factor is a financial crisis that appears to be spreading like wildfire through Europe, with 3 of its oldest members (Greece, Ireland, Portugal) already having enlisted the aid of the International Monetary Fund (IMF) to avoid bankruptcy, and with the possibility of others to follow (Italy, Spain). Adding to this the increasing cost of introducing new medications and devices, and conducting clinical research, as well as the tightening regulatory pressures and the drying pharmaceutical pipelines, cost cutting pressures are mounting on pharmaceutical industries and the biomedical sector, whether in academia or in industry. This paper will attempt to highlight some of the problems that clinical research in Europe may be facing, as well as discuss some of the potential solutions. Although this will by no means be an exhaustive analysis, the goal is to show that times of financial hardship, such as the current one, may also provide the impetus for constructive change.

The impact of the European financial crisis on clinical research within the European union or "when life gives you lemons, make lemonade"

PubMed Central

Tsoulfas, G

2012-01-01

The European Union (EU) and the world are faced with unprecedented economic challenges, which if allowed to persist could threaten its continued existence in its current form as a union. Furthermore, these same financial challenges can easily translate into societal hardship. The biomedical and pharmaceutical industries of the U.S. and Europe have been in the midst of severe financial constraints over the last few years, which will worsen in the coming years. A critical factor is a financial crisis that appears to be spreading like wildfire through Europe, with 3 of its oldest members (Greece, Ireland, Portugal) already having enlisted the aid of the International Monetary Fund (IMF) to avoid bankruptcy, and with the possibility of others to follow (Italy, Spain). Adding to this the increasing cost of introducing new medications and devices, and conducting clinical research, as well as the tightening regulatory pressures and the drying pharmaceutical pipelines, cost cutting pressures are mounting on pharmaceutical industries and the biomedical sector, whether in academia or in industry. This paper will attempt to highlight some of the problems that clinical research in Europe may be facing, as well as discuss some of the potential solutions. Although this will by no means be an exhaustive analysis, the goal is to show that times of financial hardship, such as the current one, may also provide the impetus for constructive change. PMID:23930050

Beyond income poverty: Measuring disadvantage in terms of material hardship and health

PubMed Central

Neckerman, Kathryn M.; Garfinkel, Irwin; Teitler, Julien O.; Waldfogel, Jane; Wimer, Christopher

2016-01-01

The New York City (NYC) Longitudinal Study of Wellbeing, or “Poverty Tracker,” is a survey of about 2,300 New York City residents. Its purpose is to provide a multidimensional and dynamic understanding of economic disadvantage in NYC. Measures of disadvantage were collected at baseline and a 12-month follow-up, and include three types of disadvantage: (1) income poverty, using a measure based on the new Supplemental Poverty Measure; (2) material hardship, including indicators of food insecurity, housing hardship, unmet medical needs, utility cutoffs, and financial insecurity; and (3) adult health problems, which can drain family time and resources. This paper presents initial results for NYC families with children under 18. At baseline, 56% of families with children had one or more type of disadvantage, including 28% with income poverty, 39% with material hardship, and 17% with an adult health problem. Even among nonpoor families, 33% experienced material hardship and 14% reported an adult health problem. Two-thirds of all families faced disadvantage at either baseline or follow-up, with 46% experiencing some kind of disadvantage at both time points. Respondents with a college education were much less likely to face disadvantage. Even after adjusting for educational attainment and family characteristics, the families of black and Hispanic respondents had elevated rates of disadvantage. Considering income poverty alone greatly understates the extent of disadvantage among families with children in New York City. These results suggest that in addition to addressing income poverty, policymakers should give priority to efforts to reduce material hardship and help families cope with chronic physical or mental illness. The need for these resources extends far above the poverty line. PMID:27044702

Beyond Income Poverty: Measuring Disadvantage in Terms of Material Hardship and Health.

PubMed

Neckerman, Kathryn M; Garfinkel, Irwin; Teitler, Julien O; Waldfogel, Jane; Wimer, Christopher

2016-04-01

The New York City (NYC) Longitudinal Study of Wellbeing, or "Poverty Tracker," is a survey of approximately 2300 NYC residents. Its purpose is to provide a multidimensional and dynamic understanding of economic disadvantage in NYC. Measures of disadvantage were collected at baseline and a 12-month follow-up, and include 3 types of disadvantage: 1) income poverty, using a measure on the basis of the new Supplemental Poverty Measure; 2) material hardship, including indicators of food insecurity, housing hardship, unmet medical needs, utility cutoffs, and financial insecurity; and 3) adult health problems, which can drain family time and resources. In this article initial results for NYC families with children younger than the age of 18 years are presented. At baseline, 56% of families with children had 1 or more type of disadvantage, including 28% with income poverty, 39% with material hardship, and 17% with an adult health problem. Even among nonpoor families, 33% experienced material hardship and 14% reported an adult health problem. Two-thirds of all families faced disadvantage at either baseline or follow-up, with 46% experiencing some kind of disadvantage at both time points. Respondents with a college education were much less likely to face disadvantage. Even after adjusting for educational attainment and family characteristics, the families of black and Hispanic respondents had increased rates of disadvantage. Considering income poverty alone the extent of disadvantage among families with children in NYC is greatly understated. These results suggest that in addition to addressing income poverty, policymakers should give priority to efforts to reduce material hardship and help families cope with chronic physical or mental illness. The need for these resources extends far above the poverty line. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Punching loan sharks on the nose: effective interventions to reduce financial hardship in New Zealand.

PubMed

Signal, Louise; Lanumata, Tolotea; Bowers, Sharron

2012-08-01

Growth in the high-cost, unregulated fringe lender market (with these lenders commonly referred to as loan sharks) has occurred both internationally and in New Zealand in recent years. The credit practices of loan sharks create financial hardship for many people including Māori, Pacific and low-income New Zealanders. This paper reports on research that explored strategies for reducing the impact of the fringe lender market on Māori, Pacific and low-income New Zealanders. A narrative literature review and 10 key informant interviews were conducted to provide information on how best to intervene to reduce the impact of the fringe lender market for these people. The main interventions identified were: two regulatory approaches, one for capping interest rates and another to create codes of responsible lending; access to safe affordable micro-finance options; financial literacy education; and Pacific cultural change around fa'alavelave, which are the 'obligations' of giving. Protecting consumers from the unsafe practices of fringe lenders requires a combined approach of discouraging the undesirable practices of fringe lenders through regulation and encouraging the growth of safe, affordable micro-finance options. Financial literacy education is a valuable activity for directing consumer attention to the safest options, but in isolation will have limited effect if options are limited. Health promoters have a valuable role to play in implementing these interventions.

Unemployment Effects on the Family and the Child: Interventions for Counselors.

ERIC Educational Resources Information Center

Schliebner, Connie T.; Peregoy, John J.

1994-01-01

Examines the effects of long-term unemployment on families, marital relationships, and children. Discusses impact of financial hardship, stress, and emotional upheaval as they affect family systems. Presents counseling interventions for addressing needs of children in these families. Includes 54 citations. (Author/CRR)

5 CFR 845.304 - Financial hardship.

Code of Federal Regulations, 2010 CFR

2010-01-01

... situations when the annuitant from whom collection is sought needs substantially all of his or her current income and liquid assets to meet current ordinary and necessary living expenses and liabilities. (a... primary emphasis will be placed upon the annuitant's liquid assets and current income in making such...

Expressing the sense of Congress that financial institutions should work proactively with their customers affected by the shutdown of the Federal Government who may be facing short-term financial hardship and long-term damage to their creditworthiness through no fault of their own.

THOMAS, 113th Congress

Rep. Waters, Maxine [D-CA-43

2013-10-11

House - 10/11/2013 Referred to the Committee on Financial Services, and in addition to the Committee on Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Improving Health among Elementary School Children: A Comparison of Aerobic and Mind-Body Exercise

ERIC Educational Resources Information Center

Wang, Chunyun

2012-01-01

Introduction: Children today are under much more stress than a few decades ago due to academic pressure, family financial hardship, competition with peers, and stressed parents. Consequently, stress-related health issues and behavioral problems, such as cardiovascular diseases, headaches, insomnia, anxiety, depression, violent or withdrawal…

Resume Writing in Russia and the Newly Independent States

ERIC Educational Resources Information Center

Bowen, Betsy; Sapp, David Alan; Sargsyan, Nelly

2006-01-01

This article examines the teaching of resume writing at one university in Russia and several institutions in the Newly Independent States (NIS). The authors explore challenges including variable cultural norms for written versus oral communication, severe financial and material hardship in the educational sector, cultural discomfort with the norms…

Useful Pedagogies or Financial Hardships? Interactive Response Technology (Clickers) in the Large College Classroom

ERIC Educational Resources Information Center

Boatright-Horowitz, Su L.

2009-01-01

Interactive response systems "clickers" can provide multiple benefits to the students and faculty who use them, including immediate performance feedback and greater student engagement in learning. My own exploration of this technology has yielded five pedagogically different types of polling questions, specifically measurement of student…

Cost-Benefit Analysis of Forbearances. Executive Summary.

ERIC Educational Resources Information Center

USA Group, Inc., Indianapolis, IN.

This report presents findings and recommendations resulting from a study on the costs and benefits of a Department of Education policy of encouraging lenders of student loans to grant forbearances to borrowers who experience temporary financial hardship but do not satisfy the specific conditions required for government-prescribed deferments. The…

24 CFR 572.125 - Replacement reserves.

Code of Federal Regulations, 2010 CFR

2010-04-01

... drawn down under the Cash and Management Information System when specifically needed to assist a... prevent severe financial hardship to families caused by the failure of a major system or component of the... families; and (3) The condition and age of the properties and each of their major systems and components...

38 CFR 1.923 - Administrative wage garnishment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... shall be responsible for all telephone expenses. In the absence of good cause shown, a debtor who fails... unlawful, would cause a financial hardship, or that collection of the debt may not be pursued due to... initiated. The request must be based on materially changed circumstances such as disability, divorce, or...

Financial and employment impacts of serious injury: a qualitative study.

PubMed

Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Sutherland, Ann; Hart, Melissa; Watterson, Dina; Christie, Nicola

2014-09-01

To explore the financial and employment impacts following serious injury. Semi-structured telephone administered qualitative interviews with purposive sampling and thematic qualitative analysis. 118 patients (18-81 years) registered by the Victorian State Trauma Registry or Victorian Orthopaedic Trauma Outcomes Registry 12-24 months post-injury. Key findings of the study were that although out-of-pocket treatment costs were generally low, financial hardship was prevalent after hospitalisation for serious injury, and was predominantly experienced by working age patients due to prolonged absences from paid employment. Where participants were financially pressured prior to injury, injury further exacerbated these financial concerns. Reliance on savings and loans and the need to budget carefully to limit financial burden were discussed. Financial implications of loss of income were generally less for those covered by compensation schemes, with non-compensable participants requiring welfare payments due to an inability to earn an income. Most participants reported that the injury had a negative impact on work. Loss of earnings payments from injury compensation schemes and income protection policies, supportive employers, and return to work programs were perceived as key factors in reducing the financial burden of injured participants. Employer-related barriers to return to work included the employer not listening to the needs of the injured participant, not understanding their physical limitations, and placing unrealistic expectations on the injured person. While the financial benefits of compensation schemes were acknowledged, issues accessing entitlements and delays in receiving benefits were commonly reported by participants, suggesting that improvements in scheme processes could have substantial benefits for injured patients. Seriously injured patients commonly experienced substantial financial and work-related impacts of injury. Participants of working age who were unemployed prior to injury, did not have extensive leave accrual at their pre-injury employment, and those not covered by injury compensation schemes or income protection insurance clearly represent participants "at risk" for substantial financial hardship post-injury. Early identification of these patients, and improved provision of information about financial support services, budgeting and work retraining could assist in alleviating financial stress after injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Kentucky River and Tributaries. Upper Kentucky River Navigation Project. Volume 2. Public Involvement Record.

DTIC Science & Technology

1980-11-01

after this terrible terrific financial error. I’m also hoping that the Division Office in Cincinnati has n.jt been hoodwinked by the District Office. I...know that our representatives in the Senate and the House in Washington, will not, and I repeat, will not, stand for any shenanigans to the people in...cannot be done. The closing of these locks will place an inequitable financial burden on pleasure boat owners. This hardship is even more pronounced

Ageing in India: Financial hardship from health expenditures.

PubMed

Lee, Ting-Hsuan J; Saran, Indrani; Rao, Krishna D

2018-04-01

India's rapidly ageing population raises concerns about the burden of health care payments among older individuals who may have both limited income and greater health care needs. Using a nationally representative household survey, we investigate the association between age and financial hardship due to health expenditures. We find that both the probability of experiencing health problems and mean total out-of-pocket health expenditures increase with age. Second, the probability of households experiencing catastrophic health expenditures increases with each additional member aged 60 and above-33% of households with one 60+ member and 38% of households with 2 or more 60+ members experienced catastrophic health expenditures, compared to only 20% in households with all members under the age of 60 years. Lastly, we show that individuals aged 60 and above had a much higher probability of becoming impoverished as a result of health expenditures-the probability of impoverishment for 60+ individuals was 3 percentage points higher than for individuals under the age of 60. Overall, around 4.8% of the older population, representing 4.1 million people, fell into poverty. The results suggest that there is an urgent need for public investments in financial protection programs for older people in India. Copyright © 2017 John Wiley & Sons, Ltd.

Financial risk protection and universal health coverage: evidence and measurement challenges.

PubMed

Saksena, Priyanka; Hsu, Justine; Evans, David B

2014-09-01

Financial risk protection is a key component of universal health coverage (UHC), which is defined as access to all needed quality health services without financial hardship. As part of the PLOS Medicine Collection on measurement of UHC, the aim of this paper is to examine and to compare and contrast existing measures of financial risk protection. The paper presents the rationale behind the methodologies for measuring financial risk protection and how this relates to UHC as well as some empirical examples of the types of measures. Additionally, the specific challenges related to monitoring inequalities in financial risk protection are discussed. The paper then goes on to examine and document the practical challenges associated with measurement of financial risk protection. This paper summarizes current thinking on the area of financial risk protection, provides novel insights, and suggests future developments that could be valuable in the context of monitoring progress towards UHC.

Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges

PubMed Central

Saksena, Priyanka; Hsu, Justine; Evans, David B.

2014-01-01

Financial risk protection is a key component of universal health coverage (UHC), which is defined as access to all needed quality health services without financial hardship. As part of the PLOS Medicine Collection on measurement of UHC, the aim of this paper is to examine and to compare and contrast existing measures of financial risk protection. The paper presents the rationale behind the methodologies for measuring financial risk protection and how this relates to UHC as well as some empirical examples of the types of measures. Additionally, the specific challenges related to monitoring inequalities in financial risk protection are discussed. The paper then goes on to examine and document the practical challenges associated with measurement of financial risk protection. This paper summarizes current thinking on the area of financial risk protection, provides novel insights, and suggests future developments that could be valuable in the context of monitoring progress towards UHC. PMID:25244520

Against the accommodation of subjective healthcare provider beliefs in medicine: counteracting supporters of conscientious objector accommodation arguments.

PubMed

Smalling, Ricardo; Schuklenk, Udo

2017-04-01

We respond in this paper to various counter arguments advanced against our stance on conscientious objection accommodation. Contra Maclure and Dumont, we show that it is impossible to develop reliable tests for conscientious objectors' claims with regard to the reasonableness of the ideological basis of their convictions, and, indeed, with regard to whether they actually hold they views they claim to hold. We demonstrate furthermore that, within the Canadian legal context, the refusal to accommodate conscientious objectors would not constitute undue hardship for such objectors. We reject concerns that refusing to accommodate conscientious objectors would limit the equality of opportunity for budding professionals holding particular ideological positions. We also clarify various misrepresentations of our views by respondents Symons, Glick and Jotkowitz, and Lyus. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The cellblock token economy: token reinforcement procedures in a maximum security correctional institution for adult male felons.

PubMed Central

Milan, M A; McKee, J M

1976-01-01

Two experiments were conducted (1) to explore the application of token reinforcement procedures in a maximum security correctional institution for adult male felons and (2) to determine to what extent the reinforcement procedures disrupted the day-to-day lives of inmate participants. In Experiment 1, an expanded reversal design revealed that the combination of praise and token reinforcement was more effective than the combinations of praise and noncontingent token award or direct commands on four common institutional activities. The latter two combinations were not found to be any more effective than praise alone. Experiment 2, which also employed a reversal design, indicated that the high levels of performance observed during the token reinforcement phases of Experiment 1 could be attained without subjecting participants to undue hardship in the form of increased deprivation of either social intercourse or the opportunity to engage in recreational and entertainment activities. Client safeguards are discussed in detail. PMID:977516

Raising Resilient Children during Tough Economic Times

ERIC Educational Resources Information Center

Tom, A.; Yuen, S.; Fong, G.; Nemoto, M.; Hisatake, T.; Choy, A.; Chang, W.

2009-01-01

Financial hardship can result from many different circumstances--a poor economy, the loss of a job, underemployment, the prolonged illness of a family member, divorce, poor money management, or a combination of several factors. Whatever the cause, the resulting impact on a family can be stressful for all members, including children. Stress from…

State Health Care Financing Strategies for Children with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Bachman, Sara S.; Comeau, Margaret; Tobias, Carol; Allen, Deborah; Epstein, Susan; Jantz, Kathryn; Honberg, Lynda

2012-01-01

We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were…

The Extent of Off-Farm Employment and Its Impact on Farm Women.

ERIC Educational Resources Information Center

Danes, Sharon M.; Keskinen, Susan M.

1990-01-01

Surveys off-farm employment of farm women and its impact on their lives. Describes survey data illustrating financial hardships experienced by working farm women. Describes imbalance between work and leisure as major source of dissatisfaction. Suggests service providers recognize women's "role overload" and its effects on families. (TES)

32 CFR 1642.4 - Ineligibility for Class 3-A.

Code of Federal Regulations, 2014 CFR

2014-07-01

... specifically for the purpose of evading training and service; or (2) He acquired excessive financial... dependents of persons who are serving in the Armed Forces; or (7) The hardship to the dependent is based upon... dependents of persons who are serving in the Armed Forces. (b) [Reserved] [47 FR 4658, Feb. 1, 1982, as...

32 CFR 1642.4 - Ineligibility for Class 3-A.

Code of Federal Regulations, 2013 CFR

2013-07-01

... specifically for the purpose of evading training and service; or (2) He acquired excessive financial... dependents of persons who are serving in the Armed Forces; or (7) The hardship to the dependent is based upon... dependents of persons who are serving in the Armed Forces. (b) [Reserved] [47 FR 4658, Feb. 1, 1982, as...

32 CFR 1642.4 - Ineligibility for Class 3-A.

Code of Federal Regulations, 2011 CFR

2011-07-01

... specifically for the purpose of evading training and service; or (2) He acquired excessive financial... dependents of persons who are serving in the Armed Forces; or (7) The hardship to the dependent is based upon... dependents of persons who are serving in the Armed Forces. (b) [Reserved] [47 FR 4658, Feb. 1, 1982, as...

32 CFR 1642.4 - Ineligibility for Class 3-A.

Code of Federal Regulations, 2012 CFR

2012-07-01

... specifically for the purpose of evading training and service; or (2) He acquired excessive financial... dependents of persons who are serving in the Armed Forces; or (7) The hardship to the dependent is based upon... dependents of persons who are serving in the Armed Forces. (b) [Reserved] [47 FR 4658, Feb. 1, 1982, as...

32 CFR 1642.4 - Ineligibility for Class 3-A.

Code of Federal Regulations, 2010 CFR

2010-07-01

... specifically for the purpose of evading training and service; or (2) He acquired excessive financial... dependents of persons who are serving in the Armed Forces; or (7) The hardship to the dependent is based upon... dependents of persons who are serving in the Armed Forces. (b) [Reserved] [47 FR 4658, Feb. 1, 1982, as...

31 CFR 29.523 - Equity and good conscience.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Equity and good conscience. 29.523... Standards for Waiver of Overpayments § 29.523 Equity and good conscience. Recovery is against equity and good conscience when there is substantial evidence that— (a) It would cause financial hardship to the...

Strategies to Build Assets among Low Income Families: Mapping the Field

ERIC Educational Resources Information Center

Lind, Christianne

2006-01-01

To be economically secure, families need both income and assets. Regular income helps families pay for their daily living expenses. In contrast, families need assets to weather financial hardships and get ahead. Assets provide a safety net for coping with unanticipated expenses and emergencies that could otherwise cause significant financial…

Economic hardship associated with managing chronic illness: a qualitative inquiry

PubMed Central

Jeon, Yun-Hee; Essue, Beverley; Jan, Stephen; Wells, Robert; Whitworth, Judith A

2009-01-01

Background Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness. Methods Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66). Content analysis guided the interpretation of data. Results The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients' capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses. Conclusion This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity of a critical analysis of health, social and welfare policies to identify cross-sectoral strategies to alleviate such hardship and improve the affordability of managing chronic conditions. In a climate of global economic instability, research into the economic impact of chronic illness on individuals' health and well-being and their disease management capacity, such as this study, provides timely evidence to inform policy development. PMID:19818128

Financing Higher Education in Africa: Makerere, the Quiet Revolution. Tertiary Education Thematic Group Publication Series.

ERIC Educational Resources Information Center

Court, David

This article is part of a series examining the state of higher education in Africa at the end of the 20th century. It tells the dramatic story of how Makerere University in Uganda has addressed the pervasive problem of how to provide quality education at the tertiary level without undue financial dependence on the state. It describes the main…

Financial Quality of Life for Patients With Cancer: An Exploratory Study.

PubMed

Callahan, Christine; Brintzenhofeszoc, Karlynn

2015-01-01

For people who are experiencing financial hardship, a cancer diagnosis can be devastating. For others, cancer may exacerbate financial stress, thereby influencing their livelihood, their ability to maintain employment benefits including health insurance, manage financial obligations, and participate meaningfully in cancer treatment. This study examined how vulnerabilities in psychosocial situations affect financial quality of life within the larger context of health-care decision making through a survey conducted with a cross-sectional availability sample of 90 cancer patients. Results from the multiple regression analysis found that health insurance adequacy, fewer perceived barriers to care, and reduced financial stress are significant predictors of better financial quality of life in this sample. Oncology social workers and other disciplines involved in psychosocial treatment with patients with cancer must assess and address financial and logistic aspects of life in order to provide comprehensive cancer care that meets all needs. Collaborative coordination with patients with cancer and their families to intervene psychosocially, medically, and financially are critical components of sound psychosocial and medical practice.

Cost Spreading in College Athletic Spending in the United States: Estimates and Implications

ERIC Educational Resources Information Center

Lipford, Jody W.; Slice, Jerry K.

2017-01-01

With rising costs, mounting student debt, and many schools experiencing financial hardship, the higher education industry faces unwanted scrutiny from the popular media and political sector. College athletics too have come under close examination because of rising costs and internal subsidies. In this paper, we provide estimates of the per-student…

Poverty as a Predictor of 4-Year-Olds' Executive Function: New Perspectives on Models of Differential Susceptibility

ERIC Educational Resources Information Center

Raver, C. Cybele; Blair, Clancy; Willoughby, Michael

2013-01-01

In a predominantly low-income, population-based longitudinal sample of 1,259 children followed from birth, results suggest that chronic exposure to poverty and the strains of financial hardship were each uniquely predictive of young children's performance on measures of executive functioning. Results suggest that temperament-based vulnerability…

Medical Residents: Options Exist To Make Student Loan Payments Manageable. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of Human Resources.

A study was done to evaluate the ability of medical residents to repay their Stafford loan educational debt with a repayment deferment limit of 2 years. Using data on 1990 medical school graduates, the study compared medical residents' educational debt burdens to a financial hardship indicator keyed to loan default prevention. Results indicated…

What about the Rest of Us? Small Colleges in Financial Crisis

ERIC Educational Resources Information Center

Chabotar, Kent John

2010-01-01

Economic hardship and uncertainty dominates the discussion of American higher education these days. Since about 80 percent of American students attend public institutions, much of the conversation has centered on their plummeting state aid and soaring student fees. With a hike in student fees by a third in one year, California's situation has been…

Redefining Participation? On the Positioning of Children in Swedish Welfare Benefits Appeals

ERIC Educational Resources Information Center

Fernqvist, Stina

2011-01-01

This article deals with the representation of children in the Swedish welfare state, and particularly how children and parents living in economic hardship are positioned in issues regarding financial aid. According to Article 12 in the UNCRC, children have a right to be heard "in any judicial and administrative proceedings affecting the…

20 CFR 422.415 - Will we reduce the amount that your employer must withhold from your pay when withholding that...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Will we reduce the amount that your employer must withhold from your pay when withholding that amount causes financial hardship? 422.415 Section 422.415 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES Collection of Debts...

Attracting a New Market to Northwestern's Undergraduate Programs: Older Women Living on the North Shore.

ERIC Educational Resources Information Center

Fox, Karen F. A.

Women over age 25 represent a substantial age group that may be recruited to bolster undergraduate student recruitment efforts at Northwestern University and similar institutions of higher education. By 1990, the number of recruitable 18-year-olds will fall by 20 percent nationwide, causing financial hardship for many private colleges and…

The household economic burden for acute coronary syndrome survivors in Australia.

PubMed

Hyun, Karice K; Essue, Beverley M; Woodward, Mark; Jan, Stephen; Brieger, David; Chew, Derek; Nallaiah, Kellie; Howell, Tegwen; Briffa, Tom; Ranasinghe, Isuru; Astley, Carolyn; Redfern, Julie

2016-11-08

Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship. Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.

A Copay Foundation Assistance Support Program for Patients Receiving Intravenous Cancer Therapy

PubMed Central

Rajurkar, Swapnil P.; Presant, Cary A.; Bosserman, Linda D.; McNatt, Wendy J.

2011-01-01

Purpose: With the advent of newer cancer therapies (eg, biologic and cytotoxic), treatment is becoming increasingly expensive for patients with cancer. Patients enrolled in Medicare and commercial insurance plans often have large copay requirements with each treatment cycle. Often, these patients undergo significant financial hardship, and some patients decline treatment. We have developed a support program that works closely with all copay assistance foundations to secure financial assistance to facilitate appropriate treatment. Methods: In September, 2008 we initiated a coordinated program with various copay assistance foundations, including Healthwell, Cancer Care, Patient Access, Chronic Disease Fund, Beckstrand Cancer, Lilly Cares and the Leukemia and Lymphoma Society. Patients requesting assistance with chemotherapy copay were enrolled in this program. Information about income level, chemotherapy regimens, and associated copay was given to these foundations, who then determined the amount of monetary assistance. Results: Since the initiation of this program, of 201 patients who began receiving chemotherapy, 25 (12.4%) requested assistance with this program for either intravenous or oral treatments. The current results of time delays for foundation decision, success rates and administrative costs to secure funding will be presented at the time of the poster presentation. Conclusion: Copay for chemotherapy drugs is a financial hardship for a significant number of patients. Coordinated resources must be provided and reimbursed to facilitate appropriate and sustainable cancer care. This program is a successful model for other centers to adopt. PMID:21731517

The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis.

PubMed

Madureira-Lima, Joana; Reeves, Aaron; Clair, Amy; Stuckler, David

2018-02-01

Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022-0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health. © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association

The Building Wealth and Health Network: methods and baseline characteristics from a randomized controlled trial for families with young children participating in temporary assistance for needy families (TANF).

PubMed

Sun, Jing; Patel, Falguni; Kirzner, Rachel; Newton-Famous, Nijah; Owens, Constance; Welles, Seth L; Chilton, Mariana

2016-07-16

Families with children under age six participating in the Temporary Assistance for Needy Families Program (TANF) must participate in work-related activities for 20 h per week. However, due to financial hardship, poor health, and exposure to violence and adversity, families may experience great difficulty in reaching self-sufficiency. The purpose of this report is to describe study design and baseline findings of a trauma-informed financial empowerment and peer support intervention meant to mitigate these hardships. We conducted a randomized controlled trial of a 28-week intervention called Building Wealth and Health Network to improve financial security and maternal and child health among caregivers participating in TANF. Participants, recruited from County Assistance offices in Philadelphia, PA, were randomized into two intervention groups (partial and full) and one control group. Participants completed questionnaires at baseline to assess career readiness, economic hardship, health and wellbeing, exposure to adversity and violence, and interaction with criminal justice systems. Baseline characteristics demonstrate that among 103 participants, there were no significant differences by group. Mean age of participants was 25 years, and youngest child was 30 months. The majority of participants were women (94.2 %), never married (83.5 %), unemployed (94.2 %), and without a bank account (66.0 %). Many reported economic hardship (32.0 % very low household food secure, 65.0 % housing insecure, and 31.1 % severe energy insecure), and depression (57.3 %). Exposure to adversity was prevalent, where 38.8 % reported four or more Adverse Childhood Experiences including abuse, neglect and household dysfunction. In terms of community violence, 64.7 % saw a seriously wounded person after an incident of violence, and 27.2 % had seen someone killed. Finally, 14.6 % spent time in an adult correctional institution, and 48.5 % of the fathers of the youngest child spent time in prison. Baseline findings demonstrate that caregivers participating in TANF have suffered significant childhood adversity, adult violence exposure, and poverty-related stressors that can limit workforce success. High prevalence of housing and food insecurity, exposure to adversity, violence and criminal justice systems demands comprehensive programming to support families. Trauma-informed approaches to career readiness such as the Building Wealth and Health Network offer opportunities for potential success in the workforce. This study is retrospectively registered with ClinicalTrials.gov. The Identifier is: NCT02577705 The Registration date is October 13, 2015.

Raising Cash under Duress and the Role of Cash Value Life Insurance: An Educational Example

ERIC Educational Resources Information Center

Russell, David T.; Chong, James T.; Phillips, G. Michael

2018-01-01

Consumers face hard choices when they need cash quickly. Hard choices can lead to emotional or economically unsound decisions. Traditional classroom discussions of raising funds to pay for expenses usually focus on generating income, borrowing, or the sale of real and financial assets, if hardship is discussed at all. However, many families have…

Entrepreneurialism in Student Affairs: The Eckerd College Waterfront Program Story

ERIC Educational Resources Information Center

Covert, William; Murphy, Cari

2010-01-01

In 1971 it was not financial hardship that launched a new program at Eckerd College in Saint Petersburg, Florida. Rather, it was the tragic loss of a student by drowning, followed a year later by a class temporarily stranded in a boat. That same year, under Bill Covert's leadership, twelve students formed the Florida Presbyterian College Search,…

The Impact of the Economic Downturn on Libraries: With Special Reference to University Libraries

ERIC Educational Resources Information Center

Nicholas, David; Rowlands, Ian; Jubb, Michael; Jamali, Hamid R.

2010-01-01

Evidence is presented of the extent to which libraries from around the world are experiencing financial hardship as a result of the world-wide economic downturn. Comparative analyses are provides on the grounds of country, sector and size of institution. The article concentrates on the situation of UK and US university libraries and is based on…

Role Stress, Interrole Conflict, and Job Satisfaction among University Employees: The Creation and Test of a Model

ERIC Educational Resources Information Center

Love, Keisha M.; Tatman, Anthony W.; Chapman, Benjamin P.

2010-01-01

Many universities have experienced financial hardships during the recent economic downturn. To save money, several have resorted to laying off employees, which has often resulted in increased work and stress for the remaining employees. Such an increase has the potential to adversely affect employees' sense of job satisfaction. This study created…

Employment Alone is Not Enought for America's Low-Income Children and Families. Living at the Edge Research Brief.

ERIC Educational Resources Information Center

Cauthen, Nancy K.; Lu, Hsien-Hen

Families with incomes between the official poverty level and the minimum economic security level face many of the same material hardships and financial pressures that officially poor families face, partly because as their income grows, they lose eligibility for public benefits. This report focuses on the role that public policies play in…

Thi Qar Bee Farm Thi Qar, Iraq

DTIC Science & Technology

2010-04-01

vegetation and fields where bees once gathered pollen and beekeepers face hardships from droughts and lack of financial assistance. 1...of equipment, and provided training to the bee farmers. General topography of the area was flat with vacant or agricultural land extending for a...OFFICE OF THE SPECIAL INSPECTOR GENERAL FOR IRAQ RECONSTRUCTION THI QAR BEE FARM THI QAR, IRAQ SIGIR PA--09--188

Financial considerations in living organ donation.

PubMed

Jacobs, Cheryl; Thomas, Charlie

2003-06-01

The shortage of cadaveric organs and increased success of living donor transplantation support the use of living organ donors. Clinical social workers have the opportunity to explore a variety of donor-specific issues when performing psychosocial evaluations of living donors, including motivation, psychological stability, and personal and family consequences of donation, as well as the direct and indirect financial consequences faced by living donors. Although most donor-related medical costs are covered, other associated expenses are not reimbursable and may put donors at risk for financial hardship. Out-of-pocket expenses also serve as a disincentive to donate for some volunteers. During the evaluation process, healthcare professionals should openly discuss how surgery, recovery, and any potential complications might impact prospective donors' financial situation. Donors can then decide whether they are able to realistically handle the costs of donation. We present the financial dilemmas experienced by many living donors and highlight efforts that have been made to deal with them.

Household Financial Distress and Initial Endowments: Evidence from the 2008 Financial Crisis.

PubMed

Olafsson, Arna

2016-11-01

This paper studies in utero exposure to the 2008 financial crisis. Exploiting the sudden and unexpected collapse of the Icelandic economy, I find that first-trimester exposure to the crisis led to a sizable and significant reduction in birth weight, increased the probability of a low birth weight ( < 2500 g), and decreased the probability of a high birth weight ( > 4000 g). I also find evidence that the collapse reduced the sex ratio, indicating selection in utero due to maternal prenatal stress exposure. My results imply large welfare losses from financial distress that have hitherto been ignored - because children with worse health at birth can expect substantially lower lifetime earnings - and suggest that economic hardships may in general exacerbate income inequalities in the long run as low-income households are typically more exposed to financial distress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Finances in the Older Patient with Cognitive Impairment

PubMed Central

Widera, Eric; Steenpass, Veronika; Marson, Daniel; Sudore, Rebecca

2013-01-01

Financial capacity is the ability to manage money and financial assets in ways that meet a person’s needs and which are consistent with his/her values and self-interest. Financial capacity is essential for an individual to function independently in our society; however, dementia eventually leads to a complete loss of financial capacity. Many patients with cognitive impairment and their families turn to their primary care clinician for help with financial impairment, yet most clinicians do not understand their role or how to help. We review the prevalence and impact of financial incapacity in older adults with cognitive impairment. We also articulate the role of the primary clinician which includes: (1) educating older adult patients and families about the need for advance financial planning; (2) recognizing signs of possible impaired financial capacity; (3) assessing financial impairments in cognitively impaired adults; (4) recommending interventions to help patients maintain financial independence; and (5) knowing when and to whom to make medical and legal referrals. Clearly delineating the clinician’s role in financial impairment can lead to the establishment of effective financial protections and can limit the economic, psychological, and legal hardships of financial incapacity on patients with dementia and their families. PMID:21325186

The Impact of Drought on the Emotional Well-Being of Children and Adolescents in Rural and Remote New South Wales

ERIC Educational Resources Information Center

Dean, John; Stain, Helen J.

2007-01-01

Context and Purpose: Between 2002 and 2006 New South Wales was in the grip of the worst drought for more than 100 years. Financial hardships have led governments to declare "Exceptional Circumstances." Little social research has investigated the impact of drought on children. For this study, children from rural and remote regions of New…

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

PubMed

Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

2014-08-05

Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

Doing good when times are bad: volunteering behaviour in economic hard times.

PubMed

Lim, Chaeyoon; Laurence, James

2015-06-01

This paper examines how the 2008-9 recession has affected volunteering behaviours in the UK. Using a large survey dataset, we assess the recession effects on both formal volunteering and informal helping behaviours. Whilst both formal volunteering and informal helping have been in decline in the UK since 2008, the size of the decline is significantly larger for informal helping than for formal volunteering. The decline is more salient in regions that experienced a higher level of unemployment during the recession and also in socially and economically disadvantaged communities. However, we find that a growing number of people who personally experienced financial insecurity and hardship do not explain the decline. We argue that the decline has more to do with community-level factors such as civic organizational infrastructure and cultural norms of trust and engagement than personal experiences of economic hardship. © London School of Economics and Political Science 2015.

Continuing Education for the Elderly in New Zealand: A Survey of the Opportunities. Working Paper #4.

ERIC Educational Resources Information Center

Battersby, David

One in seven New Zealanders is now 60 or older, and by the turn of the century the figure is expected to be one in five. Based on the admittedly incomplete information that is available, the majority of elderly New Zealanders live in their own homes, do not experience excessive financial hardships, and are not physically or mentally disabled.…

Identifying and Managing Undue Influence From Family Members in End-of-Life Decisions for Patients With Advanced Cancer.

PubMed

Baker, Francis X; Gallagher, Colleen M

2017-10-01

Undue influence from family members of patients with advanced cancer remains a serious ethical problem in end-of-life decision making. Despite the wealth of articles discussing the problem of undue influence, little has been written by way of practical guidance to help clinicians identify and effectively manage situations of undue influence. This article briefly lays out how to identify and manage situations of undue influence sensitively and effectively. We explain how undue influence may present itself in the clinic and distinguish it from ethically permissible expressions of relational autonomy. In addition, we lay out a process by which any clinician suspecting undue influence may gather additional information and, if necessary, conduct a family meeting to address the undue influence. It is our hope that by providing clinicians at all levels of patient care with such guidance, they will feel empowered to respond to cases of undue influence when they arise.

[Atomic Energy Control Board] annual report 1997--1998. Research report number INFO-9999-1 (in English;French)

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-11-01

The Board`s mission is to ensure that the use of nuclear energy in Canada does not pose undue risk to health, safety, security and the environment. The annual report of the Board presents information on regulatory requirements; nuclear facilities, from uranium mines to nuclear power plants and related operations; regulation of nuclear materials; radioactive waste management; compliance monitoring; research; non-proliferation, safeguards and security; international activities, and public information. A financial statement is also included.

Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact.

PubMed

Booshehri, Layla G; Dugan, Jerome; Patel, Falguni; Bloom, Sandra; Chilton, Mariana

2018-01-01

Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support). Participants completed baseline and follow-up surveys every 3 months over 15 months. Group response rates were equivalent throughout. With mixed effects analysis we compared post-program outcomes at months 9, 12, and 15 to baseline. We modeled the impact of amount of participation in group classes on participant outcomes. Despite high exposure to trauma and adversity results demonstrate that, compared to the other groups, caregivers in the full intervention reported improved self-efficacy and depressive symptoms, and reduced economic hardship. Unlike the intervention groups, the control group reported increased developmental risk among their children. Although the control group showed higher levels of employment, the full intervention group reported greater earnings. The partial intervention group showed little to no differences compared with the control group. We conclude that financial empowerment education with trauma-informed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.

The importance of providing counselling and financial support to patients receiving treatment for multi-drug resistant TB: mixed method qualitative and pilot intervention studies.

PubMed

Baral, Sushil C; Aryal, Yeshoda; Bhattrai, Rekha; King, Rebecca; Newell, James N

2014-01-17

People with multi-drug resistant tuberculosis (MDR-TB) in low-income countries face many problems during treatment, and cure rates are low. The purpose of the study was (a) to identify and document the problems experienced by people receiving care for MDR-TB, and how they cope when support is not provided, to inform development of strategies; (b) to estimate the effectiveness of two resultant strategies, counselling alone, and joint counselling and financial support, of increasing DOTS-plus treatment success under routine programme conditions. A mixed-method study comprising a formative qualitative study, pilot intervention study and explanatory qualitative study to better understand barriers to completion of treatment for MDR-TB. Participants were all people starting MDR-TB treatment in seven DOTS-plus centres in the Kathmandu Valley, Nepal during January to December 2008. The primary outcome measure was cure, as internationally defined. MDR-TB treatment caused extreme social, financial and employment hardship. Most patients had to move house and leave their job, and reported major stigmatisation. They were concerned about the long-term effects of their disease, and feared infecting others. In the resultant pilot intervention study, the two strategies appeared to improve treatment outcomes: cure rates for those receiving counselling, combined support and no support were 85%, 76% and 67% respectively. Compared with no support, the (adjusted) risk ratios of cure for those receiving counselling and receiving combined support were 1.2 (95% CI 1.0 to 1.6) and 1.2 (95% CI 0.9 to 1.6) respectively. The explanatory study demonstrated that patients valued both forms of support. MDR-TB patients are extremely vulnerable to stigma and extreme financial hardship. Provision of counselling and financial support may not only reduce their vulnerability, but also increase cure rates. National Tuberculosis Programmes should consider incorporating financial support and counselling into MDR-TB care: costs are low, and benefits high, especially since costs to society of incomplete treatment and potential for incurable TB are extremely high.

Security Deposits

DTIC Science & Technology

1987-04-01

security deposit action is described in the regulation as follows: h. Security Deposits (DACF and DACA ). (1) Issue. PCS moves create financial hardships...General Wickham, The Army Chief of Staff, specified a philosophy toward the family in the Army Family White Paper. General Wickham’s action was in...security deposits arose. 1 The Army’s action to the issue of security deposits will be thoroughly discussed in this paper. The Army’s action comes now

40 CFR 35.4055 - What if my group can't come up with the “matching funds?”

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false What if my group can't come up with the... Responsibilities As A Tag Recipient § 35.4055 What if my group can't come up with the “matching funds?” (a) EPA may... financial hardship to your group (for example, your local economy is depressed and coming up with in-kind...

40 CFR 35.4055 - What if my group can't come up with the “matching funds?”

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false What if my group can't come up with the... Responsibilities As A Tag Recipient § 35.4055 What if my group can't come up with the “matching funds?” (a) EPA may... financial hardship to your group (for example, your local economy is depressed and coming up with in-kind...

40 CFR 35.4055 - What if my group can't come up with the “matching funds?”

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false What if my group can't come up with the... Responsibilities As A Tag Recipient § 35.4055 What if my group can't come up with the “matching funds?” (a) EPA may... financial hardship to your group (for example, your local economy is depressed and coming up with in-kind...

40 CFR 35.4055 - What if my group can't come up with the “matching funds?”

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false What if my group can't come up with the... Responsibilities As A Tag Recipient § 35.4055 What if my group can't come up with the “matching funds?” (a) EPA may... financial hardship to your group (for example, your local economy is depressed and coming up with in-kind...

40 CFR 35.4055 - What if my group can't come up with the “matching funds?”

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false What if my group can't come up with the... Responsibilities As A Tag Recipient § 35.4055 What if my group can't come up with the “matching funds?” (a) EPA may... financial hardship to your group (for example, your local economy is depressed and coming up with in-kind...

15 CFR 12.2 - Undue proliferation.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., he shall initiate an inquiry for the purpose of finding facts concerning the existence of undue... possible existence of undue proliferation. Such communications should be in writing and include supporting... regarding the possible existence of undue proliferation, the Secretary will determine whether there has been...

15 CFR 12.2 - Undue proliferation.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., he shall initiate an inquiry for the purpose of finding facts concerning the existence of undue... possible existence of undue proliferation. Such communications should be in writing and include supporting... regarding the possible existence of undue proliferation, the Secretary will determine whether there has been...

Subjective financial well-being, income and health inequalities in mid and later life in Britain.

PubMed

Arber, Sara; Fenn, Kirsty; Meadows, Robert

2014-01-01

The relationship between health and income is well established, but the link between subjective financial well-being and self-reported health has been relatively ignored. This study investigates the relationship between income, subjective financial well-being and health in mid-life and later life in Britain. Analysis of the General Household Survey for 2006 examined these relationships at ages 45-64 (n = 4639) and 65 and over (n = 3104). Logistic regression analysis was used to adjust for income and other socio-economic factors associated with self-reported health. Both income and subjective financial well-being are independently associated with health in mid-life; those with lower incomes and greater subjective financial difficulties had higher risk of reporting 'less than good' health. In contrast in later life, subjective financial well-being was associated with health, but the effect of income on health was mediated entirely through subjective financial well-being. The poorer health of the divorced/separated was also entirely mediated by differences in subjective financial well-being. Research on health inequalities should pay greater attention to the link between subjective financial hardship and ill-health, especially during periods of greater economic difficulties and financial austerity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development of a financial literacy course for patients with newly diagnosed cancer.

PubMed

Shankaran, Veena; Linden, Hannah; Steelquist, Jordan; Watabayashi, Kate; Kreizenbeck, Karma; Leahy, Tony; Overstreet, Karen

2017-03-01

Although patients with cancer often face serious financial hardships, few studies have reported on strategies to mitigate this burden. Improving literacy about the financial aspects of cancer care may decrease the negative financial impact of cancer diagnosis and treatment. We obtained input from patient stakeholders on the perceived value and optimal design of a financial literacy program in the advanced cancer setting. Prospective cohort survey.  A series of semi-structured interviews were conducted, during which patients with either colorectal or breast cancer were asked to describe the impact of cancer on their finances and employment, to state their preferences about discussing costs with their providers, and to give input on development of a financial literacy course. Twenty-one patients (76% Caucasian) completed interviews, the majority of whom had Medicare or commercial insurance (71%). Lost income from early retirement or disability was the most financially burdensome experience for 67% of patients. The majority of patients (76%) reported that a financial literacy course would be helpful in navigating the cost of cancer care. Most preferred the course be administered at diagnosis in a live group format. Feedback from patients with cancer supported the development of a group financial literacy course that addresses barriers to discussing cost concerns, employment changes during cancer, and available resources for financial assistance.

Actual and perceived impacts of tobacco regulation on restaurants and firms.

PubMed

Crémieux, P Y; Ouellette, P

2001-03-01

To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele. A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not. Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments. Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.

'Her cry is my cry': resettlement experiences of refugee women at risk recently resettled in Australia.

PubMed

Vromans, L; Schweitzer, R D; Farrell, L; Correa-Velez, I; Brough, M; Murray, K; Lenette, C

2018-05-01

Refugee women entering resettlement countries on woman-at-risk visas represent a particularly vulnerable population. While their specific gender-based resettlement will likely differ from the general refugee population, little is known about their experiences of early resettlement, with which to inform resettlement policy and practice. This research aimed to explore lived experiences of recently resettled refugee women at risk in Australia. Qualitative research used focus groups and a framework approach to identify and explicate common themes in participants' experience. Two focus groups with a purposive sample of African and Afghan refugee women at risk (N = 10), aged 22-53 years, were conducted in South East Queensland, Australia (October 2016), recruited with the assistance of a local resettlement service. Discussions were audiotaped, transcribed, and themes explicated. Six superordinate themes emerged: (1) sentiment of gratitude; (2) sense of loneliness and disconnection; (3) feeling incapable; (4) experiencing distress and help-seeking; (5) experiencing financial hardship; and (6) anticipating the future. Findings indicate that resettlement policy, programs, and practice that explicitly target the needs of women-at-risk refugees are warranted, including a longer period of active service provision with specific attention to strategies that address the women's social connection, self-efficacy, emotional well-being, and financial hardships. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Pathways between acculturation and health behaviors among residents of low-income housing: The mediating role of social and contextual factors

PubMed Central

Allen, Jennifer Dacey; Caspi, Caitlin; Yang, May; Leyva, Bryan; Stoddard, Anne M.; Tamers, Sara; Tucker-Seeley, Reginald D.; Sorensen, Glorian C.

2015-01-01

Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data. PMID:25462602

Work life and mental well-being: single and coupled employed mothers in Southern Europe and Scandinavia.

PubMed

Bull, Torill

2009-09-01

Many European mothers, single and coupled, combine work outside the home and family life. The effects of this on their mental well-being may vary depending on the level of support available from the State's welfare system, since welfare may buffer working mothers from some of the stress that can arise from trying to manage significant responsibilities on the job and at home. Welfare may be especially important for single working mothers, for whom the burden of multiple roles may be even heavier. The present study assessed levels and predictors of well-being of single and coupled employed mothers in Greece, Portugal and Spain, where welfare support is relatively limited. Results were compared to a parallel study with data from Denmark, Norway and Sweden, where welfare support is relatively comprehensive. Coupled mothers in Scandinavia had significantly lower financial hardship, longer education, higher life satisfaction, more enriching jobs, practical support, financial support and social participation than coupled mothers in the Southern European sample. On the other hand, the Scandinavian coupled mothers had higher levels of work family conflict than coupled mothers in Southern Europe. Single mothers in Scandinavia, compared to single mothers in Southern Europe, had significantly longer education, higher life satisfaction and positive affect, more enriching jobs, confidant support, practical support, financial support and social participation. Level of job stress was the same for all mother groups. All groups differed significantly from each other in level of financial hardship, with Scandinavian coupled mothers being best off, followed by Scandinavian single mothers, Southern European coupled mothers, and Southern European single mothers. The regional differences suggest that single motherhood per se need not be a risk factor for poorer well-being, and that welfare policies may have a protective effect for the mental well-being of single mothers.

Policy and priorities for national cancer control planning in low- and middle-income countries: Lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study.

PubMed

2017-03-01

Evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC). The 2012-2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancer patients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs ≥ 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes. The one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4·9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages. The LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor. Copyright © 2017 Elsevier Ltd. All rights reserved.

Sex Differences in Civilian Injury in Baghdad From 2003 to 2014: Results of a Randomized Household Cluster Survey.

PubMed

Shaak, Kyle; Lafta, Riyadh; Stewart, Barclay T; Fowler, Thomas R; Al-Shatari, Sahar A Esa; Burnham, Gilbert; Cherewick, Megan; Wren, Sherry M; Groen, Reinou S; Kushner, Adam L

2018-06-01

To examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning. Reliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women. A 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship. We surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ± 21.3 vs 27 ± 16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011). Women experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.

Catalog of Navy Training Courses (CANTRAC). Volume 1. Introductory, General Information and Quota Control Notes

DTIC Science & Technology

1990-01-01

Personnel E-6 and below are allowed BAQ on a case by case basis. NAVAL TECHNICAL TRAINING CENTER DETACHMENT FORT DEVENS , MA 1. SHORT TITLE...NAVTECHTRACENDET FT DEVENS , MA 2. ADDRESS: Officer in Charge, Naval Technical Training Center Detachment, Box 91, Fort Devens , MA 01433-5910 74 3. T9I.EPIONE: Monday...Into the Fort Devens area may place them in extrome financial hardship. 5. AVAILABILITY OF ThANSPORTATION: Both Logan (Boston) and Worcester airports

Catalog of Navy Training Courses. Introductory and General Information on Training Activities. CANTRAC. Volume 1. Revision

DTIC Science & Technology

1993-01-01

TRAINING CENTER DETACHMENT FORT DEVENS , MA 1. SHORT TITLE: NTTCDET FT DEVENS , MA 2. ADDRESS: Officer in Charge, Naval Technical Training Center Detachment...Box 91, Fort Devens , MA 01433-5910 81 3. TELEPHONE: Monday - Friday, 0730 1630. Comm: (508) 796-2244/3625 AV: 256-2244/3625 After Hours...Student personnel are advised that bringing dependents into the Fort Devens area may place them in extreme financial hardship and they will not be

Debt-maturity structures should match risk preferences.

PubMed

Gapenski, L C

1999-12-01

Key to any debt-maturity matching strategy is financing assets with the appropriate debt structure. Financial managers need to establish an optimal capital structure and then choose the best maturity-matching structure for their debt. Two maturity-matching strategies that are available to healthcare financial managers are the accounting approach and the finance approach. The accounting approach, which defines asset maturities as current or fixed, is a riskier financing strategy than the finance approach, which defines asset maturities as permanent or temporary. The added risk occurs because of the accounting approach's heavy reliance on short-term debt. The accounting approach offers the potential for lower costs at the expense of higher risk. Healthcare financial managers who believe the financing function should support the organization's operations without adding undue risk should use the finance approach to maturity matching. Asset maturities in those organizations then should be considered permanent or temporary rather than current or fixed, and the debt-maturity structure should reflect this.

Cumulative hardship and wellness of low-income, young children: multisite surveillance study.

PubMed

Frank, Deborah A; Casey, Patrick H; Black, Maureen M; Rose-Jacobs, Ruth; Chilton, Mariana; Cutts, Diana; March, Elizabeth; Heeren, Timothy; Coleman, Sharon; de Cuba, Stephanie Ettinger; Cook, John T

2010-05-01

The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance. Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1-3), or severe hardship (scores of 4-6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes. Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51-0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58-0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79-0.99]). Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.

Economic Well-Being Among Older-Adult Households: Variation by Veteran and Disability Status

PubMed Central

Wilmoth, Janet M.; London, Andrew S.; Heflin, Colleen M.

2015-01-01

This analysis uses data from the Survey of Income and Program Participation (SIPP) to examine whether veteran and disability statuses are jointly associated with household-level poverty and material hardship among older adults. Compared to households that do not include a person with a disability or veteran, disabled non-veteran households are more likely to be in poverty and to experience home hardship, medical hardship, and bill-paying hardship. Disabled veteran households are not significantly different in terms of poverty, but exhibit the highest odds of home hardship, medical hardship, bill-paying hardship, and food insufficiency. The implications for social work practice are discussed. PMID:25750998

Pathways between acculturation and health behaviors among residents of low-income housing: the mediating role of social and contextual factors.

PubMed

Allen, Jennifer Dacey; Caspi, Caitlin; Yang, May; Leyva, Bryan; Stoddard, Anne M; Tamers, Sara; Tucker-Seeley, Reginald D; Sorensen, Glorian C

2014-12-01

Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Sleep Complaints in Older Blacks: Do Demographic and Health Indices Explain Poor Sleep Quality and Duration?

PubMed Central

Gamaldo, Alyssa A.; Gamaldo, Charlene E.; Allaire, Jason C.; Aiken-Morgan, Adrienne T.; Salas, Rachel E.; Szanton, Sarah; Whitfield, Keith E.

2014-01-01

Objective: To examine the relationship between measures of sleep quality and the presence of commonly encountered comorbid and sociodemographic conditions in elderly Black subjects. Method: Analyses included participants from the Baltimore Study of Black Aging (BSBA; n = 450; mean age 71.43 years; SD 9.21). Pittsburgh Sleep Quality Index (PSQI) measured overall sleep pattern and quality. Self-reported and objective measures of physical and mental health data and demographic information were collected for all participants. Results: Sociodemographic and comorbid health factors were significantly associated with sleep quality. Results from regression analyses revealed that older age, current financial strain, interpersonal problems, and stress were unique predictors of worse sleep quality. Sleep duration was significantly correlated with age, depressive affect, interpersonal problems, and stress; only age was a unique significant predictor. While participants 62 years or younger had worse sleep quality with increasing levels of stress, there was no significant relationship between sleep quality and stress for participants 81 years and older. Conclusions: Several potential mechanisms may explain poor sleep in urban, community dwelling Blacks. Perceived stressors, including current financial hardship or hardship experienced for an extended time period throughout the lifespan, may influence sleep later in life. Citation: Gamaldo AA, Gamaldo CE, Allaire JC, Aiken-Morgan AT, Salas RE, Szanton S, Whitfield KE. Sleep complaints in older blacks: do demographic and health indices explain poor sleep quality and duration? J Clin Sleep Med 2014;10(7):725-731. PMID:25024649

Understanding vulnerability to self-harm in times of economic hardship and austerity: a qualitative study.

PubMed

Barnes, M C; Gunnell, D; Davies, R; Hawton, K; Kapur, N; Potokar, J; Donovan, J L

2016-02-17

Self-harm and suicide increase in times of economic recession, but little is known about why people self-harm when in financial difficulty, and in what circumstances self-harm occurs. This study aimed to understand events and experiences leading to the episode of self-harm and to identify opportunities for prevention or mitigation of distress. Participants' homes or university rooms. 19 people who had attended hospital following self-harm in two UK cities and who specifically cited job loss, economic hardship or the impact of austerity measures as a causal or contributory factor. Semistructured, in-depth interviews. Interviews were audio recorded, transcribed and analysed cross-sectionally and as case studies. Study participants described experiences of severe economic hardship; being unable to find employment or losing jobs, debt, housing problems and benefit sanctions. In many cases problems accumulated and felt unresolvable. For others an event, such as a call from a debt collector or benefit change triggered the self-harm. Participants also reported other current or past difficulties, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem. These contributed to their sense of despair and worthlessness and increased their vulnerability to self-harm. Participants struggled to gain the practical help they felt they needed for their economic difficulties or therapeutic support that might have helped with their other co-existing or historically damaging experiences. Economic hardships resulting from the recession and austerity measures accumulated or acted as a 'final straw' to trigger self-harm, often in the context of co-existing or historically damaging life-experiences. Interventions to mitigate these effects should include providing practical advice about economic issues before difficulties become insurmountable and providing appropriate psychosocial support for vulnerable individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Understanding vulnerability to self-harm in times of economic hardship and austerity: a qualitative study

PubMed Central

Barnes, M C; Gunnell, D; Davies, R; Hawton, K; Kapur, N; Potokar, J; Donovan, J L

2016-01-01

Objective Self-harm and suicide increase in times of economic recession, but little is known about why people self-harm when in financial difficulty, and in what circumstances self-harm occurs. This study aimed to understand events and experiences leading to the episode of self-harm and to identify opportunities for prevention or mitigation of distress. Setting Participants’ homes or university rooms. Participants 19 people who had attended hospital following self-harm in two UK cities and who specifically cited job loss, economic hardship or the impact of austerity measures as a causal or contributory factor. Primary and secondary outcome measures Semistructured, in-depth interviews. Interviews were audio recorded, transcribed and analysed cross-sectionally and as case studies. Results Study participants described experiences of severe economic hardship; being unable to find employment or losing jobs, debt, housing problems and benefit sanctions. In many cases problems accumulated and felt unresolvable. For others an event, such as a call from a debt collector or benefit change triggered the self-harm. Participants also reported other current or past difficulties, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem. These contributed to their sense of despair and worthlessness and increased their vulnerability to self-harm. Participants struggled to gain the practical help they felt they needed for their economic difficulties or therapeutic support that might have helped with their other co-existing or historically damaging experiences. Conclusions Economic hardships resulting from the recession and austerity measures accumulated or acted as a ‘final straw’ to trigger self-harm, often in the context of co-existing or historically damaging life-experiences. Interventions to mitigate these effects should include providing practical advice about economic issues before difficulties become insurmountable and providing appropriate psychosocial support for vulnerable individuals. PMID:26888729

Economic Hardship and Mexican-Origin Adolescents’ Adjustment: Examining Adolescents’ Perceptions of Hardship and Parent-Adolescent Relationship Quality

PubMed Central

Delgado, Melissa Y.; Killoren, Sarah E.; Updegraff, Kimberly A.

2016-01-01

Studies examining economic hardship consistently have linked family economic hardship to adolescent adjustment via parent and family functioning, but limited attention has been given to adolescents’ perceptions of these processes. To address this, the authors investigated the intervening effects of adolescents’ perceptions of economic hardship and of parent-adolescent warmth and conflict on the associations between parental economic hardship and adolescent adjustment (i.e., depressive symptoms, risky behaviors, and school performance) in a sample of 246 Mexican-origin families. Findings revealed that both mothers’ and fathers’ reports of economic hardship were positively related to adolescents’ reports of economic hardship, which in turn, were negatively related to parent-adolescent warmth and positively related to parent-adolescent conflict with both mothers and fathers. Adolescents’ perceptions of economic hardship were indirectly related to a) depressive symptoms through warmth with mothers and conflict with mothers and fathers, b) involvement in risky behaviors through conflict with mothers and fathers, and c) GPA through conflict with fathers. Our findings highlight the importance of adolescents’ perceptions of family economic hardship and relationships with mothers and fathers in predicting adolescent adjustment. PMID:23937419

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

PubMed Central

2014-01-01

Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. PMID:25096303

Impact of trained oncology financial navigators on patient out-of-pocket spending.

PubMed

Yezefski, Todd; Steelquist, Jordan; Watabayashi, Kate; Sherman, Dan; Shankaran, Veena

2018-03-01

Patients with cancer often face financial hardships, including loss of productivity, high out-of-pocket (OOP) costs, depletion of savings, and bankruptcy. By providing financial guidance and assistance through specially trained navigators, hospitals and cancer care clinics may be able mitigate the financial burdens to patients and also minimize financial losses for the treating institutions. Financial navigators at 4 hospitals were trained through The NaVectis Group, an organization that provides training to healthcare staff to increase patient access to care and assist with OOP expenses. Data regarding financial assistance and hospital revenue were collected after instituting these programs. Amount and type of assistance (free medication, new insurance enrollment, premium/co-pay assistance) were determined annually for all qualifying patients at the participating hospitals. Of 11,186 new patients with cancer seen across the 4 participating hospitals between 2012 and 2016, 3572 (32%) qualified for financial assistance. They obtained $39 million in total financial assistance, averaging $3.5 million per year in the 11 years under observation. Patients saved an average of $33,265 annually on medication, $12,256 through enrollment in insurance plans, $35,294 with premium assistance, and $3076 with co-pay assistance. The 4 hospitals were able to avoid write-offs and save on charity care by an average of $2.1 million per year. Providing financial navigation training to staff at hospitals and cancer centers can significantly benefit patients through decreased OOP expenditures and also mitigate financial losses for healthcare institutions.

Health reform holds both risks and rewards for safety-net providers and racially and ethnically diverse patients.

PubMed

Andrulis, Dennis P; Siddiqui, Nadia J

2011-10-01

The Affordable Care Act of 2010 creates both opportunities and risks for safety-net providers in caring for low-income, diverse patients. New funding for health centers; support for coordinated, patient-centered care; and expansion of the primary care workforce are some of the opportunities that potentially strengthen the safety net. However, declining payments to safety-net hospitals, existing financial hardships, and shifts in the health care marketplace may intensify competition, thwart the ability to innovate, and endanger the financial viability of safety-net providers. Support of state and local governments, as well as philanthropies, will be crucial to helping safety-net providers transition to the new health care environment and to preventing the unintended erosion of the safety net for racially and ethnically diverse populations.

Enduring financial crisis in Greece: prevalence and correlates of major depression and suicidality.

PubMed

Economou, Marina; Angelopoulos, Elias; Peppou, Lily Evangelia; Souliotis, Kyriakos; Tzavara, Chara; Kontoangelos, Konstantinos; Madianos, Michael; Stefanis, Costas

2016-07-01

A series of repeated cross-sectional surveys conducted in 2008, 2009, 2011 and 2013 were conducted with the aim of estimating the prevalence of major depression and suicidality as well as of investigating its risk factors. The present report concentrates on the 2013 survey. A random and representative sample of 2.188 people was telephone interviewed with regard to various socio-economic indicators and the presence of major depression and suicidality, which were assessed with the germane module of the Structured Clinical Interview. Findings suggest a rise in 1-month prevalence of major depression (12.3 %) and a decline in prevalence of suicidality (2.8 %). Female gender, residence in rural area, low educational attainment, unemployment and economic hardship were found to increase the odds of suffering from major depression. The influence of economic hardship and unemployment on suicidality was also substantial and independent of major depression. Results stress the imperative need for the design and implementation of social policies and interventions that would offset the dire impact of the sustained recession in Greece.

How Children Understand Parental Mental Illness: “You don’t get life insurance. What’s life insurance?”

PubMed Central

Mordoch, Elaine

2010-01-01

Objectives: To understand how children living with parental mental illness (PMI) understand mental illness (MI) and what they want to tell other children. Method: The study design was a secondary analysis of a grounded theory study exploring Canadian children’s perceptions of living with PMI. Interviews from 22 children, ages 6 – 16, living with a parent with depression, bipolar disorder or schizophrenia receiving treatment for the MI, were re-read, coded and analyzed along with data categories, their properties, field notes and memos from the original data. Results: Children revealed that they had limited understanding of MI and received few factual explanations of what was happening. Limited information on MI caused undue hardship. Younger children worried about their parent dying, while older children also were concerned about developing MI. Children offered suggestions for other children in similar circumstances. Conclusions: This study raises awareness of children living with PMI and identifies them as a population requiring services. It incorporates children’s perceptions of what they know and need to know. Children require assistance to understand and to respond to PMI. Mental health and primary health care clinicians have opportunities to assist these children within collaborative care models developed in conjunction with school services. PMID:20119563

Poverty as a Predictor of 4-Year-Olds’ Executive Function: New Perspectives on Models of Differential Susceptibility

PubMed Central

Raver, C. Cybele; Blair, Clancy; Willoughby, Michael

2017-01-01

In a predominantly low-income, population-based longitudinal sample of 1,259 children followed from birth, results suggest that chronic exposure to poverty and the strains of financial hardship were each uniquely predictive of young children’s performance on measures of executive functioning. Results suggest that temperament-based vulnerability serves as a statistical moderator of the link between poverty-related risk and children’s executive functioning. Implications for models of ecology and biology in shaping the development of children’s self-regulation are discussed. PMID:22563675

The politics of health care reforms in U.S. presidential elections.

PubMed

Navarro, Vicente

2008-01-01

This article analyzes why people in the United States have major problems in accessing medical care that are due to financial constraints. The author suggests that the cause of these problems is the way in which medical care and elections are funded in the United States, with private sources being the largest component in the funding of both activities. The article includes a comparison of funding of the electoral process in the United States with similar electoral processes in the countries of the European Union, and postulates that privatization of the funding of U.S. elections (primary and general) is responsible for privatization of the funding of medical care-the root of people's problem in paying for their medical care. Privatization of election funding gives undue power to the economic, financial, and professional groups that dominate medicine in the United States.

Cost and economic burden of illness over 15 years in Nepal: A comparative analysis.

PubMed

Swe, Khin Thet; Rahman, Md Mizanur; Rahman, Md Shafiur; Saito, Eiko; Abe, Sarah K; Gilmour, Stuart; Shibuya, Kenji

2018-01-01

With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. To minimize the economic burden of illness, several approaches need to be adopted, including social health insurance complemented with an upgraded community-based health insurance system, subsidy program expansion for diseases with high economic burden and third party liability motor insurance to reduce the economic burden of injury.

Cost and economic burden of illness over 15 years in Nepal: A comparative analysis

PubMed Central

Rahman, Md. Mizanur; Rahman, Md. Shafiur; Saito, Eiko; Abe, Sarah K.; Gilmour, Stuart; Shibuya, Kenji

2018-01-01

Background With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. Objectives To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. Methods This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Findings Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. Conclusion To minimize the economic burden of illness, several approaches need to be adopted, including social health insurance complemented with an upgraded community-based health insurance system, subsidy program expansion for diseases with high economic burden and third party liability motor insurance to reduce the economic burden of injury. PMID:29617393

Timeline historical review of income and financial transactions: a reliable assessment of personal finances.

PubMed

Black, Anne C; Serowik, Kristin L; Ablondi, Karen M; Rosen, Marc I

2013-01-01

The need for accurate and reliable information about income and resources available to individuals with psychiatric disabilities is critical for the assessment of need and evaluation of programs designed to alleviate financial hardship or affect finance allocation. Measurement of finances is ubiquitous in studies of economics, poverty, and social services. However, evidence has demonstrated that these measures often contain error. We compare the 1-week test-retest reliability of income and finance data from 24 adult psychiatric outpatients using assessment-as-usual (AAU) and a new instrument, the Timeline Historical Review of Income and Financial Transactions (THRIFT). Reliability estimates obtained with the THRIFT for Income (0.77), Expenses (0.91), and Debt (0.99) domains were significantly better than those obtained with AAU. Reliability estimates for Balance did not differ. THRIFT reduced measurement error and provided more reliable information than AAU for assessment of personal finances in psychiatric patients receiving Social Security benefits. The instrument also may be useful with other low-income groups.

Effect of the 2008 economic crisis on the cardiovascular mortality of the Irish population: an ecological 12-year study of a heart-broken Celtic Tiger.

PubMed

Osman, M; Osman, A

2017-08-08

Ireland has endured a substantial financial crisis in 2008 and we sought to explore the effect of economic recession on Irish cardiovascular mortality. We found an increase by 17.2% in CVA-deaths during the financial crisis years (95% CI 11.1% to 23.6%). In males, we found a notable rise in the annual IHD rate by 7.56% (95% CI 4.73% to 10.46%), in annual MI rate by 2.96% (95% CI 0.16% to 5.84%), and in annual CVA death rate by 20.07% (95% CI 16.13% to 24.14%). In females our findings indicated an increased rate of CVA-related deaths during the economic crisis by 15.54% (95% CI 6.67% to 25.16%). Irish CVA-related deaths increased during the economic crisis for males and females alike. Male IHD-related deaths have also risen indicating a potential differential effect for financial hardships on male gender mortality.

How Should We Intervene on the Financial Toxicity of Cancer Care? One Shot, Four Perspectives.

PubMed

Zafar, S Yousuf; Newcomer, Lee N; McCarthy, Justin; Fuld Nasso, Shelley; Saltz, Leonard B

2017-01-01

The median price of a month of chemotherapy has increased by an order of magnitude during the past 20 years, far exceeding inflation over the same period. Along with rising prices, increases in cost sharing have forced patients to directly shoulder a greater portion of those costs, resulting in undue financial burden and, in some cases, cost-related nonadherence to treatment. What can we do to intervene on treatment-related financial toxicity of patients? No one party can single-handedly solve the problem, and the solution must be multifaceted and creative. A productive discussion of the problem must avoid casting blame and, instead, must look inward for concrete starting points toward improvement in the affordability and value of cancer care. With these points in mind, the authors-representatives from the pharmaceutical industry, insurance providers, oncologists, and patient advocacy-have each been asked to respond with a practical answer to the provocative hypothetical question, "If you could propose one thing, and one thing only, in terms of an action or change by the constituency you represent in this discussion, what would that be?"

Transition from grant funding to a self-supporting burn telemedicine program in the western United States.

PubMed

Russell, Katie W; Saffle, Jeffrey R; Theurer, Louanna; Cochran, Amalia L

2015-12-01

Many Americans have limited access to specialty burn care, and telemedicine has been proposed as a means to address this disparity. However, many telemedicine programs have been founded on grant support and then fail once the grant support expires. Our objective was to demonstrate that a burn telemedicine program can be financially viable. This retrospective review from 2005 to 2014 evaluated burn telemedicine visits and financial reimbursement during and after a Technology Opportunities Program grant to a regional burn center. In 2005, we had 12 telemedicine visits, which increased to 458 in 2014. In terms of how this compares to in-person clinic visits, we saw a consistent increase in telemedicine visits as a percentage of total clinic visits from .26% in 2005 to 14% in 2014. Median telemedicine reimbursement has been equivalent to in-person visits. Specialty telemedicine programs can successfully transition from grant-funded enterprises to self-sustaining. The availability of telemedicine services allows access to specialty expertise in a large and sparsely populated region without imposing an undue financial burden. Copyright © 2015 Elsevier Inc. All rights reserved.

Financial protection in Europe: a systematic review of the literature and mapping of data availability.

PubMed

Yerramilli, Pooja; Fernández, Óscar; Thomson, Sarah

2018-05-01

A comprehensive and context-specific approach to monitoring financial protection can provide valuable evidence on progress towards universal health coverage. This article systematically reviews the literature on financial protection in Europe to identify trends across countries and over time. It also maps the availability of data for regular monitoring in 53 countries. Two people independently searched for studies using a standard strategy. Results were extracted from 54 publications and studies analysed in terms of geographical focus, data sources, methods and depth of analysis. Financial protection varies across countries in Europe; substantial changes over time have mainly taken place in the east of the region. Although the data required for regular monitoring are widely available, the literature presents major gaps in geographical scope - most studies focus on middle-income countries; it is not up to date - the latest year of data analysed is 2011; and cross-national comparison is only possible for a handful of countries due to variation in data sources and methods. The literature is also limited in depth. Very few studies go beyond analysing how many people incur catastrophic or impoverishing out-of-pocket payments. Only a small minority analyse who is most likely to experience financial hardship and what drives lack of financial protection. The literature provides little actionable evidence on financial protection in Europe. Copyright © 2018 World Health Organization. Published by Elsevier B.V. All rights reserved.

Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners.

PubMed

Gamarel, Kristi E; Reisner, Sari L; Laurenceau, Jean-Philippe; Nemoto, Tooru; Operario, Don

2014-08-01

Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one's romantic affiliation) were associated with both partners relationship quality and mental health. Couples (n = 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor-partner interdependence models were conducted to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner's higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partner's greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.

The Relationship between Income and Material Hardship

ERIC Educational Resources Information Center

Sullivan, James X.; Turner, Lesley; Danziger, Sheldon

2008-01-01

This paper examines the relationship between income and the extent of material hardship and explores other factors that might affect hardship. Using panel data from the Women's Employment Study, we examine the incidence of material hardship from 1997 to 2003 among current and former welfare recipients. We then consider the extent to which income…

Associations of Maternal Material Hardships During Childhood and Adulthood with Prepregnancy Weight, Gestational Weight Gain, and Postpartum Weight Retention

PubMed Central

Provenzano, Audrey M.; Rifas-Shiman, Sheryl L.; Herring, Sharon J.; Rich-Edwards, Janet W.

2015-01-01

Background: We examined associations of material hardship with prepregnancy body mass index (BMI), gestational weight gain (GWG), and substantial postpartum weight retention (SPPWR; ≥5 kg at 1 year). Methods: We studied 2128 women in Project Viva, a Boston-area cohort with recruitment during1999–2002. At recruitment, women reported whether they experienced material hardship, defined as having ever received public assistance, welfare, or lacked basic necessities (food, rent, or medical care) during childhood, in adulthood before pregnancy, and/or in pregnancy. We used multivariable logistic models adjusted for age, race/ethnicity, and parity (and prepregnancy BMI for GWG and SPPWR) to examine associations of material hardship with the three weight-related outcomes (BMI, GWG, and SPPWR). Results: Mean age was 31.8 (standard deviation, 5.2) years; 66% of women were white, 16% were obese (prepregnancy BMI ≥30.0 kg/m2), 50% experienced excessive GWG, and 17% experienced SPPWR. Material hardship was most common during childhood (n=192, 9%), followed by adulthood (102, 5%), and pregnancy (41, 2%). Hardship in adulthood was associated with prepregnancy obesity (BMI ≥30 kg/m2 vs. 18.5 to <25.0 kg/m2), odds ratio ([OR] 2.35, 95% confidence interval [CI] 1.29, 4.31), but hardship in childhood was not (OR 1.26, 95% CI 0.80, 1.98). Hardship in childhood was associated with excess GWG (OR 1.45, 95% CI 0.99, 2.14), but hardship in adulthood or during pregnancy was not. We saw trends among hardship in each of the periods and associations with SPPWR, but all confidence intervals included the null. Conclusion: The timing of hardship exposure may differently influence weight before, during, and after pregnancy. PMID:25902486

43 CFR 3809.401 - Where do I file my plan of operations and what information must I include with it?

Code of Federal Regulations, 2011 CFR

2011-10-01

... would not result in unnecessary or undue degradation of public lands. (b) Your plan of operations must... BLM to determine that the plan of operations prevents unnecessary or undue degradation: (1) Operator... closure (including periods of seasonal closure) to prevent unnecessary or undue degradation. The interim...

Developing an undue influence screening tool for Adult Protective Services.

PubMed

Quinn, Mary Joy; Nerenberg, Lisa; Navarro, Adria E; Wilber, Kathleen H

2017-03-01

The study purpose was to develop and pilot an undue influence screening tool for California's Adult Protective Services (APS) personnel based on the definition of undue influence enacted into California law January 1, 2014. Methods included four focus groups with APS providers (n = 33), piloting the preliminary tool by APS personnel (n = 15), and interviews with four elder abuse experts and two APS administrators. Social service literature-including existing undue influence models-was reviewed, as were existing screening and assessment tools. Using the information from these various sources, the California Undue Influence Screening Tool (CUIST) was developed. It can be applied to APS cases and potentially adapted for use by other professionals and for use in other states. Implementation of the tool into APS practice, policy, procedures, and training of personnel will depend on the initiative of APS management. Future work will need to address the reliability and validity of CUIST.

Developing and Validating the Scale of Economic Self-Efficacy.

PubMed

Hoge, Gretchen L; Stylianou, Amanda M; Hetling, Andrea; Postmus, Judy L

2017-05-01

Experiencing intimate partner violence (IPV) and financial hardship are often intertwined. The dynamics of an abusive relationship may include economic abuse tactics that compromise a survivor's ability to work, pursue education, have access to financial resources, and establish financial skills, knowledge, and security. An increasingly common goal among programs serving IPV survivors is increasing financial empowerment through financial literacy. However, providing financial education alone may not be enough to improve financial behaviors. Psychological factors also play a role when individuals make financial choices. Economic self-efficacy focuses on the individual's perceived ability to perform economic or financial tasks, and may be considered a primary influence on one's ability to improve financial decisions and behaviors. The current study tests the reliability and validity of a Scale of Economic Self-Efficacy with a sample of female survivors of IPV. This study uses a calibration and validation analysis model including full and split-sample exploratory and confirmatory factor analyses, assesses for internal consistency, and examines correlation coefficients between economic self-efficacy, economic self-sufficiency, financial strain, and difficulty living with income. Findings indicate that the 10-item, unidimensional Scale of Economic Self-Efficacy demonstrates strong reliability and validity among this sample of IPV survivors. An ability to understand economic self-efficacy could facilitate individualized service approaches and allow practitioners to better support IPV survivors on their journey toward financial empowerment. Given the increase in programs focused on assets, financial empowerment, and economic well-being, the Scale of Economic Self-Efficacy has potential as a very timely and relevant tool in the design, implementation, and evaluation of such programs, and specifically for programs created for IPV survivors.

Economic Hardship in Childhood: A Neglected Issue in ACE Studies?

PubMed

Braveman, Paula; Heck, Katherine; Egerter, Susan; Rinki, Christine; Marchi, Kristen; Curtis, Mike

2018-03-01

Objectives Adverse childhood experiences (ACEs) have been linked with ill-health in adulthood, but ACE literature has focused on family disruption or dysfunction (e.g., child abuse, parental separation), with less attention to economic adversity. We examined whether a mother's economic hardship in childhood (EHC) was associated with women's hardships and health-risk behaviors during/just before pregnancy. Methods We analyzed population-based survey data on 27,102 postpartum California women. EHC included respondents' reports that during childhood they/their families experienced hunger because of inability to afford food or moved because of problems paying rent/mortgage and the frequency of difficulty paying for basic needs. We examined six maternal hardships/behaviors during/just before pregnancy, including four hardships (poverty, food insecurity, homelessness/no regular place to sleep, intimate partner violence) and two behaviors (smoking, binge drinking). Prevalence ratios (PRs) were calculated from sequential logistic regression models estimating associations between EHC (categorized by level of hardship) and each maternal hardship/behavior, first without adjustment, then adjusting for other childhood and current maternal factors, and finally adding family disruption/dysfunction. Results Before adjustment for family disruption/dysfunction, the highest and intermediate EHC levels were associated with each maternal hardship/behavior; after full adjustment, those associations persisted except with smoking. Higher EHC levels generally appeared associated with larger PRs, although confidence intervals overlapped. Conclusions for Policy/Practice These findings link childhood economic hardship with women's hardships, binge drinking, and possibly smoking around the time of pregnancy. Without establishing causality, they support previous research indicating that childhood economic adversity should be considered an ACE.

The effect of material hardship on child protective service involvement.

PubMed

Yang, Mi-Youn

2015-03-01

This study employs four waves of survey data on 1,135 families from the Illinois Families Study, a longitudinal panel study of Temporary Assistance for Needy Families in Illinois. This study explores the following issues within this low-income population: (1) whether material hardships are associated with child protective services (CPS) investigations, (2) whether the effect of material hardship on CPS differs by the type of child maltreatment investigated, and (3) whether psychological distress mediates the association between material hardship and CPS involvement. Results from pooled and fixed effects logistic regressions suggest that caregivers who experience material hardship are more likely to become involved in CPS. In general, investigated neglect reports are responsive to particular types of hardship such as housing and food, while investigated physical abuse reports are responsive to levels of hardship regardless of specific types. The association between material hardship and CPS involvement is not fully explained by depressive symptoms or parenting stress. The study results suggest that in order to prevent child maltreatment, it may be necessary to address a family's unmet material needs through economic support interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

When hard times take a toll: the distressing consequences of economic hardship and life events within the family-work interface.

PubMed

Young, Marisa; Schieman, Scott

2012-03-01

Using two waves of data from a national survey of working Americans (N = 1,122), we examine the associations among economic hardship, negative life events, and psychological distress in the context of the family-work interface. Our findings demonstrate that family-to-work conflict mediates the effects of economic hardship and negative events to significant others on distress (net of baseline distress and hardship). Moreover, economic hardship and negative events to significant others moderate the association between family-to-work conflict and distress. While negative events to others exacerbate the positive effect of family-to-work conflict on distress, we find the opposite for economic hardship: The positive association between hardship and distress is weaker at higher levels of family-to-work conflict. These patterns hold across an array of family, work, and sociodemographic conditions. We discuss how these findings refine and extend ideas of the stress process model, including complex predictions related to processes of stress-buffering, resource substitution, and role multiplication.

Doing science in difficult socioeconomic circumstances.

PubMed

Karasmanis, Eva P

2018-06-01

Doing scientific research can be a challenging, but creative and rewarding career. However, the challenge of doing research is orders of magnitude more difficult for scientists lacking access to the necessary resources. Resource-scarce environments are quite common worldwide and are highly contingent on the financial and social climate of one's location. Through the experiences of four scientists, this Perspective explores the challenges associated with doing research in disadvantaged socioeconomic circumstances. By reflecting on the humble beginnings of these scientists, we examine the motivation to stay in or leave one's home country, and how hardships can be leveraged to cultivate passionate and productive researchers.

Hardships and personal strategies of Vietnam War nurses.

PubMed

Scannell-Desch, E A

2000-08-01

This study describes hardships faced in Vietnam and personal strategies used to deal with these hardships as defined by 24 female military nurses who served during the war. Purposive sampling was used, and data were generated using four core questions and in-depth interviews. The research methodology was phenomenology, incorporating data analysis procedures of Colaizzi, Lincoln and Guba, and Van Manen. Eight hardship and nine personal strategy themes were identified. This study found that caring for young, severely injured, and disfigured soldiers was a significant hardship and that nurses struggled with the moral dilemmas inherent in mass casualty situations, triage policies, and the practice of returning recovered soldiers to combat. Most nurses relied on personally proven and familiar strategies to reduce or buffer the effects of emotional hardships, whereas some discovered and used new strategies.

Financial burden in recipients of allogeneic hematopoietic cell transplantation.

PubMed

Khera, Nandita; Chang, Yu-hui; Hashmi, Shahrukh; Slack, James; Beebe, Timothy; Roy, Vivek; Noel, Pierre; Fauble, Veena; Sproat, Lisa; Tilburt, Jon; Leis, Jose F; Mikhael, Joseph

2014-09-01

Although allogeneic hematopoietic cell transplantation (HCT) is an expensive treatment for hematological disorders, little is known about the financial consequences for the patients who undergo this procedure. We analyzed factors associated with its financial burden and its impact on health behaviors of allogeneic HCT recipients. A questionnaire was retrospectively mailed to 482 patients who underwent allogeneic HCT from January 2006 to June 2012 at the Mayo Clinic, to collect information regarding current financial concerns, household income, employment, insurance, out-of-pocket expenses, and health and functional status. A multivariable logistic regression analysis identified factors associated with financial burden and treatment nonadherence. Of the 268 respondents (56% response rate), 73% reported that their sickness had hurt them financially. All patients for whom the insurance information was available (missing, n = 13) were insured. Forty-seven percent of respondents experienced financial burden, such as household income decreased by >50%, selling/mortgaging home, or withdrawing money from retirement accounts. Three percent declared bankruptcy. Younger age and poor current mental and physical functioning increased the likelihood of financial burden. Thirty-five percent of patients reported deleterious health behaviors because of financial constraints. These patients were likely to be younger, have lower education, and with a longer time since HCT. Being employed decreased the likelihood of experiencing financial burden and treatment nonadherence due to concern about costs. A significant proportion of allogeneic HCT survivors experience financial hardship despite insurance coverage. Future research should investigate potential interventions to help at-risk patients and prevent adverse financial outcomes after this life-saving procedure. Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Identifying barriers to emergency care services.

PubMed

Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

2012-01-01

This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors.

PubMed

Sharp, Linda; Timmons, Aileen

2016-02-01

Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system. Postal questionnaires were distributed to 1373 people diagnosed with cancer 3-24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain. Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58-0.86) or retired (RR = 0.48, 95 % CI 0.34-0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs. Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.

"It just forces hardship": impacts of government financial penalties on non-vaccinating parents.

PubMed

Helps, Catherine; Leask, Julie; Barclay, Lesley

2018-01-22

Despite strong evidence confirming vaccination is safe and effective, some parents choose not to vaccinate their children. In 2016, the Australian Government introduced legislation strengthening links between vaccination compliance and some government payments. We interviewed thirty-one non-vaccinating parents about the impacts of this policy. Data analysis produced three key themes: 'questioning policy integrity', 'minimising impact' and 'holding my ground'. Affected parents offset reduced income by removing children from early childhood learning, reducing work commitments, moving residence to reduce living costs and accessing informal childcare arrangements. Parents reported a greater commitment to their decision not to vaccinate and an increased desire to maintain control over health choices for their children including an unprecedented willingness to become involved in protest action. Our study identifies why financial penalties have not been an effective policy measure for this sample of non-vaccinating parents, an understanding which may assist in the development of future legislation.

"It's Not All About Money": Toward a More Comprehensive Understanding of Financial Abuse in the Context of VAW.

PubMed

Eriksson, Marie; Ulmestig, Rickard

2017-12-01

Men's violence against women (VAW) is multifaceted and complex. Besides physical, psychological, and sexual violence, women subjected to VAW often suffer from economic hardship and financial abuse. Financial abuse involves different tactics used to exercise power and gain control over partners. Experiences of financial abuse make it difficult for women to leave an abusive partner and become self-sufficient. From an intersectional perspective, applying the concept of the continuum of violence, the aim of this article is to develop a more comprehensive understanding of how women subjected to men's violence in intimate relationships experience the complexity of financial abuse in their lives, in the context of VAW. Based on 19 in-depth interviews with women surviving domestic violence, the study describes how intertwined women's experiences of financial abuse are with other forms of abuse, influencing each other, simultaneously experienced as a distinct form of abuse with severe and longstanding consequences. Women in the study describe how men's abuse affects them financially, causing poverty and affecting their ability to have a reasonable economic standard. Financial abuse also causes women ill health, and damages their self-esteem and ability to work, associate, and engage in social life. The interviewed women describe how experiences of financial abuse continue across time, from their past into their present situation and molding beliefs about the future. According to the interviews, financial abuse in private life sometimes continues into the public sphere, reproduced by social workers mimicking patterns of ex-partners' abuse. Bringing out a more comprehensive understanding of the dynamic continuum of financial abuse, our results deepen knowledge about the complexity of VAW in women's lives, and thereby are important in processes of making victims of violence survivors of violence.

Hardships of the Great Recession and health: Understanding varieties of vulnerability

PubMed Central

Kirsch, Julie A; Ryff, Carol D

2016-01-01

The Great Recession of 2007–2009 is regarded as the most severe economic downturn since World War II. This study examined relationships between reported recession hardships and physical health in a national survey of American adults (N = 1275). Furthermore, education and psychological resources (perceived control, purpose in life, and conscientiousness) were tested as moderators of the health impacts of the recession. A greater number of hardships predicted poorer health, especially among the less educated. Psychological resources interacted with education and hardships to predict health outcomes. Although typically viewed as protective factors, such resources became vulnerabilities among educationally disadvantaged adults experiencing greater recession hardships. PMID:28070407

A system dynamics feedback control model study of population of "India 2001" and policies for stabilizing growth.

PubMed

Patil, M K; Janahanlal, P S

1978-06-01

A mathematical population model is presented and diagrammed. The model is a nonlinear, higher order, self-regulating, goal-seeking system. In other words, the model treats the population system like a biological system which has positive and negative feedbacks. The model incorporates the effects of important economic factors that influence human birth and death rates. It calculates the total population size, which is a determinant of resource usage. It also indicates the demographic response, through a changing birth and death rate, to a changing resource supply. The model is illustrated with Indian population data, disaggregated by age into 15 levels each of which is, in turn, divided into 4 income levels. The effect on population growth of various alternative population policies is analyzed with the goal of stabilizing the population growth quickly without causing undue hardship. Different computer runs of the model are conducted, using different levels of family planning practice, different ages at marriage, and different distributions of income throughout the country. The policy which would result in the lowest population for the year 2001 is 1 in which family planning acceptance levels would increase from 15% in 1975 to 60% in 1980 and 100% from 1990 on. However, there is widespread opposition to this policy. It is felt that a much slower rise in family planning acceptance would be a more acceptable policy for stabilizing population in India.

Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia.

PubMed

Sukeri, Surianti; Mirzaei, Masoud; Jan, Stephen

2017-01-01

Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system. A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey. The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses. Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Abortion Patients' Experience and Perceptions of Waiting Periods: Survey Evidence before Arizona's Two-visit 24-hour Mandatory Waiting Period Law.

PubMed

Karasek, Deborah; Roberts, Sarah C M; Weitz, Tracy A

2016-01-01

More than one-half of U.S. states now have laws requiring women to wait at least 24 hours between receiving information about abortion and the actual abortion procedure, with a few requiring longer waits, and one-fourth requiring that women receive this information in person. Although public discussions of waiting periods focus on how they affect women, we know little about abortion patients' perceptions of these requirements. We collected data from 379 women seeking abortion care at an abortion facility in Arizona before Arizona's 24-hour waiting period two-visit requirement went into effect. Surveys focused on patients' experiences receiving abortion care before the waiting period and perceptions about how the additional clinic visit would affect them. Most women reported one or more financial or logistical challenges in obtaining abortion care. More than two-thirds reported difficulty paying abortion appointment-related expenses. These expenses prevented or delayed almost one-half from paying other expenses, such as rent, bills, and food, with lower income women more affected. The majority expected that the additional visit would result in additional financial and logistical hardships and delay them in having an abortion, with 90% reporting that the waiting period would lead to at least one hardship. Eight percent reported that the waiting period would have a positive effect on emotional well-being, and more than one-half reported that it would have a negative effect on emotional well-being. Only a small minority of women seeking abortion care view a two-visit waiting period law as benefiting them; the overwhelming majority expect a waiting period to have adverse consequences. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Measuring the foundations of school readiness: Introducing a new questionnaire for teachers - The Brief Early Skills and Support Index (BESSI).

PubMed

Hughes, Claire; Daly, Irenee; Foley, Sarah; White, Naomi; Devine, Rory T

2015-09-01

Early work on school readiness focused on academic skills. Recent research highlights the value of also including both children's social and behavioural competencies and family support. Reflecting this broader approach, this study aimed to develop a new and brief questionnaire for teachers: The Brief Early Skills and Support Index (BESSI). The main sample, recruited from the north-west of England, included 1,456 children (49% male), aged 2.5 to 5.5 years. A second sample consisting of 258 children (44% male) aged 3 to 5.5 years was recruited to assess the test-retest reliability of the BESSI across a 1-month interval. Following development and pilot work with early years teachers, a streamlined (30 items) version of the BESSI was sent to 98 teachers and nursery staff, who rated the children in their class. The best-fitting model included four latent factors: Three child factors (Behavioural Adjustment, Language and Cognition, and Daily Living Skills) and one Family Support factor. The three child factors exhibited measurement invariance across gender. All four factors showed good internal consistency and test-retest reliability. Structural equation modelling showed that (1) boys had more problems than girls on all three child factors; (2) older children showed better Language and Cognition and Daily Living Skills than younger children; and (3) children eligible for free school meals (an index of financial hardship) had more problems on all four latent factors. Family Support latent scores predicted all three child latent factors and accounted for their correlation with financial hardship. The BESSI is a promising brief teacher-report screening tool that appears suitable for children aged 2.5 to 5.5 and provides a broader perspective upon school readiness than previous measures. © 2015 The British Psychological Society.

Gender minority stress, mental health, and relationship quality: A dyadic investigation of transgender women and their cisgender male partners

PubMed Central

Gamarel, Kristi E.; Reisner, Sari L.; Laurenceau, Jean-Philippe; Nemoto, Tooru; Operario, Don

2014-01-01

Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (non-transgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one’s romantic affiliation), were associated with both partners relationship quality and mental health. Couples (N=191) were recruited to participate in cross-sectional survey. Actor-partner interdependence models (APIM) were fit to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner’s higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partner’s greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners. PMID:24932942

The Great Recession, Public Transfers, and Material Hardship

PubMed Central

Pilkauskas, Natasha V.; Currie, Janet; Garfinkel, Irwin

2013-01-01

Economic downturns lead to lost income and increased poverty. Although high unemployment almost certainly also increases material hardship, and government transfers likely decrease hardship, the first relationship has not yet been documented and the second is poorly understood. We use data from five waves of the Fragile Families and Child Well-being Study to study the relationships between unemployment, government transfers, and material hardship. The latest wave of data was collected during the Great Recession, the worst recession since the Great Depression, providing a unique opportunity to look at how high unemployment rates affect the well-being of low income families. We find that the unemployment rate is associated with increased overall material hardship, difficulty paying bills, having utilities disconnected, and with increased usage of TANF, SNAP, UI and Medicaid. If not for SNAP, food hardship might have increased by twice the amount actually observed. PMID:24379487

Contrasting Views of Risk Perception and Influence of Financial Compensation Between Adolescent Research Participants and Their Parents

PubMed Central

Wiener, Lori; Viola, Adrienne; Wilfond, Benjamin S.; Wendler, David; Grady, Christine

2017-01-01

U.S. regulations governing pediatric research do not specify the assent process. To identify best practices, it is important to examine parents’ and adolescents’ views. The present study focuses on parents’ and adolescents’ views regarding possible research risks and the influence of financial compensation on their willingness to accept research procedures. Interviews were conducted with 177 adolescents participating in clinical research for a medical or psychiatric illness, or as healthy volunteers, and a parent. Significant discordance was found between how bothered the teen would feel from research-related side effects and procedures compared with parental report. Most teens were willing to accept non-beneficial procedures without compensation. Payment had significantly greater influence on healthy volunteers and their parents compared with those with a medical or psychiatric illness. Discordance between adolescent and parental views about risks recommends obtaining direct input from adolescents during the assent process. Modest payments should not raise concerns of undue inducement, especially in teens with pre-existing conditions. PMID:25742666

Impact of financial burden of cancer on survivors' quality of life.

PubMed

Fenn, Kathleen M; Evans, Suzanne B; McCorkle, Ruth; DiGiovanna, Michael P; Pusztai, Lajos; Sanft, Tara; Hofstatter, Erin W; Killelea, Brigid K; Knobf, M Tish; Lannin, Donald R; Abu-Khalaf, Maysa; Horowitz, Nina R; Chagpar, Anees B

2014-09-01

Little is known about the relationship between the financial burden of cancer and the physical and emotional health of cancer survivors. We examined the association between financial problems caused by cancer and reported quality of life in a population-based sample of patients with cancer. Data from the 2010 National Health Interview Survey (NHIS) were analyzed. A multivariable regression model was used to examine the relationship between the degree to which cancer caused financial problems and the patients' reported quality of life. Of 2,108 patients who answered the survey question, "To what degree has cancer caused financial problems for you and your family?," 8.6% reported "a lot," whereas 69.6% reported "not at all." Patients who reported "a lot" of financial problems as a result of cancer care costs were more likely to rate their physical health (18.6% v 4.3%, P < .001), mental health (8.3% v 1.8%, P < .001), and satisfaction with social activities and relationships (11.8% v 3.6%, P < .001) as poor compared to those with no financial hardship. On multivariable analysis controlling for all of the significant covariates on bivariate analysis, the degree to which cancer caused financial problems was the strongest independent predictor of quality of life. Patients who reported that cancer caused "a lot" of financial problems were four times less likely to rate their quality of life as "excellent," "very good," or "good" (odds ratio = 0.24; 95% CI, 0.14 to 0.40; P < .001). Increased financial burden asa result of cancer care costs is the strongest independent predictor of poor quality of life among cancer survivors. Copyright © 2014 by American Society of Clinical Oncology.

Combined effects of prenatal polycyclic aromatic hydrocarbons and material hardship on child IQ.

PubMed

Vishnevetsky, Julia; Tang, Deliang; Chang, Hsin-Wen; Roen, Emily L; Wang, Ya; Rauh, Virginia; Wang, Shuang; Miller, Rachel L; Herbstman, Julie; Perera, Frederica P

2015-01-01

Polycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation. We examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores. Prospective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years. Urban community (New York City) A community-based sample of 276 minority urban youth EXPOSURE MEASURE: Polycyclic aromatic hydrocarbon-DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood. Child IQ at 7 years assessed using the Wechsler Intelligence Scale for Children. Significant inverse effects of high cord PAH-DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child's early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (β = -8.07, 95% CI (-14.48, -1.66)) and between high cord adducts and recurrent material hardship (β = -9.82, 95% CI (-16.22, -3.42)). The findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical "stressors" like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention. Copyright © 2015 Elsevier Inc. All rights reserved.

Gender bias and judicial decisions of undue influence in testamentary challenges.

PubMed

Recupero, Patricia R; Christopher, Paul P; Strong, David R; Price, Marilyn; Harms, Samara E

2015-03-01

Allegations of undue influence constitute a common basis for contests of wills. Legal research from the 1990s suggests that gender bias factors significantly into judicial decision-making regarding alleged undue influence and testamentary intent. In this study, we sought to assess whether this bias is present today and to identify any factors that may be associated with it. Probate judges from several jurisdictions in the United States were asked to consider two hypothetical case vignettes drawn from actual published decisions. In our study, the gender of the testator played only a minor role in how judges weighed factors in the decision-making process and, overall, did not significantly influence opinions regarding the presence of undue influence. The specifics of the case and the gender of the judge emerged as the most consistent and robust potential influences on decision-making. Our results suggest that probate rulings involving undue influence are likely to represent a complex interaction of factors involving the testator's and judge's genders and the specifics of individual cases. The implications of these findings are discussed. © 2015 American Academy of Psychiatry and the Law.

Economic hardships in adulthood and mental health in Sweden. The Swedish National Public Health Survey 2009.

PubMed

Ahnquist, Johanna; Wamala, Sarah P

2011-10-11

Possible accumulative effects of a combined economic hardship's measure, including both income and non-income related economic hardships measures, on mental health has not been well investigated. The aim of this paper was to investigate; (i) independent associations between multiple measures of economic hardships and mental health problems, and (ii) associations between a combined economic hardships measure and mental health problems. We analysed data from the 2009 Swedish National Survey of Public Health comprising a randomly selected representative national sample combined with a randomly selected supplementary sample from four county councils and three municipalities consisting of 23,153 men and 28,261 women aged 16-84 years. Mental health problems included; psychological distress (GHQ-12), severe anxiety and use of antidepressant medication. Economic hardship was measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. The results from multivariate adjusted (age, country of birth, educational level, occupational status, employment status, family status and long term illness) logistic regression analysis indicate that self-reported current economic difficulties (inability to pay for ordinary bills and lack of cash reserves), were significantly associated with both women's and men's mental health problems (all indicators), while low income was not. In addition, we found a statistically significant graded association between mental health problems and levels of economic hardships. The findings indicate that indicators of self-reported current economic difficulties seem to be more strongly associated with poor mental health outcomes than the more conventional measure low income. Furthermore, the likelihood of mental health problems differed significantly in a graded fashion in relation to levels of economic hardships.

Role stress, interrole conflict, and job satisfaction among university employees: the creation and test of a model.

PubMed

Love, Keisha M; Tatman, Anthony W; Chapman, Benjamin P

2010-03-01

Many universities have experienced financial hardships during the recent economic downturn. To save money, several have resorted to laying off employees, which has often resulted in increased work and stress for the remaining employees. Such an increase has the potential to adversely affect employees' sense of job satisfaction. This study created and tested the fit of a conceptual model containing role stress and interrole conflict as a way to account for employees' job satisfaction. The model demonstrated an acceptable fit to the data and contained several significant paths. Implications of the results, study limitations, and future directions for research are discussed.

Reconceptualizing the Association between Food Insufficiency and Body Weight: Distinguishing Hunger from Economic Hardship

PubMed Central

Ross, Catherine E.; Hill, Terrence D.

2013-01-01

What is the association between food insufficiency and body weight? Although common sense would suggest a negative association, research often finds the opposite. We contrast commodity theories of material privation with stress theories, proposing that the seemingly counterintuitive association results from the confounding influence of economic hardship. Because it is a chronic stressor, economic hardship may contribute to overweight. Data from the WCF project of 2,402 disadvantaged women in Chicago, Boston, and San Antonio show that people who experience economic hardship weigh more; and that the true negative association between body weight and food insufficiency—especially going hungry because one cannot afford food—is revealed only after adjustment for economic hardship. PMID:24244066

Return to work, economic hardship, and women's postpartum health.

PubMed

Tucker, Jenna N; Grzywacz, Joseph G; Leng, Iris; Clinch, C Randall; Arcury, Thomas A

2010-10-01

This study followed a sample of 217 new mothers in a North Carolina county as they returned to work full-time, measuring their mental and physical health-related quality of life through 16 months postpartum. In general, working mothers of infants had mental health scores that were comparable to the general population of U.S. women, and physical health that was slightly better than women in general. Using ANCOVA and controlling for important demographic characteristics, health-related quality of life was compared between mothers experiencing low and high levels of economic hardship. Across the study period, women with high economic hardship, who constituted 30.7% of the sample, had levels of mental and physical health below those of women with low economic hardship. Mothers with high economic hardship also had less stable health trajectories than mothers with low economic hardship. The findings highlight the importance of reconsidering the traditionally accepted postpartum recovery period of six weeks and extending benefits, such as paid maternity and sick leave, as well as stable yet flexible work schedules.

Insurance coverage and financial burden for families of children with special health care needs.

PubMed

Chen, Alex Y; Newacheck, Paul W

2006-01-01

To examine the role of insurance coverage in protecting families of children with special health care needs (CSHCN) from the financial burden associated with care. Data from the 2001 National Survey of Children with Special Health Care Needs were analyzed. We built 2 multivariate regression models by using "work loss/cut back" and "experiencing financial problems" as the dependent variables, and insurance status as the primary independent variable of interest while adjusting for income, race/ethnicity, functional limitation/severity, and other sociodemographic predictors. Approximately 29.9% of CSHCN live in families where their condition led parents to report cutting back on work or stopping work completely. Families of 20.9% of CSHCN reported experiencing financial difficulties due to the child's condition. Insurance coverage significantly reduced the likelihood of financial problems for families at every income level. The proportion of families experiencing financial problems was reduced from 35.7% to 23.0% for the poor and 44.9% to 24.5% for low-income families with continuous insurance coverage (P < .01 for both comparisons). Similarly, the proportion of parents having to cut back or stop work was reduced from 42.8% to 35.9% for the poor (P < .05) and 43.5% to 33.9% for low-income families (P < .01). Continuous health insurance coverage provides protection from financial burden and hardship for families of CSHCN in all income groups. This evidence is supportive of policies designed to promote universal coverage for CSHCN. However, many poor and low-income families continue to experience work loss and financial problems despite insurance coverage. Hence, health insurance should not be viewed as a solution in itself, but instead as one element of a comprehensive strategy to provide financial safety for families with CSHCN.

Provincial Disparities of Growth Hormone Coverage for Young Adult Survivors of Paediatric Brain Tumours across Canada

PubMed Central

Hasan, Haroon; Howard, Fuchsia; Morgan, Steven G.; Metzger, Daniel L.; Gill, Sabrina; Johnson, Michelle; Lo, Andrea C.; Goddard, Karen

2014-01-01

Background: Young adult survivors of paediatric brain tumours (PBTs) who have been treated with radiation therapy will likely be severely growth hormone–deficient when retested at the achievement of final height. Growth hormone replacement therapy (GHRT) is administered to treat growth hormone deficiency (GHD). Public drug coverage for GHRT falls under the responsibility of provincial governments across Canada. This study sought to determine the extent of public drug coverage and cost in each Canadian province for GHRT to treat GHD during adulthood for young adult survivors of PBTs. Methods: Data were collected from provincial government resources and drug formularies from 2012–2013 on the extent of coverage for GHRT based on a clinical case scenario representative of a young adult survivor of a PBT with childhood-onset radiation-induced GHD, the ingredient cost for GHRT and the applicable provincial public drug plan cost-sharing policies. A model was then created to simulate out-of-pocket costs incurred by a young adult male and a young adult female survivor of a PBT for one year of GHRT in each province with applicable cost-sharing arrangements and levels of low annual individual total income that best represent the majority of young adult survivors of PBTs. Out-of-pocket costs were expressed as a percentage of annual income. Comparisons were made between provinces descriptively, and variation among provinces was summarized statistically. Results: Alberta, Manitoba, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador provide coverage for GHD during adulthood on a case-by-case basis, while British Columbia, Saskatchewan, Nova Scotia and Prince Edward Island provide no coverage. The percentage of annual income to fund GHRT across the provinces without public coverage ranged from 14.4% to 25.5% for males and 21.5% to 38.3% for females, and with public coverage was 0.0% to 4.1% for males and 0.0% to 5.0% for females. Interpretation: There are considerable out-of-pocket costs and variation in coverage provided by provincial public drug plans to fund GHRT for young adult survivors of PBTs with GHD. The implementation of a national drug formulary could potentially prevent undue financial hardship and remove disparities resulting from variations in provincial drug plans. PMID:24726076

Unintended costs and consequences of school closures implemented in preparation for Hurricane Isaac in Harrison County School District, Mississippi, August-September 2012

PubMed Central

Zheteyeva, Yenlik; Rainey, Jeanette J.; Gao, Hongjiang; Jacobson, Evin U.; Adhikari, Bishwa B.; Shi, Jianrong; Mpofu, Jonetta J.; Bhavnani, Darlene; Dobbs, Thomas; Uzicanin, Amra

2017-01-01

Introduction School closures, while an effective measure against the spread of disease during a pandemic, may carry unintended social and economic consequences for students and families. We evaluated these costs and consequences following a 4-day school closure in Mississippi’s Harrison County School District (HCSD). Methods In a survey of all households with students enrolled in HCSD, we collected information on difficulties related to the school closure, including interruption of employment and pay, loss of access to subsidized school meals, and arrangement of alternative childcare. We analyzed this information in the context of certain demographic characteristics of the survey respondents and households, such as race, level of education, and income. We also estimated the average number of lost work days and documented the childcare alternatives chosen by households affected by the school closure. Results We received 2,229 (28.4%) completed surveys from an estimated 7,851 households eligible to participate. About half (1,082 [48.5%]) of the households experienced at least some difficulty during the closure, primarily in three areas: uncertainty about duration of the closure, lost income, and the effort of arranging alternate childcare. Adults working outside the home, particularly the major wage earner in the household, were more likely to suffer lost income while schools were closed, an effect mitigated by paid leave benefits. Difficulty arranging childcare was reported most frequently by respondents with lower levels of education and households with younger children. Beyond the top three concerns expressed by households in HCSD, the survey also shed light on the issue of food insecurity when subsidized school meals are not available. Reported by 17.9% of households participating in the subsidized school lunch program, difficulty providing meals during the closure was associated with higher numbers of dependent children, selection of “other” as the race of the household respondent, and lower levels of education. Conclusion To help prevent undue financial hardship in families of school children, public health authorities and school administrators should provide recommendations for childcare alternatives and paid leave or remote work options during prolonged school closures, particularly to households in which all adults work outside of the home. PMID:29091717

7 CFR 1714.8 - Hardship rate loans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Hardship rate loans. 1714.8 Section 1714.8 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PRE-LOAN POLICIES AND PROCEDURES FOR INSURED ELECTRIC LOANS General § 1714.8 Hardship rate loans...

18 CFR 294.101 - Shortages of electric energy and capacity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... without undue prejudice or disadvantage; and (ii) It shall also identify any agreement, law, or regulation... treat without undue discrimination or preference, prejudice, or disadvantage firm power wholesale...

Parenting stress and child behaviour problems among parents with intellectual disabilities: the buffering role of resources.

PubMed

Meppelder, M; Hodes, M; Kef, S; Schuengel, C

2015-07-01

Parents with intellectual disabilities (ID) are at risk for high levels of parenting stress. The present study evaluated resources, including parental adaptive functioning, financial resources and access to a support network, as moderators of the association between child behaviour problems and parenting stress. A total of 134 parents with ID and their children (ages 1-7 years) were recruited from 10 Dutch care organisations. Questionnaires were administered to the parents to obtain information on parenting stress in the parent and child domain, financial resources and their support network. Teachers and care workers reported on child behaviour problems and parental adaptive functioning, respectively. Parents experienced more stress with regard to their children than towards their own functioning and situation. Parenting stress was less in parents who were not experiencing financial hardship. Child behaviour problems were associated with high child-related parenting stress, not parent-related parenting stress. Large support networks decreased the association between child behaviour problems and child-related parenting stress. Financial resources did not significantly moderate the association. Parenting stress among parents with ID is focused on problems with the child, especially when little social support is available. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Employment Hardship among Mexican-Origin Women

ERIC Educational Resources Information Center

De Anda, Roberto M.

2005-01-01

This study compares the prevalence and causes of employment hardship between Mexican-origin and White women. Data come from the March 1992, 1996, and 2000 Current Population Surveys. Using logistic regression, the author assesses whether there is a difference between Mexican-origin and White women in employment hardship, controlling for personal…

Economic Hardship and Adaptation among Asian American Families

ERIC Educational Resources Information Center

Ishii-Kuntz, Masako; Gomel, Jessica N.; Tinsley, Barbara J.; Parke, Ross D.

2010-01-01

Asian American families are often portrayed as affluent, having achieved a high level of education and occupational prestige. Despite this model-minority image, many Asian Americans suffer from economic hardship. Using a sample of 95 Asian Americans, this study examines the effect of perceived economic hardship on coping behavior, family…

An Exploratory Study of Trust and Material Hardship in Ghana

ERIC Educational Resources Information Center

Addai, Isaac; Pokimica, Jelena

2012-01-01

We explore associations among interpersonal (thick and thin) and institutional (legislative, executive, and judicial) trust and material hardship outcomes in Ghana. We use data from the 2008 Afrobarometer survey. Material hardship is conceptualized in terms of frequency of going without five basic necessities/consumptive deprivations, each of…

45 CFR 50.7 - Personal hardship, persecution and visa extension considerations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Personal hardship, persecution and visa extension... Personal hardship, persecution and visa extension considerations. (a) It is not within the Department's... not responsible for considering requests to extend visas. (c) Inquiries concerning the above should be...

45 CFR 50.7 - Personal hardship, persecution and visa extension considerations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Personal hardship, persecution and visa extension... Personal hardship, persecution and visa extension considerations. (a) It is not within the Department's... not responsible for considering requests to extend visas. (c) Inquiries concerning the above should be...

45 CFR 50.7 - Personal hardship, persecution and visa extension considerations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Personal hardship, persecution and visa extension... Personal hardship, persecution and visa extension considerations. (a) It is not within the Department's... not responsible for considering requests to extend visas. (c) Inquiries concerning the above should be...

45 CFR 50.7 - Personal hardship, persecution and visa extension considerations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Personal hardship, persecution and visa extension... Personal hardship, persecution and visa extension considerations. (a) It is not within the Department's... not responsible for considering requests to extend visas. (c) Inquiries concerning the above should be...

45 CFR 50.7 - Personal hardship, persecution and visa extension considerations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Personal hardship, persecution and visa extension... Personal hardship, persecution and visa extension considerations. (a) It is not within the Department's... not responsible for considering requests to extend visas. (c) Inquiries concerning the above should be...

23 CFR 710.503 - Protective buying and hardship acquisition.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Protective buying and hardship acquisition. 710.503... ENVIRONMENT RIGHT-OF-WAY AND REAL ESTATE Property Acquisition Alternatives § 710.503 Protective buying and... location (Protective Buying), or to alleviate hardship to a property owner or owners on the preferred...

Family economic hardship and Chinese adolescents' sleep quality: A moderated mediation model involving perceived economic discrimination and coping strategy.

PubMed

Bao, Zhenzhou; Chen, Chuansheng; Zhang, Wei; Zhu, Jianjun; Jiang, Yanping; Lai, Xuefen

2016-07-01

The association between family economic hardship and adolescent adjustment outcomes, including sleep quality, is well-established. Few studies, however, have examined the mediating and moderating mechanisms underlying the relation between family economic hardship and adolescents' sleep quality. The aim of this study was to investigate the effect of family economic hardship on Chinese adolescents' sleep quality, as well as the role of perceived economic discrimination as a mediator and the role of coping strategy as a moderator. Survey data from a cross-sectional sample of 997 Chinese adolescents (45% male, mean age = 15.04 years) were analyzed using path analysis in Mplus 7.0. The results of this study indicated that family economic hardship was significantly associated with adolescents' sleep quality. This association was mediated by adolescents' perceived economic discrimination. In addition, adolescents' coping strategy significantly moderated the path from perceived economic discrimination to sleep quality, with the "shift" coping strategy as a protective factor. The present study contributes to our understanding of key mechanisms underlying the association between family economic hardship and adolescent sleep quality and highlights the importance of improving sleep quality for adolescents exposed to economic hardship. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. All rights reserved.

Unemployment and work interruption among African American single mothers: effects on parenting and adolescent socioemotional functioning.

PubMed

McLoyd, V C; Jayaratne, T E; Ceballo, R; Borquez, J

1994-04-01

Using interview data from a sample of 241 single African American mothers and their seventh- and eighth-grade children, this study tests a model of how 2 economic stressors, maternal unemployment and work interruption, influence adolescent socioemotional functioning. In general, these economic stressors affected adolescent socioemotional functioning indirectly, rather than directly, through their impact on mothers' psychological functioning and, in turn, parenting behavior and mother-child relations. Current unemployment, but not past work interruption, had a direct effect on depressive symptomatology in mothers. As expected, depressive symptomatology in mothers predicted more frequent maternal punishment of adolescents, and this relation was fully mediated by mothers' negative perceptions of the maternal role. More frequent maternal punishment was associated with increased cognitive distress and depressive symptoms in adolescents, and consistent with predictions, these relations were partially mediated by adolescents' perceptions of the quality of relations with their mothers. Increased availability of instrumental support, as perceived by mothers, predicted fewer depressive symptoms in mothers, less punishment of adolescents, and less negativity about the maternal role. Both economic stressors were associated with higher levels of perceived financial strain in mothers, which in turn predicted adolescents' perceptions of economic hardship. Adolescents who perceived their families as experiencing more severe economic hardship reported higher anxiety, more cognitive distress, and lower self-esteem.

Effects of poverty on academic failure and delinquency in boys: a change and process model approach.

PubMed

Pagani, L; Boulerice, B; Vitaro, F; Tremblay, R E

1999-11-01

Using data from the Montreal Longitudinal-Experimental Study, we examined the impact of poverty (and its correlate, family configuration status) on academic placement and self-reported delinquency in boys at age 16. We then investigated whether the relation between family economic hardship and antisocial behaviour is direct or indirect by considering the value of parenting practices and academic failure as process variables in the model. Data included official records, and parent, teacher, and self-reports. The temporal intensity of poverty was classified into five categories: never-poor; always-poor; poor-earlier; poor-later; and transitory-poverty. Family configuration status was classified by both temporal characteristics and number of marital transitions: intact-family; short-term-single; long-term-single; short-term-remarried; long-term-remarried; and multiple-marital-transitions. Results revealed that when maternal education and early childhood behaviour were controlled, poverty had an effect on both academic failure and extreme delinquency. This effect was independent of family configuration status. Although they both significantly predicted extreme delinquency on their own, academic failure and parental supervision did not mediate the relationship between poverty and delinquency. Divorce increased the risk of theft and fighting at age 16, regardless of financial hardship. Parental supervision only helped explain the effects of divorce on boys' fighting.

5 CFR 575.208 - Approval criteria and written determination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... undue disruption of an activity or function that is deemed essential to the agency's mission or without undue disruption of service to the public. (2) The written determination under paragraph (a) of this...

40 CFR 1033.620 - Hardship provisions for manufacturers and remanufacturers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... economic hardship provisions specified in 40 CFR 1068.245, we may approve a period of delayed compliance... other conditions as appropriate, such as requiring payment of fees to negate an economic gain that such... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Hardship provisions for manufacturers...

Growing up Faster, Feeling Older: Hardship in Childhood and Adolescence

ERIC Educational Resources Information Center

Johnson, Monica Kirkpatrick; Mollborn, Stefanie

2009-01-01

We examine whether hardship while growing up shapes subjective age identity, as well as three types of experiences through which it may occur. Drawing on data from the National Longitudinal Study of Adolescent Health, we find that hardship in several domains during childhood and adolescence is associated with feeling relatively older and…

Intergenerational continuity in economic hardship, parental positivity, and positive parenting: The association with child behavior

PubMed Central

Jeon, Shinyoung; Neppl, Tricia K.

2015-01-01

The current study examined intergenerational continuity in economic hardship, parental positivity, and positive parenting across generations based on both the Family Stress Model and the Family Resilience Framework. The study included 220 generation one (G1) parents, their target youth (generation two: G2) who participated from adolescence through adulthood, and the target’s child (generation three: G3). Assessments included observational and self-report measures. Results indicated that G1 economic hardship negatively influenced both G1 positivity and G1 positive parenting. Similarly, G2 economic hardship was negatively related to both G2 positivity and G2 positive parenting which, in turn, was associated with G3 positive behavior to G2. For both G1 and G2, parental positivity mediated the association between economic hardship and positive parenting. G2 economic hardship was indirectly related to G3 positive behavior through G2 parental positivity and positive parenting. An important finding is that the intergenerational continuity of economic hardship, positivity, and positive parenting were transmitted from G1 to G2. Results suggest that even in times of economic adversity, parental positivity and positive parenting were transmitted from G1 parents to their G2 youth during adulthood. Such continuity seems to influence the positive behavior of the G3 children. PMID:26371448

The undue burden of paying for abortion: An exploration of abortion fund cases.

PubMed

Ely, Gretchen E; Hales, Travis; Jackson, D Lynn; Maguin, Eugene; Hamilton, Greer

2017-02-01

The results of a secondary data analysis of 3,999 administrative cases from a national abortion fund, representing patients who received pledges for financial assistance to pay for an abortion from 2010 to 2015, are presented. Case data from the fund's national call center was analyzed to assess the impact of the fund and examine sample demographics which were compared to the demographics of national abortion patients. Procedure costs, patient resources, funding pledges, additional aid, and changes over time in financial pledges for second-trimester procedures were also examined. Results indicate that the fund sample differed from national abortion patients in that fund patients were primarily single, African American, and seeking funding for second trimester abortions. Patients were also seeking to fund expensive procedures, costing an average of over $2,000; patients were receiving over $1,000 per case in pledges and other aid; and funding pledges for second trimester procedures were increasing over time. Abortion funding assistance is essential for women who are not able to afford abortion costs, and it is particularly beneficial for patients of color and those who are younger and single. Repeal of policy banning public funding of abortion would help to eliminate financial barriers that impede abortion access.

Undue influence of weight and shape: is it distinct from body dissatisfaction and concern about weight and shape?

PubMed

Wade, T D; Zhu, G; Martin, N G

2011-04-01

Three cognitive constructs are risk factors for eating disorders: undue influence of weight and shape, concern about weight and shape, and body dissatisfaction (BD). Undue influence, a diagnostic criterion for eating disorders, is postulated to be closely associated with self-esteem whereas BD is postulated to be closely associated with body mass index (BMI). We understand less about the relationships with concern about weight and shape. The aim of the current investigation was examine the degree of overlap across these five phenotypes in terms of latent genetic and environmental risk factors in order to draw some conclusions about the similarities and differences across the three cognitive variables. A sample of female Australian twins (n=1056, including 348 complete pairs), mean age 35 years (S.D.=2.11, range 28-40), completed a semi-structured interview about eating pathology and self-report questionnaires. An independent pathways model was used to investigate the overlap of genetic and environmental risk factors for the five phenotypes. In terms of variance that was not shared with other phenotypes, self-esteem emerged as being separate, with 100% of its variance unshared with the other phenotypes, followed by undue influence (51%) and then concern (34%), BD (28%) and BMI (32%). In terms of shared genetic risk, undue influence and concern were more closely related than BD, whereas BMI and BD were found to share common sources of risk. With respect to environmental risk factors, concern, BMI and BD were more closely related to each other than to undue influence.

Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer?

PubMed

Pisu, Maria; Kenzik, Kelly M; Oster, Robert A; Drentea, Patricia; Ashing, Kimlin T; Fouad, Mona; Martin, Michelle Y

2015-04-15

Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship. Patients with lung cancer (LC) and colorectal cancer (CRC) participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium were surveyed approximately 4 months (baseline) and 12 months (follow-up) after diagnosis. Economic hardship at follow-up was present if participants 1) indicated difficulty living on household income; and/or 2) for the following 2 months, anticipated experiencing hardships (inadequate housing, food, or medical attention) or reducing living standards to the bare necessities of life. The authors tested whether African Americans (AAs) and Hispanics were more likely than whites to experience economic hardship controlling for sex, age, education, marital status, cancer stage, treatment, and economic status at baseline (income, prescription drug coverage). Of 3432 survivors (39.7% with LC, 60.3% with CRC), 14% were AA, 7% were Hispanic, and 79% were white. AAs and Hispanics had lower education and income than whites. Approximately 68% of AAs, 58% of Hispanics, and 44.5% of whites reported economic hardship. In LC survivors, the Hispanic-white disparity was not significant in unadjusted or adjusted analyses, and the AA-white disparity was explained by baseline economic status. In CRC survivors, the Hispanic-white disparity was explained by baseline economic status, and the AA-white disparity was not explained by the variables that were included in the model. Economic hardship was evident in almost 1 in 2 cancer survivors 1 year after diagnosis, especially AAs. Research should evaluate and address risk factors and their impact on survival and survivorship outcomes. © 2015 American Cancer Society.

Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women.

PubMed

Gross, Rachel S; Mendelsohn, Alan L; Gross, Michelle B; Scheinmann, Roberta; Messito, Mary Jo

2016-07-01

To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women. We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether 4 domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered individually and also cumulatively, were associated with having a low internal locus of control over the prevention of child obesity. The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least 1 hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (adjusted odds ratio, 2.38; 95% confidence interval, 1.50-3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship with an increased odds of having a low internal locus of control. Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately affect infant feeding practices and child weight trajectories. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Prenatal Material Hardships and Infant Regulatory Capacity at 10 Months Old in Low-Income Hispanic Mother-Infant Pairs.

PubMed

Fuller, Anne; Messito, Mary Jo; Mendelsohn, Alan L; Oyeku, Suzette O; Gross, Rachel S

2018-05-02

Prenatal maternal stresses have been associated with infant temperament patterns linked to later behavioral difficulties. Material hardships, defined as inability to meet basic needs, are important prenatal stressors. Our objective was to determine the associations between prenatal material hardships and infant temperament at 10 months. This was a longitudinal study of mother-infant pairs in a randomized controlled trial of a primary care-based early obesity prevention program (Starting Early). Independent variables representing material hardship were: housing disrepair, food insecurity, difficulty paying bills and neighborhood stress (neighborhood safety). Dependent variables representing infant temperament were assessed using questions from three subscales of the Infant Behavior Questionnaire: orienting/regulatory capacity, negative affect, and surgency/extraversion. We used linear regression to investigate associations between individual and cumulative hardships and each temperament domain, adjusting for confounders, and testing for depression as a moderator. 412 mother-infant pairs completed 10 month assessments. 32% reported food insecurity, 26% difficulty paying bills, 35% housing disrepair and 9% neighborhood stress. In adjusted analyses, food insecurity was associated with lower orienting/regulatory capacity scores (B=-0.25, 95% CI -0.47, -0.04), as were neighborhood stress (B=-0.50, 95% CI -0.83, -0.16) and experiencing 3-4 hardships (compared with none) (B=-0.54, 95% CI -0.83, -0.21). For neighborhood stress, the association was stronger among infants of mothers with prenatal depressive symptoms (interaction term p=0.06). Prenatal material hardships were associated with lower orienting/regulatory capacity. These findings support the need for further research exploring how temperament relates to child behavior, and for policies to reduce prenatal material hardships. Copyright © 2018. Published by Elsevier Inc.

Economic hardship and depression across the life course: the impact of welfare state regimes.

PubMed

Levecque, Katia; Van Rossem, Ronan; De Boyser, Katrien; Van de Velde, Sarah; Bracke, Piet

2011-06-01

Previous research in the United States suggests that depression related to economic hardship decreases with age. We test whether this pattern can be generalized to other developed nations. Based on data from 23 countries in the European Social Survey (2006--2007), multilevel analyses show that the moderating role of age depends on the socio-political context. While the hardship--depression link is not significantly different across the life course in Nordic and Bismarckian regimes, the hardship--depression link increases with age in Southern and Eastern European countries and decreases with age in strength in Anglo-Saxon welfare states. Our findings suggest that welfare state regimes play a significant role in attenuating, boosting, or even reversing the health effects of social experiences such as economic hardship on aging. Health knowledge gained through research that ignores the socio-political context may be limited in terms of generalization.

Adapting to Life after Hurricane Katrina and the Deepwater Horizon Oil Spill: An Examination of Psychological Resilience and Depression on the Mississippi Gulf Coast.

PubMed

Blackmon, Bret J; Lee, Joohee; Cochran, David M; Kar, Bandana; Rehner, Timothy A; Baker, Alvin M

2017-01-02

The purpose of this study was to examine relationships among depression, psychological resilience, and other sociodemographic factors of individuals who were highly exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. A spatially stratified random sample of 294 Mississippi Gulf Coast residents living in close proximity to the Gulf of Mexico were surveyed. Findings indicated that low education attainment, financial hardship, and disaster-related damages increased the likelihood of depression, whereas psychological resilience and having health insurance reduced the odds of depression. Implications for enhancing psychological resilience and increasing access to health insurance are discussed.

Management of Pediatric Trauma.

PubMed

2016-08-01

Injury is still the number 1 killer of children ages 1 to 18 years in the United States (http://www.cdc.gov/nchs/fastats/children.htm). Children who sustain injuries with resulting disabilities incur significant costs not only for their health care but also for productivity lost to the economy. The families of children who survive childhood injury with disability face years of emotional and financial hardship, along with a significant societal burden. The entire process of managing childhood injury is enormously complex and varies by region. Only the comprehensive cooperation of a broadly diverse trauma team will have a significant effect on improving the care of injured children. Copyright © 2016 by the American Academy of Pediatrics.

Stressors, social support, religious practice, and general well-being among Korean adult immigrants.

PubMed

Lee, Kyoung Hag; Woo, Hyeyoung

2013-10-01

Through this cross-sectional study the authors explore how stressors, social support, and religious practice are associated with the general well-being of 147 Korean adult immigrants through interviews. Hierarchical regression analysis reveals that low English proficiency and financial hardship are significantly related to low general well-being. However, high social support and religious practice are significantly associated with high general well-being. Social service and health care providers need to carefully assess stressors, social support systems, and spiritual issues for providing appropriate services/programs for English, culture, or social activities as well as spiritual intervention to maximize the strengths of Korean immigrants coping with health issues.

Family caregivers of people with dementia

PubMed Central

Brodaty, Henry; Donkin, Marika

2009-01-01

Family caregivers of people with dementia, often called the invisible second patients, are critical to the quality of life of the care recipients. The effects of being a family caregiver, though sometimes positive, are generally negative, with high rates of burden and psychological morbidity as well as social isolation, physical ill-health, and financial hardship. Caregivers vulnerable to adverse effects can be identified, as can factors which ameliorate or exacerbate burden and strain. Psychosocial interventions have been demonstrated to reduce caregiver burden and depression and delay nursing home admission. Comprehensive management of the patient with dementia includes building a partnership between health professionals and family caregivers, referral to Alzheimer's Associations, and psychosocial interventions where indicated. PMID:19585957

United States public policy and the elderly: the disproportionate risk to the well-being of women.

PubMed

Burkhauser, R V; Duncan, G J

1991-01-01

"Cross-sectional comparisons show that poverty among the aged in the United States has dropped dramatically over the last two decades. We use longitudinal data to identify economic events associated with unfavorable economic outcomes and to trace the influence of these events on women and men at different ages. We find that while social insurance programs appear to prevent severe financial hardship from the most frequent work-related events, they are far less effective in cushioning the economic impact of widowhood and divorce, especially for women. We suggest a number of policy changes that would provide some measure of social insurance against adverse family-related events." excerpt

Financial background and student debt impact on postgraduate residency choices of medical students in Singapore.

PubMed

Fong, Jie Ming Nigel; Tan, Yeong Tze Wilnard; Sayampanathan, Andrew Arjun; Mohan, Niraj; Koh, Yun Qing; Jang, Jin Hao Justin; Low, Jin Rong Ivan; Vasudevan, Anupama; Ng, Chew Lip; Tambyah, Paul Ananth

2018-06-07

Medical school fees are rising globally. Student debt and financial background may affect residency choices, but few studies have been conducted in Asia. This study aimed to explore the relationship between financial background, student debt and postgraduate residency choices among medical students in Singapore. An anonymised survey of all medical students in Singapore was conducted, with a response rate of 67.9%. 40.5% of our study population were graduates with debt. Medical students with monthly per capita household income < SGD 1,000 were more likely to graduate with debt (unadjusted odds ratio [OR] [95% confidence interval {CI}] 2.0 [1.6-2.7]; p < 0.001) and feel burdened by the cost of medical education (unadjusted OR [95% CI] 2.8 [2.0-3.9]; p < 0.001). Students with per capita monthly household income < SGD 1,000 (unadjusted OR [95% CI] 1.818 [1.338-2.470], p < 0.001; adjusted OR [95% CI] 1.692 [1.202-2.381], p = 0.003) and those with debt (unadjusted OR [95% CI] 1.623 [1.261-2.090], p < 0.001; adjusted OR [95% CI] 1.393 [1.048-1.851], p = 0.022) were more likely to rank at least one economic factor as 'very significant' in influencing their postgraduate training choices. It is concerning that despite financial aid schemes, the cost of medical education remained a burden to students from lower income households in Singapore. Student debt and financial background may distort postgraduate career choices, creating an undue push toward high-paying specialties.

Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys.

PubMed

Zhao, Yuan; Kershaw, Trace; Ettinger, Adrienne S; Higgins, Chandra; Lu, Michael C; Chao, Shin M

2015-10-01

We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01-2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.

The stem cell debate continues: the buying and selling of eggs for research.

PubMed

Baylis, F; McLeod, C

2007-12-01

Now that stem cell scientists are clamouring for human eggs for cloning-based stem cell research, there is vigorous debate about the ethics of paying women for their eggs. Generally speaking, some claim that women should be paid a fair wage for their reproductive labour or tissues, while others argue against the further commodification of reproductive labour or tissues and worry about voluntariness among potential egg providers. Siding mainly with those who believe that women should be financially compensated for providing eggs for research, the new stem cell guidelines of the International Society for Stem Cell Research (ISSCR) legitimise both reimbursement of direct expenses and financial compensation for many women who supply eggs for research. In this paper, the authors do not attempt to resolve the thorny issue of whether payment for eggs used in human embryonic stem cell research is ethically legitimate. Rather, they want to show specifically that the ISSCR recommended payment practices are deeply flawed and, more generally, that all payment schemes that aim to avoid undue inducement of women risk the global exploitation of economically disadvantaged women.

Financial issues constraining the use of pancreata recovered for islet transplantation: a white paper.

PubMed

Markmann, J F; Kaufman, D B; Ricordi, C; Schwab, P M; Stock, P G

2008-08-01

Islet transplantation is a very promising therapy for select patients with type 1 diabetes. Continued clinical investigation is required to define the long-term safety and efficacy outcomes before the procedure will be accepted as a standard of care even for those with the most severe manifestations of diabetes. Threatening successful accomplishment of these and other innovative studies designed to advance the field are the complex financial cost accounting issues that pose undue burden on organ procurement organizations and transplant centers trying to manage the costs of the pancreata from deceased donors needed to isolate islets. Compounding the problem is the recent ruling by CMS regarding 'intent to transplant' (CMS-1543-R Dec. 21, 2006: Allocation of Donor Acquisition Costs Incurred by Organ Procurement Organizations) that does not account for the clinical need to complete the manufacturing process for islets before suitability and transplant intent of the pancreata involved can be determined. We provide a consensus document supported by a diverse group of stakeholders in islet transplantation to suggest actions to address this problem.

Family Economic Hardship and Progression of Poor Mental Health in Middle-Aged Husbands and Wives

ERIC Educational Resources Information Center

Wickrama, K. A. S.; Surjadi, Florensia F.; Lorenz, Frederick O.; Conger, Rand D.; O'Neal, Catherine Walker

2012-01-01

Using prospective data from 370 middle-aged husbands and wives during a 12-year period, we investigated the intra-individual and dyadic influence of family economic hardship on the levels of depressive symptoms of husbands and wives over their middle years. The results suggest that family economic hardship during the early middle years contributes…

Food Hardships and Child Behavior Problems among Low-Income Children. Discussion Paper No. 1290-04

ERIC Educational Resources Information Center

Slack, Kristen Shook; Yoo, Joan

2004-01-01

Using data from two waves of a panel study of families who currently or recently received cash welfare benefits, we test hypotheses about the relationship between food hardships and behavior problems among two different age groups (458 children ages 3-5-and 747 children ages 6-12). Results show that food hardships are positively associated with…

Legal Standards for Brain Death and Undue Influence in Euthanasia Laws.

PubMed

Pope, Thaddeus Mason; Okninski, Michaela E

2016-06-01

A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for brain death, requiring the amendment of either or both. In South Australia, a Bill seeks to establish a legal right for a defined category of persons suffering unbearably to request voluntary euthanasia. However, an essential criterion of a voluntary decision is that it is not tainted by undue influence, and this Bill falls short of providing adequate guidance to assess for undue influence.

Economic Benefits and Treatment Progress as Determinants of the Sustainability of Vietnamese Voluntary Co-Located Patients Clusters

PubMed Central

Vuong, Quan-Hoang

2017-01-01

Background Over the past 15 years or so, in Vietnam, a phenomenon has steadily grown more and more widespread: the forming of co-located patients communities. Poor patients choose to live together, seeking/lending supports from/to one another. Despite the undeniable existence of these communities, little is researched or known about how co-located patients perceive the value of what they receive as cluster members, or how they assess their future connection to the communities they are living in. Materials and Methods The study employs multiple logistic regressions method to investigate relationships between factors such as perceived satisfaction from community-provided financial means, reported health improvements, along with patients’ short-and longer-term commitments to these communities. Results The results suggest meaningful empirical relationships: 1) between, on one hand, gender, perceived values and sustainability of patients communities, financial stress faced by patients and the financial benefits they received from the community, and, on the other hand, their propensity to stay connected to it; and 2) between economic conditions, length of stay with a community, general level of satisfaction, health improvements on one hand and long-term commitment to these communities on the other hand. Conclusions Patients who choose to stick to co-location clusters do so for an economic reason: finding means to fight their financial hardship. This may suggest a degree of complication higher than one would have thought in dealing with poor patients from a social point of view. Concretely, the majority of the public only focuses on charity programs and in-king donations, while ignoring the more sustainable – and, at the same time, more complicated – alternative which is to create suitable income-generating jobs for patient. In addition, patients are not only those who seek to ask for supports but can potentially be the donors contributing to the sustainability of those voluntary communities. Significance for public health Poor patients in transitioning economy, Vietnam included, to a market model oftentimes live in desparate economic hardship. Voluntary co-location emerged to be a solution for the poor in absence of adequate social supports for public health. This short report represents one of the first investigations into the social psychology and underlying economics of those communities. The understanding would likely be useful for planning and designing future policy response for this critical aspect of public health in Vietnam. By appropriate interventions and supports, the government and society can help to reduce economic inequality and deliver better inclusive economic growth. PMID:28480174

Progress on catastrophic health spending in 133 countries: a retrospective observational study.

PubMed

Wagstaff, Adam; Flores, Gabriela; Hsu, Justine; Smitz, Marc-François; Chepynoga, Kateryna; Buisman, Leander R; van Wilgenburg, Kim; Eozenou, Patrick

2018-02-01

The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations between catastrophic health spending and macroeconomic and health system variables at the country level. We did a retrospective observational study of health spending using data obtained from household surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between 1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption. We estimated global incidence by aggregating up from every country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation between a country's incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini coefficient for income inequality, and the share of total health expenditure spent by social security funds, other government agencies, private insurance schemes, and non-profit institutions. The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in 2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and incidence correlated negatively with the share of total health spending channelled through social security funds and other government agencies. The proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions. Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID). © 2017 The World Bank and World Health Organization. Published by Elsevier. This is an Open Access Article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this Article, there should be no suggestion that The World Bank or WHO endorse any specific organisation, products or services. The use of The World Bank or the WHO logo is not permitted. This notice should be preserved along with the Article's original URL.

Social Determinants of Perceived Discrimination among Black Youth: Intersection of Ethnicity and Gender.

PubMed

Assari, Shervin; Caldwell, Cleopatra Howard

2018-02-15

Most of the existing sociological and epidemiological literature has focused on the protective effects of high socioeconomic status (SES) on population health through reducing exposure to risk factors and increasing human and material resources that can mitigate adversities. Recent studies, however, have documented poor mental health of high SES Blacks, particularly African American males and Caribbean Black females. The literature also shows a link between perceived discrimination and poor mental health. To better understand the extra costs of upward social mobility for minority populations, this study explored ethnic by gender variations in the associations between SES indicators and perceived discrimination in an ethnically diverse national sample of Black youth. This study included 810 African American and 360 Caribbean Black youth who were sampled in the National Survey of American Life-Adolescent supplement (NSAL-A). Three SES indicators (financial hardship, family income, and income to needs ratio) were the independent variables. The dependent variable was perceived (daily) discrimination. Age was the covariate. Ethnicity and gender were the focal moderators. Linear regressions were used for data analysis in the pooled sample and also based on the intersection of ethnicity and gender. Considerable gender by ethnicity variations were found in the patterns of the associations between SES indicators and perceived discrimination. Financial hardship was a risk factor for perceived discrimination in African American males only. High family income and income to needs ratio were associated with high (but not low) perceived discrimination in African American males and Caribbean Black females. SES indicators were not associated with perceived discrimination for African American females or Caribbean Black males. When it comes to Black youth, high SES is not always protective. Whether SES reduces or increases perceived discrimination among Black youth depends on the intersection of ethnicity by gender. Additional research is needed to understand why and how high SES increases exposure and vulnerability to discrimination for some groups of Black youth.

Development and preliminary evaluation of the OsteoArthritis Questionnaire (OA-Quest): a psychometric study.

PubMed

Busija, L; Buchbinder, R; Osborne, R H

2016-08-01

This study reports the development of the OsteoArthritis Questionnaire (OA-Quest) - a new measure designed to comprehensively capture the potentially modifiable burden of osteoarthritis. Item development was guided by the a priori conceptual framework of the Personal Burden of Osteoarthritis (PBO) which captures 8 dimensions of osteoarthritis burden (Physical distress, Fatigue, Physical limitations, Psychosocial distress, Physical de-conditioning, Financial hardship, Sleep disturbances, Lost productivity). One hundred and twenty three candidate items were pretested in a clinical sample of 18 osteoarthritis patients. The measurement properties of the OA-Quest were assessed with exploratory factor analysis (EFA), Rasch modelling, and confirmatory factor analysis (CFA) in a community-based sample (n = 792). EFA replicated 7 of the 8 PBO domains. An exception was PBO Fatigue domain, with items merging into the Physical distress subscale in the OA-Quest. Following item analysis, a 42-item 7-subscale questionnaire was constructed, measuring Physical distress (seven items, Cronbach's α = 0.93), Physical limitations (11 items, α = 0.95), Psychosocial distress (seven items, α = 0.93), Physical de-conditioning (four items, α = 0.87), Financial hardship (four items, α = 0.93), Sleep disturbances (five items, α = 0.96), and Lost productivity (four items α = 0.90). A highly restricted 7-factor CFA model had excellent fit with the data (χ(2)(113) = 316.36, P < 0.001; chi-square/degrees of freedom = 2.8; comparative fit index [CFI] = 0.97; root mean square error of approximation [RMSEA] = 0.07), supporting construct validity of the new measure. The OA-Quest is a new measure of osteoarthritis burden that is founded on a comprehensive conceptual model. It has strong evidence of construct validity and provides reliable measurement across a broad range of osteoarthritis burden. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Social Determinants of Perceived Discrimination among Black Youth: Intersection of Ethnicity and Gender

PubMed Central

Caldwell, Cleopatra Howard

2018-01-01

Most of the existing sociological and epidemiological literature has focused on the protective effects of high socioeconomic status (SES) on population health through reducing exposure to risk factors and increasing human and material resources that can mitigate adversities. Recent studies, however, have documented poor mental health of high SES Blacks, particularly African American males and Caribbean Black females. The literature also shows a link between perceived discrimination and poor mental health. To better understand the extra costs of upward social mobility for minority populations, this study explored ethnic by gender variations in the associations between SES indicators and perceived discrimination in an ethnically diverse national sample of Black youth. This study included 810 African American and 360 Caribbean Black youth who were sampled in the National Survey of American Life—Adolescent supplement (NSAL-A). Three SES indicators (financial hardship, family income, and income to needs ratio) were the independent variables. The dependent variable was perceived (daily) discrimination. Age was the covariate. Ethnicity and gender were the focal moderators. Linear regressions were used for data analysis in the pooled sample and also based on the intersection of ethnicity and gender. Considerable gender by ethnicity variations were found in the patterns of the associations between SES indicators and perceived discrimination. Financial hardship was a risk factor for perceived discrimination in African American males only. High family income and income to needs ratio were associated with high (but not low) perceived discrimination in African American males and Caribbean Black females. SES indicators were not associated with perceived discrimination for African American females or Caribbean Black males. When it comes to Black youth, high SES is not always protective. Whether SES reduces or increases perceived discrimination among Black youth depends on the intersection of ethnicity by gender. Additional research is needed to understand why and how high SES increases exposure and vulnerability to discrimination for some groups of Black youth. PMID:29462893

Unhealthy marketing of pharmaceutical products: An international public health concern.

PubMed

Mulinari, Shai

2016-05-01

I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care.

19 CFR 111.34 - Undue influence upon Department of Homeland Security employees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Undue influence upon Department of Homeland Security employees. 111.34 Section 111.34 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CUSTOMS BROKERS Duties and Responsibilities of Customs...

19 CFR 111.34 - Undue influence upon Department of Homeland Security employees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Undue influence upon Department of Homeland Security employees. 111.34 Section 111.34 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CUSTOMS BROKERS Duties and Responsibilities of Customs...

19 CFR 111.34 - Undue influence upon Department of Homeland Security employees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Undue influence upon Department of Homeland Security employees. 111.34 Section 111.34 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CUSTOMS BROKERS Duties and Responsibilities of Customs...

19 CFR 111.34 - Undue influence upon Department of Homeland Security employees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Undue influence upon Department of Homeland Security employees. 111.34 Section 111.34 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CUSTOMS BROKERS Duties and Responsibilities of Customs...

19 CFR 111.34 - Undue influence upon Department of Homeland Security employees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Undue influence upon Department of Homeland Security employees. 111.34 Section 111.34 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CUSTOMS BROKERS Duties and Responsibilities of Customs...

18 CFR 157.35 - Undue discrimination or preference.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Undue discrimination or preference. 157.35 Section 157.35 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Fast Track Processing procedures contained in § 385.206(h). (c) Each prospective applicant conducting...

15 CFR 0.735-19 - Reporting undue influence to superiors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Government position, former Government employment, family relationship, political position, or otherwise, the.... 0.735-19 Section 0.735-19 Commerce and Foreign Trade Office of the Secretary of Commerce EMPLOYEE RESPONSIBILITIES AND CONDUCT Regulatory Limitations Upon Employee Conduct § 0.735-19 Reporting undue influence to...

RELATIONAL SCHEMAS, HOSTILE ROMANTIC RELATIONSHIPS, AND BELIEFS ABOUT MARRIAGE AMONG YOUNG AFRICAN AMERICAN ADULTS

PubMed Central

Simons, Ronald L.; Simons, Leslie Gordon; Lei, Man Kit; Landor, Antoinette

2011-01-01

The present study tests a developmental model designed to explain the romantic relationship difficulties and reluctance to marry often reported for African Americans. Using longitudinal data from a sample of approximately 400 African American young adults, we examine the manner in which race-related adverse experiences during late childhood and early adolescence give rise to the cynical view of romantic partners and marriage held by many young African Americans. Our results indicate that adverse circumstances disproportionately suffered by African American youth (viz., harsh parenting, family instability, discrimination, criminal victimization, and financial hardship) promote distrustful relational schemas that lead to troubled dating relationships, and that these negative relationship experiences, in turn, encourage a less positive view of marriage. PMID:22328799

Decisions in poverty contexts.

PubMed

Shafir, Eldar

2017-12-01

The circumstances surrounding poverty-tight financial challenges, instability of income and expenses, low savings, no insurance, and several other stressors-translate into persistent and cognitively taxing hardship for people in poverty contexts. Thoughts about money and expenses loom large, shape mental associations, interfere with other experiences, and are difficult to suppress. The persistent juggling of insufficient resources affects attention, cognitive resources, and ensuing decisions. Despite the demanding struggle with challenging circumstances, people in poverty encounter disdain rather than admiration, and obstacles rather than support. Societal appreciation for the power of context, along with behaviorally informed programs designed to facilitate life under poverty, are essential for those in poverty contexts to be able to make the most of their challenging circumstances. Copyright © 2017 Elsevier Ltd. All rights reserved.

Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries.

PubMed

Jagsi, Reshma; Pottow, John A E; Griffith, Kent A; Bradley, Cathy; Hamilton, Ann S; Graff, John; Katz, Steven J; Hawley, Sarah T

2014-04-20

To evaluate the financial experiences of a racially and ethnically diverse cohort of long-term breast cancer survivors (17% African American, 40% Latina) identified through population-based registries. Longitudinal study of women diagnosed with nonmetastatic breast cancer in 2005 to 2007 and reported to the SEER registries of metropolitan Los Angeles and Detroit. We surveyed 3,133 women approximately 9 months after diagnosis and 4 years later. Multivariable models evaluated correlates of self-reported decline in financial status attributed to breast cancer and of experiencing at least one type of privation (economically motivated treatment nonadherence and broader hardships related to medical expenses). Among 1,502 patients responding to both surveys, median out-of-pocket expenses were ≤ $2,000; 17% of respondents reported spending > $5,000; 12% reported having medical debt 4 years postdiagnosis. Debt varied significantly by race: 9% of whites, 15% of blacks, 17% of English-speaking Latinas, and 10% of Spanish-speaking Latinas reported debt (P = .03). Overall, 25% of women experienced financial decline at least partly attributed to breast cancer; Spanish-speaking Latinas had significantly increased odds of this decline relative to whites (odds ratio [OR], 2.76; P = .006). At least one privation was experienced by 18% of the sample; blacks (OR, 2.6; P < .001) and English-speaking Latinas (OR, 2.2; P = .02) were significantly more likely to have experienced privation than whites. Racial and ethnic minority patients appear most vulnerable to privations and financial decline attributable to breast cancer, even after adjustment for income, education, and employment. These findings should motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.

War experiences and psychotic symptoms among former child soldiers in Northern Uganda: the mediating role of post-war hardships – the WAYS Study

PubMed Central

Amone-P’Olak, Kennedy; Otim, Balaam Nyeko; Opio, George; Ovuga, Emilio; Meiser-Stedman, Richard

2014-01-01

Psychotic symptoms have been associated with post-traumatic stress disorder and war experiences. However, the relationships between types of war experiences, the onset and course of psychotic symptoms, and post-war hardships in child soldiers have not been investigated. This study assessed whether various types of war experiences contribute to psychotic symptoms differently and whether post-war hardships mediated the relationship between war experiences and later psychotic symptoms. In an ongoing longitudinal cohort study (the War-Affected Youths Survey), 539 (61% male) former child soldiers were assessed for psychotic symptoms, post-war hardships, and previous war experiences. Regression analyses were used to assess the contribution of different types of war experiences on psychotic symptoms and the mediating role of post-war hardships in the relations between previous war experiences and psychotic symptoms. The findings yielded ‘witnessing violence’, ‘deaths and bereavement’, ‘involvement in hostilities’, and ‘sexual abuse’ as types of war experiences that significantly and independently predict psychotic symptoms. Exposure to war experiences was related to psychotic symptoms through post-war hardships (β = .18, 95% confidence interval = [0.10, 0.25]) accounting for 50% of the variance in their relationship. The direct relation between previous war experiences and psychotic symptoms attenuated but remained significant (β = .18, 95% confidence interval = [0.12, 0.26]). Types of war experiences should be considered when evaluating risks for psychotic symptoms in the course of providing emergency humanitarian services in post-conflict settings. Interventions should consider post-war hardships as key determinants of psychotic symptoms among war-affected youths. PMID:24718435

STATE DEPARTMENT: Staffing Shortfalls and Ineffective Assignment System Compromise Diplomatic Readiness at Hardship Posts

DTIC Science & Technology

2002-06-01

its permanent positions—both in terms of the number and types of employees in its workforce . Therefore, it is difficult for the department to ensure...in its Foreign Service overseas workforce . Many positions at hardship posts, including some of strategic importance to the United States, remain... workforce are in hardship posts, which have a vacancy rate of 12.6 percent, compared with a vacancy rate of 8.4 percent in nonhardship posts

16 CFR 1119.4 - Factors considered in determining civil penalties.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) The appropriateness of such penalty in relation to the size of the business of the person charged, including how to mitigate undue adverse economic impacts on small businesses; and (F) Such other factors as... relation to the size of the business of the person charged, including how to mitigate undue adverse...

Sibling Caregivers of People With Intellectual and Developmental Disabilities: Sociodemographic Characteristics and Material Hardship Prevalence.

PubMed

Sonik, Rajan A; Parish, Susan L; Rosenthal, Eliana S

2016-10-01

In growing numbers, people with intellectual and developmental disabilities are outliving their parents, or at least their parents' ability to care for them. Consequently, adult siblings without intellectual and developmental disabilities are increasingly taking on primary caregiving responsibilities. However, adult siblings have received little study generally, and sibling caregivers have received even less. We used nationally representative data from the Survey of Income and Program Participation (SIPP) to describe the social characteristics and material hardship levels of sibling caregivers, in comparison to the general working age adult population. This study finds moderate material hardship to be pervasive among sibling caregivers, though extreme levels of hardship are possibly being abated somewhat through public benefit programs. Implications for greater service needs are discussed.

How IRBs view and make decisions about coercion and undue influence.

PubMed

Klitzman, Robert

2013-04-01

Scholars have debated how to define coercion and undue influence, but how institutional review boards (IRBs) view and make decisions about these issues in actual cases has not been explored. I contacted the leadership of 60 US IRBs (every fourth one in the list of the top 240 institutions by National Institutes of Health funding), and interviewed 39 IRB leaders or administrators from 34 of these institutions (response rate=55%), and 7 members. IRBs wrestled with defining of 'coercion' and 'undue inducement', most notably in deciding about participant compensation. IRBs often use these terms synonymously and define undue inducement in varying ways, often wrestling with these issues, relying on 'gut feelings', and seeking compromises. Ambiguities arose, partly reflecting underlying tensions: whether subjects should 'get paid' versus 'volunteer' (ie, whether subjects should be motivated by compensation vs altruism), and whether subjects should be paid differently based on income, given possible resultant selection bias. Lack of consistent standards emerged between and even on single IRBs. Questions arose concerning certain aspects and types of studies; for example, how to view and weigh providing free care in research, whether and how recruitment flyers should mention compensation, and how to avoid coercion in paediatric, developing world, or students research. These data, the first to probe qualitatively how IRBs view and approach questions about coercion, undue influence and participant compensation, and to examine how IRBs have reviewed actual cases, reveal several critical ambiguities and dilemmas, and have vital implications for future practice, education, policy and research.

Social context of HIV risk behaviours among male-to-female transgenders of colour.

PubMed

Nemoto, T; Operario, D; Keatley, J; Villegas, D

2004-08-01

To explore the social context of drug use and sexual behaviours that put male-to-female (MTF) transgenders at risk for HIV, focus groups were conducted consisting of African American, Latina and Asian and Pacific Islander MTF transgenders (N = 48) who reside or work in San Francisco, California. Participants were likely to report having unprotected sex with primary partners to signify love and emotional connection, as well as to receive gender validation from their partners. In contrast, viewing sex work with customers as a business encouraged intentious to use condoms. Safer sex intentions with customers were frequently undermined by urgent financial needs, which stemmed from transphobia, employment discrimination and costly procedures associated with gender transition. Participants reported using drugs as a way to cope with or escape life stresses associated with relationships, sex work, transphobia and financial hardship. Interventions with at-risk MTF transgenders should address the interpersonal and social context of unsafe sex and drug use, particularly the unique roles of relationship issues with male partners, stigma, discrimination and community norms regarding sex work and drug use.

Nurses as family caregivers - barriers and enablers facing nurses caring for children, parents or both.

PubMed

Clendon, Jill; Walker, Léonie

2017-03-01

To examine the dual caregiving and nursing responsibilities of nurses in New Zealand with a view to identifying potential strategies, policies and employment practices that may help to retain nurses with caregiving responsibilities in the workplace. As the nursing workforce ages, child-bearing is delayed and older family members are living longer, family caregiving responsibilities are impacting more on the working life of nurses. This may complicate accurate workforce planning assumptions. An explorative, descriptive design using interviews and focus groups with 28 registered nurses with family caregiving responsibilities. A depth of (largely hidden) experience was exposed revealing considerable guilt, physical, emotional and financial hardship. Regardless of whether the nurse chose to work or had to for financial reasons, family always came first. Demographic and societal changes related to caregiving may have profound implications for nursing. Workplace support is essential to ensure that nurses are able to continue to work. Increased awareness, support, flexibility and specific planning are required to retain nurses with family caregiving responsibilities. © 2016 John Wiley & Sons Ltd.

The association between neighborhood economic hardship, the retail food environment, fast food intake, and obesity: findings from the Survey of the Health of Wisconsin.

PubMed

Laxy, Michael; Malecki, Kristen C; Givens, Marjory L; Walsh, Matthew C; Nieto, F Javier

2015-03-13

Neighborhood-level characteristics such as economic hardship and the retail food environment are assumed to be correlated and to influence consumers' dietary behavior and health status, but few studies have investigated these different relationships comprehensively in a single study. This work aims to investigate the association between neighborhood-level economic hardship, the retail food environment, fast food consumption, and obesity prevalence. Linking data from the population-based Survey of the Health of Wisconsin (SHOW, n = 1,570, 2008-10) and a commercially available business database, the Wisconsin Retail Food Environment Index (WRFEI) was defined as the mean distance from each participating household to the three closest supermarkets divided by the mean distance to the three closest convenience stores or fast food restaurants. Based on US census data, neighborhood-level economic hardship was defined by the Economic Hardship Index (EHI). Relationships were analyzed using multivariate linear and logistic regression models. SHOW residents living in neighborhoods with the highest economic hardship faced a less favorable retail food environment (WRFEI = 2.53) than residents from neighborhoods with the lowest economic hardship (WRFEI = 1.77; p-trend < 0.01). We found no consistent or significant associations between the WRFEI and obesity and only a weak borderline-significant association between access to fast food restaurants and self-reported fast food consumption (≥ 2 times/week, OR = 0.59-0.62, p = 0.05-0.09) in urban residents. Participants reporting higher frequency of fast food consumption (≥ 2 times vs. <2 times per week) were more likely to be obese (OR = 1.35, p = 0.06). This study indicates that neighborhood-level economic hardship is associated with an unfavorable retail food environment. However inconsistent or non-significant relationships between the retail food environment, fast food consumption, and obesity were observed. More research is needed to enhance methodological approaches to assess the retail food environment and to understand the complex relationship between neighborhood characteristics, health behaviors, and health outcomes.

76 FR 802 - Florida Power and Light Company, Turkey Point, Units 3 and 4; Exemption

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-06

..., health physics, chemistry, and security, to maintain the safe and secure operation of the facility. The... exemption is authorized by law. No Undue Risk to Public Health and Safety The underlying purposes of 10 CFR... previously evaluated. Therefore, there is no undue risk to public health and safety. Consistent With Common...

Income is not enough: incorporating material hardship into models of income associations with parenting and child development.

PubMed

Gershoff, Elizabeth T; Aber, J Lawrence; Raver, C Cybele; Lennon, Mary Clare

2007-01-01

Although research has clearly established that low family income has negative impacts on children's cognitive skills and social-emotional competence, less often is a family's experience of material hardship considered. Using the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (N=21,255), this study examined dual components of family income and material hardship along with parent mediators of stress, positive parenting, and investment as predictors of 6-year-old children's cognitive skills and social-emotional competence. Support was found for a model that identified unique parent-mediated paths from income to cognitive skills and from income and material hardship to social-emotional competence. The findings have implications for future study of family income and child development and for identification of promising targets for policy intervention.

Disability, Poverty, and Material Hardship since the Passage of the ADA

PubMed Central

Drew, Julia A. Rivera

2015-01-01

The past 25 years have seen an unprecedented expansion in formal civil rights for people with disabilities that, among other things, was predicted to improve their economic well-being. Studies of economic well-being among people with disabilities have traditionally focused on employment and earnings, despite the fact that a minority of people with disabilities are employed. More recent literature has expanded to include measures of income poverty and material hardship, but has not examined trends in these dimensions of economic well-being over time or across different groups of people with disabilities. The current study uses nationally representative data covering the 1993-2010 period to examine trends over time in cross-sectional and dynamic measures of income poverty, and multiple dimensions of material hardship. It also describes differences in time trends by education, sex, race/ethnicity, and employment status among people with disabilities in income poverty and any material hardship. Levels of both material hardship and income poverty are high across the entire period for all groups, but while material hardship remains at the same level between 1993 and 2010, income poverty declines. These findings show that there has been little improvement over the past two decades in the economic well-being of people with disabilities, and additional research is needed to understand the mechanisms that keep even groups that are relatively privileged – college graduates and full-time, full-year workers – at very low levels of economic well-being. PMID:27042381

The effects of financial pressures on adherence and glucose control among racial/ethnically diverse patients with diabetes.

PubMed

Ngo-Metzger, Quyen; Sorkin, Dara H; Billimek, John; Greenfield, Sheldon; Kaplan, Sherrie H

2012-04-01

The Affordable Care Act is designed to decrease the numbers of uninsured patients in U.S. However, even with insurance, patients who have financial hardships may have difficulty obtaining their medications because of cost issues. Among patients with type 2 diabetes, to examine the association between patients' self-reported financial pressures on cost-related medication non-adherence and glucose control. Additionally, to examine whether having insurance decrease the financial pressures of diabetes care. Racially/ethnically diverse patients (N = 1,361; 249 non-Hispanic whites, 194 Vietnamese, and 533 Mexican American) with type 2 diabetes were recruited from seven outpatient clinics for a cross-sectional, observational study. Although both Vietnamese and Mexican-American patients reported having low annual incomes, more Mexican Americans reported the presence of financial barriers to getting medical care and perceived financial burden due to their diabetes, compared to whites and Vietnamese (p < 0.001). Over half (53.2%) of Mexican Americans reported cost-related non-adherence compared to 27.2% of white and 27.6% of Vietnamese patients (p < 0.001). Perceived financial burden was found to be associated with poor glucose control (HbA1c ≥8%), after adjusting for sociodemographic and health characteristics (aOR = 1.70, 95%CI 1.09-2.63), but not when adjusting for non-adherence. Similarly, a significant association between presence of financial barriers and HbA1c (aOR = 1.69, 95%CI 1.23-2.32) was attenuated with the inclusion of insurance status in the model. Being uninsured (aOR = 1.90, 95%CI 1.13-3.21) and non-adherent (aOR = 1.49, 95%CI 1.06-2.08) were each independently associated with HbA1c. While having health insurance coverage eliminated some of the financial barriers associated with having diabetes, low-income patients still faced significant financial burdens. Thus, providing health insurance to more individuals is only the first step towards eliminating health disparities. It is important to address medication cost in order to improve medication adherence and glucose control.

Single mothers' self-assessment of health: a systematic exploration of the literature.

PubMed

Rousou, E; Kouta, C; Middleton, N; Karanikola, M

2013-12-01

This study aimed to explore single mothers' self-assessed level of health status compared to partnered mothers and the relevant factors associated with it. The number of single-mother families is increasing worldwide. A large body of international research reveals that single mothers experience poorer physical and mental health than their married counterparts. An important contributory factor for this health disparity appears to be socio-economic disadvantage. A systematic search of the literature was conducted using the keywords 'lone' or 'single' and 'mother*' or 'parent*' or 'family structure' in combination with 'health'. EMBASE, CINAHL, COCHRANE and PUBMED databases were searched for quantitative research studies published in the past decade. Eleven quantitative research articles with self-assessment of health status in single mothers were identified. Single mothers report lower levels of health status compared to partnered mothers. These inequalities appear to be associated with financial hardship and lack of social support. Both these factors increase single mothers' susceptibility to stress and illness. Despite the study limitations (e.g. results based mainly on secondary data from household surveys), it provides evidence that single motherhood places women in an adverse social position that is associated with prolonged stress mainly due to unemployment, economic hardship and social exclusion, which affects negatively their health status. These findings can be seen as a challenge for health professionals, especially those working in the community sector and policy makers too, to establish supportive measures for this vulnerable group focused on socio-economic factors. © 2013 International Council of Nurses.

Broader health coverage is good for the nation's health: evidence from country level panel data.

PubMed

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.

Consequences of Arizona's immigration policy on social capital among Mexican mothers with unauthorized immigration status

PubMed Central

Valdez, Carmen R.; Padilla, Brian; Valentine, Jessa Lewis

2013-01-01

This study explores the consequences of increasingly restrictive immigration policies on social capital among Mexican mothers with unauthorized immigrant status in Arizona. Three focus groups conducted in Arizona explore how mothers’ experiences with immigration policies have affected their neighborhood, community, and family ties. Focus group content and interactions revealed that perceived racial profiling was common among mothers and led to fear of family separation. Several described direct experiences with detention and deportation. Although detention and deportation strengthened social ties between mothers and other unauthorized immigrants, these experiences were detrimental to social ties between mothers and members of the mainstream society, including their children's teachers. Finally, immigration policies were perceived to affect parent-child ties negatively, as mothers reported family stress, financial hardship, and decreased parental availability. PMID:24371370

Unemployment as a source of mental distress to individuals and their family: Unemployed parents' perceptions during the economic recession.

PubMed

Frasquilho, Diana; de Matos, Margarida Gaspar; Santos, Teresa; Gaspar, Tânia; Caldas de Almeida, J M

2016-08-01

Due to the economic recession, several people in Europe became unemployed. This situation may risk their mental health. This study explored parents' perceptions about their unemployment's effects in daily life during the recession. A total of 59 unemployed parents (40.7% fathers and 59.3% mothers), ageing 44.4 years (±6.2), answer a question on how the unemployment affected their family lives. Thematic analysis was used to analyse data. The findings suggest that unemployment is a source of adult and youth mental distress and of economic hardship and changes in family relations. Support to unemployed individuals and their families could benefit from these insights when granting the needed financial and socioemotional assistance. © The Author(s) 2016.

Broader health coverage is good for the nation's health: evidence from country level panel data

PubMed Central

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries. PMID:25598588

Repercussions of imprisonment for conjugal violence: discourses of men 1

PubMed Central

de Sousa, Anderson Reis; Pereira, Álvaro; Paixão, Gilvânia Patrícia do Nascimento; Pereira, Nadirlene Gomes; Campos, Luana Moura; Couto, Telmara Menezes

2016-01-01

ABSTRACT Objective: to know the consequences that men experience related to incarceration by conjugal violence. Methods: qualitative study on 20 men in jail and indicted in criminal processes related to conjugal violence in a Court specialized in Family and Domestic Violence against women. The interviews were classified based on Collective Subject Discourse method, using NVIVO(r) software. Results: the collective discourse shows that the experience of preventive imprisonment starts a process of family dismantling, social stigma, financial hardship and psycho-emotional symptoms such as phobia, depression, hypertension, and headaches. Conclusion: due to the physical, mental and social consequences of the conjugal violence-related imprisonment experience, it is urgent to look carefully into the somatization process as well as to the prevention strategies regarding this process. PMID:27982312

Income Is Not Enough: Incorporating Material Hardship Into Models of Income Associations With Parenting and Child Development

PubMed Central

Gershoff, Elizabeth T.; Aber, J. Lawrence; Raver, C. Cybele; Lennon, Mary Clare

2010-01-01

Although research has clearly established that low family income has negative impacts on children’s cognitive skills and social – emotional competence, less often is a family’s experience of material hardship considered. Using the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (N = 21,255), this study examined dual components of family income and material hardship along with parent mediators of stress, positive parenting, and investment as predictors of 6-year-old children’s cognitive skills and social – emotional competence. Support was found for a model that identified unique parent-mediated paths from income to cognitive skills and from income and material hardship to social – emotional competence. The findings have implications for future study of family income and child development and for identification of promising targets for policy intervention. PMID:17328694

Economic Hardship and Depression Among Women in Latino Farmworker Families.

PubMed

Pulgar, Camila A; Trejo, Grisel; Suerken, Cynthia; Ip, Edward H; Arcury, Thomas A; Quandt, Sara A

2016-06-01

Farmworker family members risk poor mental health due to stressors including poverty, relocation, and documentation status. This paper explores the relationship between farm-work related stressors and depressive symptoms in women of Latino farmworker families. 248 mothers of young children completed fixed-response interviews in Spanish. Measures included the Center for Epidemiologic Studies-Depression Scale, Migrant Farmworker Stress Inventory, and USDA Household Food Security Survey Module. Bivariate analyses indicated greater depressive symptoms with more economic hardship, more farm work-related stressors, greater age, and being unmarried. In multivariable logistic regression, economic hardship remained the only factor associated with depressive symptoms. Greater economic hardship, but not general farm work-related stress, is a main factor associated with depression in women of Latino farmworker families. Maternal depression can have consequences for both mothers and families. Mental health services for women in farmworker families should be targeted to those with the greatest economic challenges.

And still WE rise: Parent-child relationships, resilience, and school readiness in low-income urban Black families.

PubMed

Anderson, Riana Elyse

2018-02-01

The Family Stress Model acknowledges forms of resilience in the face of hardship; however, few studies have emerged on the potentially positive role of familial relationships in the academic, psychological, and prosocial success of impoverished Black children. The current study evaluates how parent-child relationship conflict and financial stress are associated with children's school readiness (i.e., academic, psychosocial, and socioemotional indicators). Latent profile analyses, incorporating financial stress, general stress, and parent-child relationship variables were used to test whether varying family stress profiles differentially predicted children's school readiness in Black families with children entering kindergarten (N = 292). Findings revealed 4 latent classifications with profiles of low, moderate, moderate/high, and high/moderate stress and conflict variables, respectively. Whereas the low-profile was associated with the most desirable school readiness indicators overall, children in the high/moderate-profile were rated as significantly more psychosocially and socioemotionally prepared for school than their moderate/high-profile counterparts. Families with less conflictual parent-child relationships had more optimal school readiness relative to families with higher conflict and less financial strain. The findings of the current study have the potential to contribute to theories of poverty and parent-child relationships, as well as guide therapeutic services focused on family relationships through school- and community-related programs for impoverished urban Black youth and their families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Familial transient financial difficulties during infancy and long-term developmental concerns.

PubMed

Ramanathan, S; Balasubramanian, N; Faraone, S V

2017-09-01

Socioeconomic difficulties affect the cognitive and emotional development of children. However, the focus of prior studies has largely been on poverty and material hardship. This study expands on the existing literature by examining the impact of familial transient financial difficulties during infancy on long-term cognitive and behavioral outcomes. The National Longitudinal Surveys of Youth (79) were used to assess the association between a transient drop in family income by 50% or more (called transient income decline or TID) during the first 3 years of life and later-life Peabody Individual Achievement Math and Reading scores and behavior problem index (BPI) scores (N = 8272-17 348; median assessment age = 9 years). A subsample of matched siblings (N = 2049-4238) was examined to tease out maternal and intra-familial effects. Exposure to TID predicted increased total and externalizing BPI scores (std. coefficients of 0.10 and 0.09, respectively, p < 0.01) in the overall sample. Among matched siblings, exposure to TID predicted increased total, externalizing, and internalizing BPI scores (std. coefficients of 0.27, 0.25, and 0.23, respectively, p < 0.01). Familial transient financial difficulties can have long-lasting behavioral effects for infants. The study identifies an early risk factor and at-risk children, thus providing insight into developing early intervention measures for infants to avoid long-term behavioral problems.

Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care.

PubMed

Ifanti, Amalia A; Argyriou, Andreas A; Kalofonou, Foteini H; Kalofonos, Haralabos P

2013-11-01

This review study explores the available data relating to the impact of financial crisis and subsequently applied austerity measures on the health care, social services and health promotion policies in Greece. It is evident that Greece is affected more than any other European country by the financial crisis. Unemployment, job insecurity, income reduction, poverty and increase of mental disorders are among the most serious consequences of crisis in the socioeconomic life. The health system is particularly affected by the severe austerity measures. The drastic curtailing of government spending has significantly affected the structure and functioning of public hospitals that cope with understaffing, deficits, drug shortage and basic medical supplies. Moreover, health promotion policies are constrained, inhibiting thus the relevant initiatives toward disease prevention and health promotion education practices. Overall, the current economic situation in Greece and its impact on real life and health care is quite concerning. Policy makers should not disregard the implications that austerity and fiscal policies have on the health sector. Greater attention is needed in order to ensure that individuals would continue getting public health care and having access to preventive and social support services. To face the economic hardship, policy makers are expected to implement human-centered approaches, safeguarding the human dignity and the moral values. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The new medical-industrial complex.

PubMed

Relman, A S

1980-10-23

The most important health-care development of the day is the recent, relatively unheralded rise of a huge new industry that supplies health-care services for profit. Proprietary hospitals and nursing homes, diagnostic laboratories, home-care and emergency-room services, hemodialysis, and a wide variety of other services produced a gross income to this industry last year of about $35 billion to +40 billion. This new "medical-industrial complex" may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and "cream-skimming," and it may also exercise undue influence on national health policy. In this medical market, physicians must act as discerning purchasing agents for their patients and therefore should have no conflicting financial interests. Closer attention from the public and the profession, and careful study, are necessary to ensure that the "medical-industrial complex" puts the interest of the public before those of its stockholders.

[Using the concept of universal health coverage to promote the health system reform in China].

PubMed

Hu, S L

2016-11-06

The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

To be involved or not to be involved: a survey of public preferences for self-involvement in decision-making involving mental capacity (competency) within Europe.

PubMed

Daveson, Barbara A; Bausewein, Claudia; Murtagh, Fliss E M; Calanzani, Natalia; Higginson, Irene J; Harding, Richard; Cohen, Joachim; Simon, Steffen T; Deliens, Luc; Bechinger-English, Dorothee; Hall, Sue; Koffman, Jonathan; Ferreira, Pedro Lopes; Toscani, Franco; Gysels, Marjolein; Ceulemans, Lucas; Haugen, Dagny F; Gomes, Barbara

2013-05-01

The Council of Europe has recommended that member states of European Union encourage their citizens to make decisions about their healthcare before they lose capacity to do so. However, it is unclear whether the public wants to make such decisions beforehand. To examine public preferences for self-involvement in end-of-life care decision-making and identify associated factors. A population-based survey with 9344 adults in England, Belgium, Germany, Italy, the Netherlands, Portugal and Spain. Across countries, 74% preferred self-involvement when capable; 44% preferred self-involvement when incapable through, for example, a living will. Four factors were associated with a preference for self-involvement across capacity and incapacity scenarios, respectively: higher educational attainment ((odds ratio = 1.93-2.77), (odds ratio = 1.33-1.80)); female gender ((odds ratio = 1.27, 95% confidence interval = 1.14-1.41), (odds ratio = 1.30, 95% confidence interval = 1.20-1.42)); younger-middle age ((30-59 years: odds ratio = 1.24-1.40), (50-59 years: odds ratio = 1.23, 95% confidence interval = 1.04-1.46)) and valuing quality over quantity of life or valuing both equally ((odds ratio = 1.49-1.58), (odds ratio = 1.35-1.53)). Those with increased financial hardship (odds ratio = 0.64-0.83) and a preference to die in hospital (not a palliative care unit) (odds ratio = 0.73, 95% confidence interval = 0.60-0.88), a nursing home or residential care (odds ratio = 0.73, 95% confidence interval = 0.54-0.99) were less likely to prefer self-involvement when capable. For the incapacity scenario, single people were more likely to prefer self-involvement (odds ratio = 1.34, 95% confidence interval = 1.18-1.53). Self-involvement in decision-making is important to the European public. However, a large proportion of the public prefer to not make decisions about their care in advance of incapacity. Financial hardship, educational attainment, age, and preferences regarding quality and quantity of life require further examination; these factors should be considered in relation to policy.

An evaluation of hardship licensing for DWIs. Volume 2, Effect on general and specific deterrants

DOT National Transportation Integrated Search

1989-08-01

The research described in this report attempted to assess the effects of offering hardship licenses to drivers under suspension for drinking/driving offenses. The results of this research lead to the following conclusions: Court Operations - Changes ...

7 CFR 1470.27 - Contract violations and termination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the participant's control prevented compliance with the contract. If a participant claims hardship... prevented compliance with the contract. If a participant claims hardship, that claim must be well documented... out its role in this section, NRCS may consult with the local conservation district. ...

Financial stress response profiles and psychosocial functioning in low-income parents.

PubMed

Perzow, Sarah E D; Bray, Bethany C; Wadsworth, Martha E

2018-06-01

Parenting in the context of poverty is accompanied by heightened stress and heightened stakes. How parents respond to poverty-related stress has important implications for family functioning, but research investigating individual differences in low-income mothers' and fathers' responses to financial stress and their associations with parents' concurrent psychosocial adaptation is lacking. A better understanding of differences in stress responses among low-income parents is required to develop and tailor prevention programs that meet these families' needs. This study applies latent profile analysis (LPA) to identify and describe profiles of financial stress responses (problem solving, emotion regulation, emotion expression, cognitive restructuring, positive thinking, acceptance, distraction, denial, avoidance, wishful thinking, rumination, intrusive thoughts, emotional arousal, physiologic arousal, impulsive action, emotional numbing, cognitive interference, escape, and inaction) and examines associations between profile membership and psychosocial functioning in low-income parents. Five profiles were identified that were distinguished by self-reported voluntary and involuntary financial stress responses: active (32% of sample), low (11%), high (11%), negative cognitive (NC; 17%), and average (29%) responders. Notable differences emerged on measures of life stress, economic hardship, psychopathology, and social support, with individuals in the NC responders profile reporting the most difficulty and members of the active responders profile reporting the greatest adaptation. These findings offer a more nuanced understanding of how mothers and fathers respond to chronic poverty-related stress and have valuable implications for intervention efforts to promote adaptive stress responses and psychosocial functioning in low-income families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

23 CFR 710.503 - Protective buying and hardship acquisition.

Code of Federal Regulations, 2013 CFR

2013-04-01

... hardship acquisition. (a) General conditions. Prior to the STD obtaining final environmental approval, the STD may request FHWA agreement to provide reimbursement for advance acquisition of a particular parcel... the currently approved STIP; (2) The STD has complied with applicable public involvement requirements...

23 CFR 710.503 - Protective buying and hardship acquisition.

Code of Federal Regulations, 2011 CFR

2011-04-01

... hardship acquisition. (a) General conditions. Prior to the STD obtaining final environmental approval, the STD may request FHWA agreement to provide reimbursement for advance acquisition of a particular parcel... the currently approved STIP; (2) The STD has complied with applicable public involvement requirements...

23 CFR 710.503 - Protective buying and hardship acquisition.

Code of Federal Regulations, 2014 CFR

2014-04-01

... hardship acquisition. (a) General conditions. Prior to the STD obtaining final environmental approval, the STD may request FHWA agreement to provide reimbursement for advance acquisition of a particular parcel... the currently approved STIP; (2) The STD has complied with applicable public involvement requirements...

8 CFR 1240.58 - Extreme hardship.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Extreme hardship. 1240.58 Section 1240.58 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Suspension of Deportation and...

8 CFR 1240.58 - Extreme hardship.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Extreme hardship. 1240.58 Section 1240.58 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Suspension of Deportation and...

8 CFR 1240.58 - Extreme hardship.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Extreme hardship. 1240.58 Section 1240.58 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Suspension of Deportation and...

Dynamics of family economic hardship and the progression of health problems of husbands and wives during the middle years: a perspective from rural Mid-West.

PubMed

Wickrama, K A S; Hwa Kwag, Kyung; Lorenz, Federick O; Conger, Rand D; Surjadi, Florensia F

2010-12-01

The objective of this study was to investigate the influence of theoretically important dimensions of stability and change in economic hardship during early middle years on decade-long health problems of husbands and wives. The study used prospective data collected from 360 middle-aged husbands and wives during a 12-year period. The variables included self-reported economic hardship (22 items), mental and physical health, and physical impairment. The results supported the hypothesis that the dynamics of family economic hardship (in terms of stability and change) during the early middle years contribute to subsequent onset of health problems of middle-aged husbands and wives. These health problems in turn progress as an interrelated process through intrahealth-domain continuities, cross-health domain proliferations, and dyadic associations as they pass through midlife. A better understanding of these processes may aid in the formation and effective implementation of health promotion programs for middle-aged husbands and wives.

Life Course Pathways of Economic Hardship and Mobility and Midlife Trajectories of Health.

PubMed

Willson, Andrea E; Shuey, Kim M

2016-09-01

We utilize over 40 years of prospective data from the Panel Study of Income Dynamics (N = 1,229) and repeated-measures latent class analysis to examine how long-term patterns of stability and change in economic hardship from childhood to adulthood are related to subsequent trajectories of midlife health. We review conceptual and methodological approaches to examining health inequality across the life course and highlight the contribution of a person-centered, disaggregated approach to modeling health and its association with long-term pathways of economic resources, including changing resources associated with mobility. Findings suggest those who experienced early mobility out of economic hardship were less likely than those in persistent economic hardship to experience a high-risk health trajectory, while experiencing later mobility did not lessen this risk. We conclude with a call for further investigation into the role of social mobility and the timing, degree, and direction of change in investigations of health inequality. © American Sociological Association 2016.

Family Structure Transitions and Changes in Maternal Resources and Well-Being

PubMed Central

Osborne, Cynthia; Berger, Lawrence M.; Magnuson, Katherine

2013-01-01

This paper uses data from the Fragile Families and Child Wellbeing Study to examine whether family instability is associated with changes in perceived social support, material hardship, maternal depression, and parenting stress among mothers of young children. In addition to accounting for the number of transitions a mother experiences over the first five years of her child’s life, we pay close attention to the type and timing of these transitions. We find that mothers who transition to cohabitation or marriage with their child’s biological father experience declines in material hardship and that those who transition to cohabitation or marriage with another man exhibit modest declines in both material hardship and depression. Mothers who exit cohabiting or marital relationships encounter decreases in perceived social support and increases in material hardship, depression, and parenting stress. Overall, our results suggest that both the type and, to a much lesser degree, the timing of family structure transitions may influence maternal well-being. PMID:22215507

Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility

PubMed Central

2011-01-01

Background Mindfulness-based stress reduction (MBSR) programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. Methods We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes. Results and discussion Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. Conclusion A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health. PMID:21627807

Rasch Analyses of Very Low Food Security among Households and Children in the Three City Study*

PubMed Central

Moffitt, Robert A.; Ribar, David C.

2017-01-01

The longitudinal Three City Study of low-income families with children measures food hardships using fewer questions and some different questions from the standard U.S. instrument for measuring food security, the Household Food Security Survey Module (HFSSM) in the Current Population Survey (CPS). We utilize a Rasch measurement model to identify thresholds of very low food security among households and very low food security among children in the Three City Study that are comparable to thresholds from the HFSSM. We also use the Three City Study to empirically investigate the determinants of food insecurity and of these specific food insecurity outcomes, estimating a multivariate behavioral Rasch model that is adapted to address longitudinal data. The estimation results indicate that participation in the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program reduce food insecurity, while poverty and disability among caregivers increase it. Besides its longitudinal structure, the Three City Study measures many more characteristics about households than the CPS. Our estimates reveal that financial assistance through social networks and a household's own financial assets reduce food insecurity, while its outstanding loans increase insecurity. PMID:29187764

Rasch Analyses of Very Low Food Security among Households and Children in the Three City Study.

PubMed

Moffitt, Robert A; Ribar, David C

2016-04-01

The longitudinal Three City Study of low-income families with children measures food hardships using fewer questions and some different questions from the standard U.S. instrument for measuring food security, the Household Food Security Survey Module (HFSSM) in the Current Population Survey (CPS). We utilize a Rasch measurement model to identify thresholds of very low food security among households and very low food security among children in the Three City Study that are comparable to thresholds from the HFSSM. We also use the Three City Study to empirically investigate the determinants of food insecurity and of these specific food insecurity outcomes, estimating a multivariate behavioral Rasch model that is adapted to address longitudinal data. The estimation results indicate that participation in the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program reduce food insecurity, while poverty and disability among caregivers increase it. Besides its longitudinal structure, the Three City Study measures many more characteristics about households than the CPS. Our estimates reveal that financial assistance through social networks and a household's own financial assets reduce food insecurity, while its outstanding loans increase insecurity.

Breastfeeding considerations of opioid dependent mothers and infants.

PubMed

Hilton, Tara C

2012-01-01

The American Academy of Pediatrics (AAP) has a long-standing recommendation against breastfeeding if the maternal methadone dose is above 20 mg/day. In 2001, the AAP lifted the dose restriction of maternal methadone allowing methadone-maintained mothers to breastfeed. The allowance of breastfeeding among mothers taking methadone has been met with opposition due to the uncertainty that exists related to methadone exposure of the suckling infant. Methadone-maintained mothers are at higher risk for abuse, concomitant psychiatric disorders, limited access to healthcare, and financial hardship. Breastfeeding rates among methadone-maintained women tend to be low compared to the national average. This manuscript will discuss the implications for healthcare practitioners caring for methadone-maintained mothers and infants and associated risks and benefits of breastfeeding. This population of mothers and infants stands to obtain particular benefits from the various well-known advantages of breastfeeding.

When practice transformation impedes practice improvement.

PubMed

Bujold, Edward

2015-01-01

I lead a small practice in rural western North Carolina. We have embraced the patient-centered medical home model and other practice-improvement initiatives, and I have seen our practice transformed in many positive ways. But in the past year alone, my staff and I have spent hundreds of hours studying for and taking exams, certifying for numerous programs, and updating our electronic health records system (EHR) to meet new national requirements and then relearning our EHR. Seeing patients used to be the hardest part of my job. It is now the easiest by far. I am considering walking away from the time-intensive PCMH certification even though it would cause financial hardship. We have more important business at hand-taking excellent care of patients, improving our practice, and meaningfully engaging with our patients. © 2015 Annals of Family Medicine, Inc.

Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three U.S. cities.

PubMed

Díaz, Rafael M; Ayala, George; Bein, Edward

2004-08-01

Based on data from a probability sample of 912 Latino gay men in 3 U.S. cities, a multivariate model of sexual risk was tested, including experiences of homophobia, racism, and poverty as predictors. Participants reported multiple instances of verbal and physical abuse, rude mistreatment, and discrimination on account of their sexual orientation and their race or ethnicity. Many reported experiences of poverty, such as inability to pay for basic necessities of food or shelter. Men who reported more instances of social discrimination and financial hardship were more psychologically distressed and more likely to participate in "difficult" sexual situations, as predicted. Participation in difficult sexual situations mediates the effects of social oppression and psychological distress on sexual risk behavior. (c) 2004 APA

Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health.

PubMed

Hallo De Wolf, Antenor; Toebes, Brigit

2016-12-01

The goal of universal health coverage is to "ensure that all people obtain the health services they need without suffering financial hardship when paying for them." There are many connections between this goal and the state's legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors' involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide "public goods"; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care?

A call for improved transparency in financial aspects of clinical trials: a case study of the CREATE-X trial in the New England Journal of Medicine.

PubMed

Ozaki, Akihiko; Takita, Morihito; Tanimoto, Tetsuya

2018-06-01

Introduction Globally, laws and guidelines for managing conflict of interest are increasingly implemented to achieve transparency in financial ties between physicians and pharmaceutical and medical device industries, yet little information is available regarding the limitations of the current frameworks for disclosing these financial ties. Case In June 2017, the Capecitabine for Residual Cancer as Adjuvant Therapy (CREATE-X) trial was published in the New England Journal of Medicine. In this study, which suggested the post-surgery addition of capecitabine would improve survival of high-risk breast cancer patients, the cost of capecitabine for off-label use was illegally claimed to the Japanese public health insurance system, rather than being covered by the research budget. This illegal claim led to the profit of more than 100,000,000 JPY (approximately 0.91 million USD) for Chugai Pharmaceutical Company (CPC), which manufactures capecitabine. Additional evidence suggests that the CPC made donations of at least 100,000,000 JPY (approximately 0.91 million USD) and 236,000,000 JPY (approximately 2.1 million USD) to the Japan Breast Cancer Research Group (JBCRG), the study's sponsor and funder where the majority of the Japanese authors served high-level positions, and the Advanced Clinical Research Organization, the other study funder, respectively, during the study period, though the total amount has not been clarified. Neither the CPC's involvement nor its undue profit was mentioned in the published article. Conclusion This case report highlights the lack of financial transparency in the CREATE-X trial, and discusses the potential limitations that may exist in the current frameworks for disclosing financial ties between physicians and relevant industries in clinical trials. Achieving improved transparency is essential to heighten credibility in the findings of clinical trials.

Selling conscience short: a response to Schuklenk and Smalling on conscientious objections by medical professionals.

PubMed

Maclure, Jocelyn; Dumont, Isabelle

2017-04-01

In a thought-provoking paper, Schuklenk and Smalling argue that no right to conscientious objection should be granted to medical professionals. First, they hold that it is impossible to assess either the truth of conscience-based claims or the sincerity of the objectors. Second, even a fettered right to conscientious refusal inevitably has adverse effects on the rights of patients. We argue that the main problem with their position is that it is not derived from a broader reflection on the meaning and implications of freedom of conscience and reasonable accommodation. We point out that they collapse two related but distinct questions, that is, the subjective conception of freedom of conscience and the sincerity test. We note that they do not successfully show that the standard norm according to which exemption claims should not impose undue hardship on others is unworkable. We suggest that the main reason why arguments such as no one is forced to be a medical professional are flawed is that public norms should not constrain citizens to choose between two of their basic rights unless it is necessary. In fine, Schuklenk and Smalling, who see conscience claims as arbitrary dislikes, sell freedom of conscience short and forego any attempts at balancing the competing rights involved. We maintain the authors neglect that most of legal reasoning is contextual and that the blanket restriction of healthcare professionals' freedom of conscience is disproportionate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Exploring Barriers of the Health System to Rehabilitation Services for People with Disabilities in Iran: A Qualitative Study

PubMed Central

Abdi, Kianoush; Arab, Mohammad; Rashidian, Arash; Kamali, Mohammad; Khankeh, Hamid Reza; Farahani, Farideh Khalajabadi

2015-01-01

Introduction The United Nations (UN) identified health as a basic human right, but, unfortunately, the evidence shows that people with disabilities (PWD) often have lower levels of health than the general population. This can be associated with problems in access to the services and programs. The aim of this study was to explore barriers of the health system to rehabilitation services for PWD in Iran. Methods This was a qualitative study conducted on 21 participants using semi-structured, in-depth interviews and content analysis from June 2014 to July 2015. Data analysis was performed by MAXQDA version 10. Results “Barriers” were the most prominent challenge of people with disabilities that needed access to rehabilitation services. These barriers were categorized into eight concepts of deficiency in the system that provides rehabilitation services, defect of education, deficiency in detecting and screening of people with disability, defect of stewardship in rehabilitation, ignoring socio-cultural factors, accessibility hardships, lack of identification, and financial hardships in rehabilitation. Conclusions An efficient rehabilitation plan requires a common understanding, considering the long-term complications involved in addressing the barriers. Understanding the barriers of the health system to rehabilitation services requires comprehensive management that first should be familiar with all of PWD, providers, policy makers, and other beneficiaries. It also is necessary for policy makers to consider rehabilitation services as a main part of the health plan; especially, they must change their oversight of rehabilitation services and programs. Thus, policy makers should have need comprehensive management and recommended further research. PMID:26767101

40 CFR 59.662 - What temporary provisions address hardship due to unusual circumstances?

Code of Federal Regulations, 2010 CFR

2010-07-01

... FOR CONSUMER AND COMMERCIAL PRODUCTS Control of Evaporative Emissions From New and In-Use Portable Fuel Containers Special Compliance Provisions § 59.662 What temporary provisions address hardship due... exemption will jeopardize the solvency of your company. (4) No other allowances are available under the...

43 CFR 417.4 - Changed conditions, emergency, or hardship modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Changed conditions, emergency, or hardship modifications. 417.4 Section 417.4 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION...

43 CFR 417.4 - Changed conditions, emergency, or hardship modifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Changed conditions, emergency, or hardship modifications. 417.4 Section 417.4 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION...

43 CFR 417.4 - Changed conditions, emergency, or hardship modifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Changed conditions, emergency, or hardship modifications. 417.4 Section 417.4 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION...

43 CFR 417.4 - Changed conditions, emergency, or hardship modifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Changed conditions, emergency, or hardship modifications. 417.4 Section 417.4 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION...

43 CFR 417.4 - Changed conditions, emergency, or hardship modifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Changed conditions, emergency, or hardship modifications. 417.4 Section 417.4 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION...

Poverty and Material Hardship in Grandparent-Headed Households

ERIC Educational Resources Information Center

Baker, Lindsey A.; Mutchler, Jan E.

2010-01-01

Using the 2001 Survey of Income and Program Participation, the current study examines poverty and material hardship among children living in 3-generation (n = 486), skipped-generation (n = 238), single-parent (n = 2,076), and 2-parent (n = 6,061) households. Multinomial and logistic regression models indicated that children living in…

Linking Family Hardship to Children's Lives.

ERIC Educational Resources Information Center

Elder, Gen H., Jr.; And Others

1985-01-01

Used newly developed codes for parenting behavior during the Great Depression reported in the Oakland Growth Study. Results indicated that economic hardship adversely influenced the psychosocial well-being of adolescent girls, but not boys, by increasing the rejecting behavior of fathers. This effect was particularly strong for unattractive girls.…

40 CFR 59.663 - What are the provisions for extending compliance deadlines for manufacturers under hardship?

Code of Federal Regulations, 2010 CFR

2010-07-01

... compliance costs prevents you from meeting the requirements of this subpart by the required compliance date... compliance deadlines for manufacturers under hardship? 59.663 Section 59.663 Protection of Environment... Fuel Containers Special Compliance Provisions § 59.663 What are the provisions for extending compliance...

23 CFR 710.503 - Protective buying and hardship acquisition.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Protective buying and hardship acquisition. 710.503... in 23 CFR parts 450 and 771; (3) A determination has been completed for any property subject to the provisions of 23 U.S.C. 138; and (4) Procedures of the Advisory Council on Historic Preservation are...

10 CFR 455.132 - State evaluation of requests for severe hardship assistance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... State plan pursuant to § 455.20(x). Secondary criteria such as climate, fuel cost and fuel availability... 10 Energy 3 2011-01-01 2011-01-01 false State evaluation of requests for severe hardship... SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS State...

10 CFR 455.132 - State evaluation of requests for severe hardship assistance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... State plan pursuant to § 455.20(x). Secondary criteria such as climate, fuel cost and fuel availability... 10 Energy 3 2014-01-01 2014-01-01 false State evaluation of requests for severe hardship... SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS State...

10 CFR 455.132 - State evaluation of requests for severe hardship assistance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... State plan pursuant to § 455.20(x). Secondary criteria such as climate, fuel cost and fuel availability... 10 Energy 3 2010-01-01 2010-01-01 false State evaluation of requests for severe hardship... SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS State...

10 CFR 455.132 - State evaluation of requests for severe hardship assistance.

Code of Federal Regulations, 2013 CFR

2013-01-01

... State plan pursuant to § 455.20(x). Secondary criteria such as climate, fuel cost and fuel availability... 10 Energy 3 2013-01-01 2013-01-01 false State evaluation of requests for severe hardship... SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS State...

10 CFR 455.132 - State evaluation of requests for severe hardship assistance.

Code of Federal Regulations, 2012 CFR

2012-01-01

... State plan pursuant to § 455.20(x). Secondary criteria such as climate, fuel cost and fuel availability... 10 Energy 3 2012-01-01 2012-01-01 false State evaluation of requests for severe hardship... SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS State...

How Do Families Manage Their Economic Hardship?

ERIC Educational Resources Information Center

Baek, Eunyoung; DeVaney, Sharon A.

2010-01-01

Using data from the 2007 Survey of Consumer Finances, this study examined how families manage their economic hardship. A conceptual model was developed based on risk management theory and the permanent income hypothesis. About half of families used credit and about a third used their own savings to make up the difference between income and…

Chronic Family Economic Hardship, Family Processes and Progression of Mental and Physical Health Symptoms in Adolescence

ERIC Educational Resources Information Center

Lee, Tae Kyoung; Wickrama, K. A. S.; Simons, Leslie Gordon

2013-01-01

Research has documented the relationship between family stressors such as family economic hardship and marital conflict and adolescents' mental health symptoms, especially depressive symptoms. Few studies, however, have examined the processes whereby supportive parenting lessens this effect and the progression of mental health and physical health…

Economic Hardship in the Family of Origin and Children's Psychological Well-Being in Adulthood

ERIC Educational Resources Information Center

Sobolewski, Juliana M.; Amato, Paul R.

2005-01-01

Past research consistently indicates that poverty and economic hardship have negative consequences for children. Few studies, however, have examined whether these consequences persist into adulthood. This study addresses this gap by assessing whether economic resources in the family of origin have long-term effects on psychological well-being in…

Economic Hardship and Marital Relations in the 1930's.

ERIC Educational Resources Information Center

Liker, Jeffrey K.; Elder, Glen H., Jr.

Economic loss and hardship during the 1929 Depression produced marital tension resulting from increased conflict over finances and temperamental behavior of husbands and wives. Data on 110 couples were obtained from the Berkeley Study at the Institute of Human Development in California. Annual data were collected from wife, home observer, and…

75 FR 30430 - In the Matter of Certain Silicon Microphone Packages and Products Containing the Same;

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... temporary relief, and its analyses of irreparable harm, the balance of hardships and the public interest..., irreparable harm, balance of hardships, and public interest. On the likelihood of success on the merits, the...) precluded temporary relief here. Nonetheless, the ALJ considered the remaining two factors (balance of...

17 CFR 269.10 - Form TH-Notification of reliance on temporary hardship exemption.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form TH-Notification of....10 Form TH—Notification of reliance on temporary hardship exemption. Form TH shall be filed by any...: For Federal Register citations affecting Form TH, see the List of CFR Sections Affected, which appears...

Negotiating Parenthood: Experiences of Economic Hardship among Parents with Cognitive Difficulties

ERIC Educational Resources Information Center

Fernqvist, Stina

2015-01-01

People with cognitive difficulties often have scarce economic resources, and parents with cognitive difficulties are no exception. In this article, parents' experiences are put forth and discussed, for example, how does economic hardship affect family life? How do the parents experience support, what kind of strain does the scarce economy put on…

Arab Students in a Hebrew University--Existing but Unnoticed

ERIC Educational Resources Information Center

Halabi, Rabah

2016-01-01

This article focuses on ways in which Arab students cope with challenges of integrating into the academic life of a Hebrew university in Israel. From this research we can learn that the students face considerable hardships during their university studies. Some of these hardships derive from language barriers. In addition, findings show that the…

Cultural repertoires and food-related household technology within colonia households under conditions of material hardship

PubMed Central

2012-01-01

Introduction Mexican-origin women in the U.S. living in colonias (new-destination Mexican-immigrant communities) along the Texas-Mexico border suffer from a high incidence of food insecurity and diet-related chronic disease. Understanding environmental factors that influence food-related behaviors among this population will be important to improving the well-being of colonia households. This article focuses on cultural repertoires that enable food choice and the everyday uses of technology in food-related practice by Mexican-immigrant women in colonia households under conditions of material hardship. Findings are presented within a conceptual framework informed by concepts drawn from sociological accounts of technology, food choice, culture, and material hardship. Methods Field notes were provided by teams of promotora-researchers (indigenous community health workers) and public-health professionals trained as participant observers. They conducted observations on three separate occasions (two half-days during the week and one weekend day) within eight family residences located in colonias near the towns of Alton and San Carlos, Texas. English observations were coded inductively and early observations stressed the importance of technology and material hardship in food-related behavior. These observations were further explored and coded using the qualitative data package Atlas.ti. Results Technology included kitchen implements used in standard and adapted configurations and household infrastructure. Residents employed tools across a range of food-related activities identified as forms of food acquisition, storage, preparation, serving, feeding and eating, cleaning, and waste processing. Material hardships included the quality, quantity, acceptability, and uncertainty dimensions of food insecurity, and insufficient consumption of housing, clothing and medical care. Cultural repertoires for coping with material hardship included reliance on inexpensive staple foods and dishes, and conventional and innovative technological practices. These repertoires expressed the creative agency of women colonia residents. Food-related practices were constrained by climate, animal and insect pests, women’s gender roles, limitations in neighborhood and household infrastructure, and economic and material resources. Conclusions This research points to the importance of socioeconomic and structural factors such as gender roles, economic poverty and material hardship as constraints on food choice and food-related behavior. In turn, it emphasizes the innovative practices employed by women residents of colonias to prepare meals under these constraints. PMID:22587790

Cultural repertoires and food-related household technology within colonia households under conditions of material hardship.

PubMed

Dean, Wesley R; Sharkey, Joseph R; Johnson, Cassandra M; St John, Julie

2012-05-15

BSTRACT: Mexican-origin women in the U.S. living in colonias (new-destination Mexican-immigrant communities) along the Texas-Mexico border suffer from a high incidence of food insecurity and diet-related chronic disease. Understanding environmental factors that influence food-related behaviors among this population will be important to improving the well-being of colonia households. This article focuses on cultural repertoires that enable food choice and the everyday uses of technology in food-related practice by Mexican-immigrant women in colonia households under conditions of material hardship. Findings are presented within a conceptual framework informed by concepts drawn from sociological accounts of technology, food choice, culture, and material hardship. Field notes were provided by teams of promotora-researchers (indigenous community health workers) and public-health professionals trained as participant observers. They conducted observations on three separate occasions (two half-days during the week and one weekend day) within eight family residences located in colonias near the towns of Alton and San Carlos, Texas. English observations were coded inductively and early observations stressed the importance of technology and material hardship in food-related behavior. These observations were further explored and coded using the qualitative data package Atlas.ti. Technology included kitchen implements used in standard and adapted configurations and household infrastructure. Residents employed tools across a range of food-related activities identified as forms of food acquisition, storage, preparation, serving, feeding and eating, cleaning, and waste processing. Material hardships included the quality, quantity, acceptability, and uncertainty dimensions of food insecurity, and insufficient consumption of housing, clothing and medical care. Cultural repertoires for coping with material hardship included reliance on inexpensive staple foods and dishes, and conventional and innovative technological practices. These repertoires expressed the creative agency of women colonia residents. Food-related practices were constrained by climate, animal and insect pests, women's gender roles, limitations in neighborhood and household infrastructure, and economic and material resources. This research points to the importance of socioeconomic and structural factors such as gender roles, economic poverty and material hardship as constraints on food choice and food-related behavior. In turn, it emphasizes the innovative practices employed by women residents of colonias to prepare meals under these constraints.

Constructing and Validating a Multiple-Indicator Construct of Economic Hardship in a National Sample of Adolescents with Disabilities

ERIC Educational Resources Information Center

Murray, Christopher; Doren, Bonnie; Gau, Jeff M.; Zvoch, Keith; Seeley, John R.

2015-01-01

The purpose of the current study was to develop a multi-indicator construct of economic hardship among adolescents with disabilities (N = 9,230) participating in the National Longitudinal Transition Study-2, the largest, most comprehensive investigation of adolescents with disabilities ever conducted. Five theoretically relevant indicators (i.e.,…

Economic Hardship and Depression across the Life Course: The Impact of Welfare State Regimes

ERIC Educational Resources Information Center

Levecque, Katia; Van Rossem, Ronan; De Boyser, Katrien; Van de Velde, Sarah; Bracke, Piet

2011-01-01

Previous research in the United States suggests that depression related to economic hardship decreases with age. We test whether this pattern can be generalized to other developed nations. Based on data from 23 countries in the European Social Survey (2006-2007), multilevel analyses show that the moderating role of age depends on the…

22 CFR 41.63 - Two-year home-country physical presence requirement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... hardship upon the alien's spouse or child (if such spouse or child is a citizen of the United States or a... spouse or child (if such spouse or child is a citizen of the United States or a legal permanent resident... and physical presence requirement would impose exceptional hardship upon the spouse or child of the...

17 CFR 249.447 - Form TH-Notification of reliance on temporary hardship exemption.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form TH-Notification of... § 249.447 Form TH—Notification of reliance on temporary hardship exemption. Form TH shall be filed by... Note: For Federal Register citations affecting Form TH, see the List of CFR Sections Affected, which...

17 CFR 274.404 - Form TH-Notification of reliance on temporary hardship exemption.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form TH-Notification of... Forms for Electronic Filing § 274.404 Form TH—Notification of reliance on temporary hardship exemption. Form TH shall be filed by any electronic filer who submits to the Commission, pursuant to a temporary...

17 CFR 259.604 - Form TH-Notification of reliance on temporary hardship exemption.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form TH-Notification of... OF 1935 Forms for Electronic Filing § 259.604 Form TH—Notification of reliance on temporary hardship exemption. Form TH shall be filed by any electronic filer who submits to the Commission, pursuant to a...

17 CFR 239.65 - Form TH-Notification of reliance on temporary hardship exemption.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Form TH-Notification of... Statements § 239.65 Form TH—Notification of reliance on temporary hardship exemption. Form TH shall be filed... Note: For Federal Register citations affecting Form TH, see the List of CFR Sections Affected, which...

High-burden epidemics in Greece in the era of economic crisis. Early signs of a public health tragedy.

PubMed

Bonovas, S; Nikolopoulos, G

2012-09-01

Economic hardships have unleashed epidemics of infectious diseases in many countries in the past. In the era of the current financial crisis in Greece, it is interesting to assess the preliminary evidence concerning outbreaks of infectious diseases. Description and evaluation of published surveillance data. Greece has been suffering a high burden of different large-scale epidemics during the last three years. These include the increased mortality of influenza during the pandemic and the first post-pandemic seasons, the emergence and spread of West Nile virus, the appearance of clusters of non-imported malaria and the outbreak of Human Immunodeficiency Virus infection among people who inject drugs. The economic turmoil in Greece seems to impact the infectious disease dynamics. It is essential to safeguard and even bolster budgetary allocations to the public health sector, in order to alleviate the effects of the economic downturn.

Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

PubMed Central

2016-01-01

Abstract The goal of universal health coverage is to “ensure that all people obtain the health services they need without suffering financial hardship when paying for them.” There are many connections between this goal and the state’s legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors’ involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide “public goods”; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care? PMID:28559678

An attributional analysis of reactions to poverty: the political ideology of the giver and the perceived morality of the receiver.

PubMed

Weiner, Bernard; Osborne, Danny; Rudolph, Udo

2011-05-01

An attributional analysis of reactions to poverty is presented. The article begins by discussing the perceived causes of poverty and their taxonomic properties (locus, stability, and controllability). One antecedent of causal beliefs, political ideology, is then examined in detail, followed by a review of the effects of causal beliefs on emotions and behavior. It is contended that helping the poor is a moral issue, but the moral evaluation concerns the targeted recipient of aid rather than the potential help giver. Persons perceived as responsible for their plight, a dominant construal for conservatives, elicit anger and neglect. In contrast, those seen as not responsible for their financial hardship, an outlook predominantly endorsed by liberals, arouse sympathy and help giving. Sympathy is the most important proximal determinant of aid. This analysis is extended to reactions to achievement failure, abortion, and rape. Policy implications are also examined.

Durbolota (weakness), chinta rog (worry illness), and poverty: explanations of white discharge among married adolescent women in an urban slum in Dhaka, Bangladesh.

PubMed

Rashid, Sabina Faiz

2007-03-01

I carried out ethnographic fieldwork among 153 married adolescent girls, aged 15-19, in a Dhaka slum from December 2001 to January 2003, including 50 in-depth interviews and eight case studies. I also held discussions with family and community members. In this article, I focus on popular understandings of vaginal discharge being caused by durbolota (weakness) and chinta rog (worry illness), as mentioned by young women. Eighty-eight young women reported that they had experienced white discharge, blaming it on a number of factors such as stress and financial hardships, tensions in the household, marital instability, hunger anxiety, and reproductive burdens. For married adolescent women in the urban slum, white discharge has many levels of meaning linked to the broader social, political, and material inequalities in their everyday lives.

The Intergenerational Effects of Paternal Migration on Schooling and Work: What Can We Learn from Children's Time Allocations?

PubMed

Antman, Francisca M

2011-11-01

This paper explores the short-run effects of a father's U.S. migration on his children's schooling and work outcomes in Mexico. To get around the endogeneity of paternal migration, I use individual fixed effects and instrumental variables estimation (FEIV) where the instrumental variables are based on U.S. city-level employment statistics in two industries popular with Mexican immigrants. Overall, the estimates suggest that in the short-run, children reduce study hours and increase work hours in response to a father's U.S. migration. Decomposing the sample into sex- and age-specific groups suggests that this is mainly driven by the effects of paternal migration on 12-15 year-old boys. These results are consistent with a story in which the immediate aftermath of a father's migration is one of financial hardship that is borne in part by relatively young children.

The Intergenerational Effects of Paternal Migration on Schooling and Work: What Can We Learn from Children's Time Allocations?*

PubMed Central

Antman, Francisca M.

2012-01-01

This paper explores the short-run effects of a father's U.S. migration on his children's schooling and work outcomes in Mexico. To get around the endogeneity of paternal migration, I use individual fixed effects and instrumental variables estimation (FEIV) where the instrumental variables are based on U.S. city-level employment statistics in two industries popular with Mexican immigrants. Overall, the estimates suggest that in the short-run, children reduce study hours and increase work hours in response to a father's U.S. migration. Decomposing the sample into sex- and age-specific groups suggests that this is mainly driven by the effects of paternal migration on 12–15 year-old boys. These results are consistent with a story in which the immediate aftermath of a father's migration is one of financial hardship that is borne in part by relatively young children. PMID:22505791

Saline Systems highlights for 2005

PubMed Central

2006-01-01

On the 4th of July, 2005, the Saline Systems editorial group launched the new online open access journal, Saline Systems, with BioMed Central as the publisher. The scope of the journal includes both basic and applied research on halophilic organisms and saline environments, from gene systems to ecosystems. The stated goal of the journal is to meet publication needs for researchers working in coastal and inland saline environments and provide an interdisciplinary and readily accessible forum for scientists worldwide. The inaugural volume of the journal contains a significant number of high quality original research papers and reviews on a wide range of relevant topics. At the end of the launch period, from January 1, 2006 onwards, the journal will be introducing article-processing charges to cover the cost of publication. Charges will be partly or completely waived for authors from BioMed Central institutional subscribers and in cases of financial hardship. PMID:16417635

The Supreme Court, abortion, and the jurisprudence of class.

PubMed Central

Mariner, W K

1992-01-01

The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a woman's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's methods do not create an "undue burden" on the decision. Any restriction on abortion is a burden; whether it is "undue" (and therefore unconstitutional) depends on one's circumstances. The Court appears to view the difference between an undue burden and mere inconvenience from the perspective of privilege. The restrictions that were upheld may not significantly affect middle-class access to abortion, but they could prove insurmountable for many less privileged women. PMID:1443311

Designing for Diversity: Incorporating Cultural Competence in Prevention Programs for Urban Youth

ERIC Educational Resources Information Center

Golstein, Marion J.; Noguera, Pedro A.

2006-01-01

Low-income urban youth of color frequently confront a wide variety of challenges and hardships that other young people do not experience. The prevalence of hardships that urban youth of color face has contributed to the notion that this group is by its very nature at risk, and promotes stereotypes depicting these youth as irresponsible,…

Economic Stress, Parenting, and Child Adjustment in Mexican American and European American Families

ERIC Educational Resources Information Center

Parke, Ross D.; Coltrane, Scott; Duffy, Sharon; Buriel, Raymond; Dennis, Jessica; Powers, Justina; French, Sabine; Widaman, Keith F.

2004-01-01

To assess the impact of economic hardship on 111 European American and 167 Mexican American families and their 5th-grade (M age 11.4 years) children, a family stress model was evaluated. Structural equation analyses revealed that economic hardship was linked to indexes of economic pressure that were related to depressive symptoms for mothers and…

5 CFR Appendix A to Subpart E of... - Schedule of Environmental Differentials Paid for Exposure to Various Degrees of Hazards, Physical...

Code of Federal Regulations, 2010 CFR

2010-01-01

... diving research tests which seek to establish limits for safe pressure profiles by working in a pressure... Paid for Exposure to Various Degrees of Hazards, Physical Hardships, and Working Conditions of an... to Various Degrees of Hazards, Physical Hardships, and Working Conditions of an Unusual Nature This...

Protection of health research participants in the United States: a review of two cases.

PubMed

Douglass, Alison; Crampton, Peter

2004-06-01

Two research-related deaths and controversies in the United States during recent years have raised public concern over the safety of research participants. This paper explores the reasons why, in two studies, there was a failure of ethical oversight. The issues exposed by these failures have international relevance as they could possibly occur anywhere where human health research is carried out. Five factors that contributed to these failures are highlighted: 1. failure to support and resource research ethics committees; 2. failure of the research oversight process to adequately assess the risks and benefits of research, while giving undue emphasis to informed consent; 3. conflicts of interest arising from financial relationships and research ethics committee membership; 4. lack of consistent oversight of privately funded research; and 5. incompetent or intentional failure to adhere by ethical guidelines. There is considerable headway to be made in the United States, as in other countries, in the fostering and maintenance of robust systems of human research oversight.

Parents' perspectives of life challenges experienced by long-term paediatric brain tumour survivors: work and finances, daily and social functioning, and legal difficulties.

PubMed

Howard, A Fuchsia; Hasan, Haroon; Bobinski, Mary Anne; Nurcombe, Wendy; Olson, Robert; Parkinson, Maureen; Goddard, Karen

2014-09-01

Paediatric brain tumour survivors (PBTS) are at high risk for medical, neurocognitive and psychological sequelea during adulthood. Details illustrating the types and breadth of these chronic sequelae are essential to fully comprehend their impact on daily living. This study describes Canadian parents of PBTS perspectives of life challenges experienced by their now adult son or daughter related to work and finances, daily and social functioning, and legal difficulties. Parents of PBTS completed an anonymous online exploratory survey. Forty-six of 60 invited parents completed the survey. Parents reported that PBTS experienced difficulty gaining or sustaining employment (65 %) because of their health and/or a disability and employers reticence to hire and adequately support PBTS. Independent living was considered unaffordable for PBTS who received a disability allowance (82 %) and those who were employed (50 %). Thirty percent indicated their family experienced hardship because of PBTS medical expenses, which were usually paid for out of pocket (76 %). Although the majority of PBTS were independent with daily tasks and social functioning, a subgroup required continuous support. Forty percent of employed PBTS received limited assistance to accommodate their special needs. Parents indicated their son or daughter had been the victim of theft, fraud or assault (37 %), and commonly considered them vulnerable, in need of protection and feared for their future safety. Research that further illuminates the hardships facing PBTS and informs the development of support and resources to address PBTS vulnerabilities is warranted. PBTS are at risk for unemployment, financial challenges and legal difficulties, which appear to be poorly addressed by health and social programs.

Solar-driven membrane distillation demonstration in Leupp, Arizona.

PubMed

Ravisankar, Vishnu Arvind; Seaman, Robert; Mirchandani, Sera; Arnold, Robert G; Ela, Wendell P

2016-03-01

The Navajo Nation is the largest and one of the driest Native American reservations in the US. The population in the Navajo Nation is sporadically distributed over a very large area making it extremely ineffective to connect homes to a centralized water supply system. Owing to this population distribution and the multi decadal drought prevailing in the region, over 40% of the 300,000 people living on Navajo Tribal Lands lack access to running potable water. For many people the only alternative is hauling water from filling stations, resulting in economic hardship and limited supply. A solution to this problem is a de-centralized off-grid water source. The University of Arizona and US Bureau of Reclamation's Solar Membrane Distillation (SMD), stand-alone, pilot desalination system on the Navajo Reservation will provide an off-grid source of potable water; the pilot will serve as a proximal water source, ease the financial hardships caused by the drought, and provide a model for low-cost water treatment systems in arid tribal lands. Bench-scale experiments and an earlier field prototype plant showed viable operation of a solar heated, membrane distillation (MD) system, but further optimization is required. The objectives of the Navajo pilot study are to i) demonstrate integration of solar collectors and membrane distillation, ii) optimize operational parameters, iii) demonstrate and monitor technology performance during extended duration operation, and iv) facilitate independent system operation by the Navajo Water Resources Department, including hand-over of a comprehensive operations manual for implementation of subsequent SMD systems. The Navajo SMD system is designed as a perennial installation that includes remote communication of research data and full automation for remote, unmanned operation.

The relationship between childhood adversity and food insecurity: 'It's like a bird nesting in your head'.

PubMed

Chilton, Mariana; Knowles, Molly; Rabinowich, Jenny; Arnold, Kimberly T

2015-10-01

Adverse childhood experiences, including abuse, neglect and household instability, affect lifelong health and economic potential. The present study investigates how adverse childhood experiences are associated with food insecurity by exploring caregivers' perceptions of the impact of their childhood adversity on educational attainment, employment and mental health. Semi-structured audio-recorded in-person interviews that included (i) quantitative measures of maternal and child health, adverse childhood experiences (range: 0-10) and food security using the US Household Food Security Survey Module; and (ii) qualitative audio-recorded investigations of experiences with abuse, neglect, violence and hunger over participants' lifetimes. Households in Philadelphia, PA, USA. Thirty-one mothers of children <4 years old who reported low or very low household food security. Twenty-one caregivers (68 %) reported four or more adverse childhood experiences, and this severity was significantly associated with reports of very low food security (Fisher's exact P=0·021). Mothers reporting emotional and physical abuse were more likely to report very low food security (Fisher's exact P=0·032). Qualitatively, participants described the impact of childhood adverse experiences with emotional and physical abuse/neglect, and household substance abuse, on their emotional health, school performance and ability to maintain employment. In turn, these experiences negatively affected their ability to protect their children from food insecurity. The associations between mothers' adverse experiences in childhood and reports of current household food security should inspire researchers, advocates and policy makers to comprehensively address family hardship through greater attention to the emotional health of caregivers. Programmes meant to address nutritional deprivation and financial hardship should include trauma-informed approaches that integrate behavioural interventions.