Doug Oman

Background: Children in working poor families are among the most disadvantaged, yet little is known about barriers to care for these children. Objectives: We sought to compare health care access and use by children from working poor families with other poor and nonpoor children and consider the extent to which expansions in public health insurance have contributed to increased access in California. Methods: This was cross-sectional study using data from the 2001 California Health Interview Survey, a representative telephone survey. Using this survey, we were able to include 16,528 children younger than the age of 18 in our analysis. We measured financial and nonfinancial access to health care and service use. Results: Children in working poor families had higher odds of being uninsured (adjusted odds ratio 2.9, 95% confidence interval 2.0, 4.1; adjusted odds ratio 3.7, 95% confidence interval 2.9, 4.8, respectively) compared with children in nonworking poor/TANF and nonpoor families. Disparities in nonfinancial access and use between the working poor and nonworking poor narrowed considerably when controlling for insurance and other covariates. Compared with nonpoor children, disparities in access were wider. The largest disparities in use were in dental care. After controlling for insurance and other covariates, disparities remained. Conclusions: Despite public insurance expansions, particularly through Healthy Families, disparities in insurance coverage between the working poor and other poor and nonpoor children remain, placing children of the working poor at a disadvantage for access and use. Insurance coverage expansions must be protected and coupled with continued efforts to narrow nonfinancial barriers to care.

To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.

Objective. To compare the extent with which child‐only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees.Data Sources/Setting. We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey.Study Design. We conducted a cross‐sectional study of 5,521 public health insurance–eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child‐only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations.Data Collection. We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement.Findings. Among the sampled children, 13 percent were uninsu...

Older residents ( N 5 1972) in California were investigated prospectively for association of volunteering service to others and all-cause mortality. Potential confounding factors were studied: demographics, health status, physical functioning, health habits, social support, religious involvement, and emotional states. Possible interaction effects of volunteering with religious involvement and social support were also explored. Results showed that 31 percent ( n 5 630) of respondents volunteered, about half ( n5289) for more than one organization. High volunteers ([.greaterequal]2 organizations) had 63 percent lower mortality than nonvolunteers (age and sex-adjusted) with relative hazard (RH) 5 0.37, confidence interval (CI) 5 0.24, 0.58. Multivariate adjustment moderately reduced difference to 44 percent (RH 5 0.56, CI 5 0.35, 0.89), mostly due to physical functioning, health habits, and social support. Unexpectedly, volunteering was slightly more protective for those with high reli...

Comments on the article by I. Prilleltensky and O. Prilleltensky regarding the impact of critical psychology on the health professions. In this comment, the authors briefly review literature that suggests, sometimes quite strongly, that religious and spiritual involvement may contribute, in concert with several other factors, to better health and less disease.

This study examined how training in a nonsectarian toolkit of spiritually based self-management techniques affected the caregiving self-efficacy (confidence) of health professionals, including physicians, nurses, psychologists, and chaplains. Before and after an 8-week, 2-hour per week training in the meditation-based Eight Point Program of Easwaran (1978/1991b), participants ( n = 14) completed a newly developed 32-item caregiving self-efficacy questionnaire. Data were also gathered regarding sociodemographic characteristics, spiritual and religious self-perceptions and practices, and program adherence. Results indicated that mean pre/post self-efficacy increases were large (Cohen's d > 0.80), statistically significant ( p < 0.01), and associated with greater use of specific pro-gram practices. Three participants reported increases in self-perceived spirituality. Self-efficacy increases were largest for participants identifying themselves as least spiritual at pretest ( p...

OBJECTIVES: This study analyzed the prospective association between attending religious services and all-cause mortality to determine whether the association is explainable by 6 confounding factors: demographics, health status, physical functioning, health habits, social functioning and support, and psychological state. METHODS: The association between self-reported religious attendance and subsequent mortality over 5 years for 1931 older residents of Marin County, California, was examined by proportional hazards regression. Interaction terms of religion with social support were used to explore whether other forms of social support could substitute for religion and diminish its protective effect. RESULTS: Persons who attended religious services had lower mortality than those who did not (age- and sex-adjusted relative hazard [RH] = 0.64; 95% confidence interval [CI] = 0.52, 0.78). Multivariate adjustment reduced this relationship only slightly (RH = 0.76; 95% CI = 0.62, 0.94), prima...

Abstract 1. We report psychometric properties, correlates, and underlying theory of the Spiritual Modeling Self-Efficacy (SMSE) scale. The SMSE, the first spiritually oriented self-efficacy measure, is a 10-item self-report assessment of perceived efficacy for learning from spiritual models. Spiritual models are defined as community-based or prominent people who function for respondents as exemplars of spiritual qualities, such as compassion, self-control, or faith. Demographic, spiritual, and personality correlates were examined in a ...

Objective Mantram or holy name repetition has long been practiced in every major religious tradition. Repetition of a mantram as a mindfulness practice is helpful for stress management and resilience building. The objective of this article is to provide an overview of the key features of mantram and the Mantram Repetition Program (MRP) developed in the US Veterans Healthcare System, the evidence base for the MRP, and its applications. Methods MRP practices are portable and do not require an extended or regularized period of sitting, in contrast to most methods of meditation. Core functions of MRP practices include focus shifting, frame activation, and fostering of mindfulness. We review scientific research, including multiple randomized trials, that has investigated the MRP. Results Research on the MRP has documented reductions in posttraumatic stress symptoms, insomnia, hyperarousal, and depression, as well as enhancement of quality of life, self-efficacy, and mindfulness. Mantram ...

Several evidence-based treatments are available to veterans diagnosed with posttraumatic stress disorder (PTSD). However, not all veterans benefit from these treatments or prefer to engage in them. The current study explored whether (1) a mantram repetition program (MRP) increased mindful attention among veterans with PTSD, (2) mindful attention mediated reduced PTSD symptom severity and enhanced psychological well-being, and (3) improvement in mindful attention was due to the frequency of mantram repetition practice. Data from a randomized controlled trial comparing MRP plus treatment as usual (MRP+TAU) or TAU were analyzed using hierarchical linear models. A total of 146 veterans with PTSD from military-related trauma were recruited from a Veterans Affairs outpatient PTSD clinic (71 MRP+TAU; 75 TAU). The Clinician Administered PTSD Scale (CAPS), PTSD Checklist (PCL), the Brief Symptom Inventory-18 depression subscale, Health Survey SF-12v2, and Mindfulness Attention Awareness Scal...