Welfare sanctions are financial penalties applied to individuals who fail to comply with welfare program rules. Their widespread use reflects a turn toward disciplinary approaches to poverty management. In this article, we investigate how implicit racial biases and discrediting social markers interact to shape officials' decisions to impose sanctions. We present experimental evidence based on hypothetical vignettes that case managers are more likely to recommend sanctions for Latina and black clients—but not white clients—when discrediting markers are present. We triangulate these findings with analyses of state administrative data. Our results for Latinas are mixed, but we find consistent evidence that the probability of a sanction rises significantly when a discrediting marker (i.e., a prior sanction for noncompliance) is attached to a black rather than a white welfare client. Overall, our study clarifies how racial minorities, especially African Americans, are more likely to be punished for deviant behavior in the new world of disciplinary welfare provision.
Objective
The goal of this project was to quantify the prevalence of gaps in cardiology care, identify predictors of gaps, and assess barriers to care among adult congenital heart disease (ACHD) patients.
Background
ACHD patients risk interruptions in care that are associated with undesired outcomes.
Methods
Patients (≥18years) with first presentation to an ACHD clinic completed a survey regarding gaps in, and barriers to, care.
Results
Among 12 ACHD centers, 922 subjects (54% female) were recruited. A >3 year gap in cardiology care was identified in 42%, with 8% having gaps longer than a decade. Mean age at first gap was 19.9 years. The majority of respondents had more than high school education, and knew their heart condition. Most common reasons for gaps included feeling well, unaware follow-up required, and complete absence from medical care. Disease complexity was predictive of gap in care with 59% of mild, 42% of moderate and 26% of severe disease subjects reporting gaps (p<0.0001). Clinic location significantly predicted gaps (p<0.0001) while gender, race, and education level did not. Common reasons for returning to care were new symptoms, referral from provider, and desire to prevent problems.
Conclusions
ACHD patients have gaps in cardiology care; the first lapse commonly occurred around 19 years, a time when transition to adult services is contemplated. Gaps were more common among subjects with mild and moderate diagnoses and at particular locations. These results provide a framework for developing strategies to decrease gaps and address barriers to care in the ACHD population.
In this cohort of adult patients with Fontan physiology, endothelin blockade with bosentan resulted in improved 6MWD and MRI-derived resting cardiac output, suggesting a positive effect on pulmonary vascular resistance and pulmonary blood flow. Bosentan was well tolerated and hepatic function was not adversely affected.
Studies have shown that neighborhood conditions and experiences may individually or collectively impact health. Using 38 years of longitudinal data from the Panel Study of Income Dynamics (PSID), we clarify the relationship between child and adult neighborhood quality and self-reported adult health, using sibling fixed effects models. Overall, we find support for positive long-term health effects, both for growing up in affluent neighborhoods and for growing up in neighborhoods where one is surrounded by comparative advantage. Relative to childhood neighborhood factors, adult neighborhoods have little to no effect in almost every model specification. We find mixed evidence, as well, that these relationships are stronger for nonwhites than for whites. Our findings suggest that childhood is a critical point for intervention in the long-term health effects of residential conditions.
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