This dissertation offers an empirical examination of the relationship between community social capital and health care safety net capacity. The ability and willingness of federally qualified health centers (FQHCs) and private physicians to serve the uninsured is crucial to ensuring that all Americans have access to a basic level of health care. Among other factors, this ability and willingness has been found to be a consequence of unique community values and traditions. This dissertation examined the extent to which the level of community social capital (community rates of participation in club meetings, projects, volunteer and civic activities) was related to three health care provider outcomes; 1) the willingness of private physicians to deliver uncompensated care; 2) the financial capacity of FQHCs to provide uncompensated care; and 3) the amount of FQHC resources directed toward the provision of largely uncompensated community-oriented services.Community and health care provider data on 1,248 FQHCs across 183 U.S. counties and 12,406 private physicians across 1,029 U.S. counties were collected from multiple data sources. Comprehensive multivariate analyses including Canonical Correlation Analysis (CCA), Ordinary Least Square (OLS) and Hierarchical Linear Modeling (HLM), and a planned comparison was conducted on these data at the community ecological and individual provider levels of analysis.Based on a literature review and the theoretical components of social capital theory, I developed a conceptual framework that proposed a relationship among social context, institutional frameworks and organizational behavior. The dissertation research sought to determine the extent to which the social context in which the organization was embedded influenced organizational behavior.I found that the relationship between community social capital and health care safety net capacity was weak and the direction of the association mixed. Among the findings was a positive and significant relationship between civic participation and FQHC grant revenues. Unexpected findings included significant correlations between community social capital and Medicaid generosity, and social capital and uninsurance. Although the data analysis suggested that unmeasured factors were largely responsible for variation in safety net capacity, it raised interesting questions that provoke future study. Important implications for theory, policy and practice are discussed.

Throughout the International Monetary Fund's history it has been criticized for failing to address the negative impact its adjustment programs have on the poor in borrowing countries. This study examines the Fund's declared intention and actions regarding the construction of a social safety net in Indonesia from October 1997 until May 1998. A historical narrative using Constructivism as a theoretical framework is used to explain the relationship between the IMF, Suharto and the effect their interaction had on social safety net construction. This historical perspective reveals that rather than working towards building a social safety net, the Fund's main priority was the decentralization of Indonesian political and economic structures. / Master of Arts

Project (D. Min.)--Emmanuel School of Religion, Johnson City, Tenn., 1999. / Vita. Includes bibliographical references (leaves 109-122).

Project (D. Min.)--Emmanuel School of Religion, Johnson City, Tenn., 1999. / Vita. Includes bibliographical references (leaves 109-122).

Project (D. Min.)--Emmanuel School of Religion, Johnson City, Tenn., 1999. / Vita. Includes bibliographical references (leaves 109-122).

OBJECTIVE: In recent decades scientific advancements and improvements in treatment options have significantly reduced breast cancer mortality. Unfortunately, not all have experienced these improvements; there is a widening gap in mortality rates between Black and Non-Hispanic, White women. While race may be one factor in this disparity, the interactions between social, environmental, and economic circumstances and their differential impact across racial and ethnic groups invariably contribute to observed mortality differences. Socio-legal concerns are experienced often by patients at safety-net hospitals and have the potential to become barriers to care and impact the receipt of timely care. Regarded as basic life needs, socio-legal barriers are amenable to legal intervention but if the needs remain unmet, negative health outcomes may results. Understanding the burden of socio-legal concerns in at-risk populations is necessary to address these barriers to care. To date, systematic assessment of socio-legal concerns among newly diagnosed breast cancer patients has not been well documented. METHODS: We conducted a secondary analysis of I-HELP survey data collected for Project SUPPORT, an RCT comparative effectiveness study that compared standard navigation to legally enhanced navigation at Boston Medical Center. The survey, administered in English, Spanish or Haitian Creole by trained Research Assistants at baseline, 3 and 6 months, systematically assessed participants socio-legal concerns within four categories: Employment, Disability Benefits, Housing and Utilities and Personal and Family Stability. Demographic information was extracted from participants’ electronic medical records, supplemented by surveys on health literacy and employment. Means, medians, frequencies and percentages were used to describe and quantify the burden, type and change in concern at each follow-up point. T-tests and Fischer exact tests were used to evaluate differences in socio-demographic characteristics on the presence, type and trends among the concerns. RESULTS: Overall 262 breast cancer patients enrolled in Project SUPPORT and completed the baseline I-HELP survey. The racial distribution of the participants reflects the diverse population served by Boston Medical Center with the majority of the participants (n=200, 76%) being non-white. Overall, 77% (201/262) of participants reported 1 or more concerns across all categories with 44% (115/262) reporting 3 or more concerns. Among the four categories of concern, the most frequently reported concern was related to housing with 61% (161/262) reporting at least one housing concern. Participants most likely to express any concern were 50 years old or younger, non-English speaking and employed. For the majority of participants, the burden of concern remained constant or increased during the first 6-months of treatment. Non-white women were most likely to experience a persistent concern over the first six months. CONCLUSIONS: Our findings confirmed that the majority of breast cancer patients experience some kind of socio-legal concern at the time of diagnosis. Also, socio-legal concerns persist throughout the course of treatment. The reported results emphasize the continued need for systematic assessment during cancer treatment. Additionally, collaboration between the medical and legal sectors in cancer care delivery at safety-net hospitals offers a means to address barriers to care and improve health outcomes.

No description available.

HOPE VI, instituted in 1993 and subsequent related policies, resulted in the demolition of traditional public housing and the relocation of former residents. For former residents living on low incomes, combining housing subsidy and other social services is important to survival. One crucial type of social services support provides food supplements. Research indicates that among low-income families, many do not receive necessary food social services. For example, among eligibles, food stamp utilization is at 50 to 60%, and for Special Supplemental Nutrition Program for Women Infants and Children (WIC) rates vary from 38 to 73%. Research indicates that 35% of food insecure older adults are ineligible for the Elder Nutrition Program, and approximately 60% of eligibles are wait-listed upon application. Social services utilization patterns among eligibles are affected by neighborhood contexts. Relocation due to public housing transformation policies has been shown to change neighborhood context. This in turn has affected former public housing resident’s cultural capital and social capital. But how this affects food social services utilization has not been studied. I use Klinenberg’s (2002) activist client thesis as a framework to investigate the effect of cultural capital and social capital for housing subsidy recipients (relocated public housing residents) in Atlanta on their utilization of food social services using secondary longitudinal data from the Georgia State University Urban Health Initiative analyzed using ordered logistic regression. Most specifically, my research investigated how varying neighborhood contexts affect food social services utilization for former public housing residents in Atlanta. This research informs public policy on the provision of housing subsidy and the provision of food social services.

Objective: The Hayes E. Willis Health Center (HWHC) was opened in a neighborhood of South Richmond in October 1993 to remove the barriers that prevented South Richmond residents from accessing primary healthcare services. The major objective of this study was to determine the effectiveness of the HWHC in providing primary care to the South Richmond Community deemed to be in need. An additional objective was to describe the changes in characteristics of clinic users and illnesses seen over time.Methods: Patient data was compared from the HWHC�s first full year of operation in which patient data was collected (1995) to the most current year (2003) to determine if the targeted population of South Richmond had been serviced by the HWHC. A combined total of 20,190 visits occurred in 1995 and 2003 by a total of 7,552 patients. A Pearson chi-square analysis was performed to test whether the observed differences in proportions between the two study groups (1995 and 2003) were statistically different for the variable of patient residence location, as well as the variables of race, sex, age, type of insurance used, and clinic visited. Results: The patient population living in the original target area of South Richmond has declined from 82.6% in 1995 to 67.1% in 2003. The proportion of patients residing within the metropolitan Richmond area, but outside of South Richmond, has increased from 13.2% in 1995 to 21.1% in 2003. The proportion of clinic patients residing outside of Richmond completely has nearly tripled � from 4.2% to 11.8%.Conclusions: While the HWHC has gained popularity with non-South Richmond residents, it is clear that it has in fact been successful in offering primary care health services for the residents of South Richmond. The HWHC, and the public health policy that created it, should be viewed as an ideal model for other areas in Richmond, as well as other metropolitan areas across the United States to emulate and implement in their own communities.

This dissertation consists of three essays examining the role of two particular social safety net programs, the Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Program (SNAP), on the well-being of children from disadvantaged households. While the impact of these programs on the adults and parents of the household have been studied extensively, less is known about their effect on children. This is true for both their immediate impact on child well-being and any long-run impacts on children who grow up under these programs. Given the demonstrated importance of child well-being on later life adult outcomes, understanding the lasting effects of the programs is of great policy importance. In Essay 1, I examine the effect of welfare reform on long-run educational attainment and family structure outcomes on children who grew up under the reformed welfare system. In the early 1990’s, the United States reformed its welfare system through state waivers and the TANF program. These changes altered family resources and potential investments for childhood human capital, which in turn could affect later adult outcomes. Using data from the Panel Study of Income Dynamics (PSID) Child Development Supplement (CDS) and the Transition to Adulthood Supplement (TAS), I examine the short-run effects of welfare reform on cognitive and noncognitive outcomes and the long-run impact of welfare reform on adult education and family structure through age 28. I find that as children, these individuals have higher reading test scores by an average of 6 percent of a standard deviation. As adults, I find robust evidence that these treated individuals are on average 9 percent more likely to graduate college. I also find some evidence that they are more likely to be married and less likely to have a child out of wedlock. The impacts of welfare reform are larger for women than men for childhood test scores and college completion, marriage rates, and out of wedlock births as adults. In Essay 2, I continue to study the effects of welfare reform on child well-being, here focusing on the effect of welfare reform on the health insurance coverage, healthcare utilization, and the health status of children. In addition to changing the overall resources available to the family to invest in child health, welfare reform also has specific implications for health insurance coverage. As mothers were moved to work they could gain private coverage and welfare reform eliminated automatic eligibility for Medicaid. In this essay, I use data from the PSID CDS. I find a 3-5 percent decrease in the likelihood that a child has had their annual checkup but no change to the insurance coverage of children. For health status, I find lower rates of asthma by 17 percent among African American children and an increase of 3-5 healthy days a year for all children. I present suggestive evidence that the improvements in child health are driving the reduction in healthcare utilization. Given the evidence in the literature on the importance of childhood health, these improvements have potentially large ramifications for future adult health. Finally, in Essay 3 I explore the effect of the real purchasing power of SNAP benefits for households with children on dietary quality of food acquisitions and food insecurity. SNAP, formerly food stamps, is one of the most important components of the social safety net. However, there is concern that benefits are inadequate given high food insecurity rates among participating households. Currently SNAP does not account for variation in local food prices and does not sufficiently consider the dietary needs of adolescent children. Using data from the Food Acquisition and Purchase Survey (FoodAPS), I exploit variation in county level food prices and family composition to estimate the purchasing power of food expenditures for SNAP and SNAP–eligible households to test for the effect of additional benefits on dietary quality and food security. I find that a ten percent increase in purchasing power is associated with increased per person weekly acquisition of grains, proteins, dairy, and vegetables by 1.5-2.5 percent. However the quantity of added sugars also increases by approximately two percent, suggesting an ambiguous impact on health. In line with these modest changes in quantity, I do not find a statistically significant impact of purchasing power on food insecurity rates.