BackgroundWe sought to determine whether maternal Medicaid retention influences child Medicaid retention because caregivers play a critical role in assuring children’s health access.MethodsWe conducted a longitudinal prospective cohort study of a convenience sample of 604 Medicaid-eligible mother-child dyads followed from the infant’s birth through 24 months of age with parent surveys. Individual enrollment status was abstracted from administrative Medicaid eligibility files. Generalized estimating equations quantified the effect of maternal Medicaid enrollment status on child Medicaid retention, adjusting for relevant covariates. Because varying lengths of gaps may have different effects on child health outcomes, Medicaid enrollment status was further categorized by length of gap: any gap, > 14-days, and > 60-days.ResultsThis cohort consists primarily of African-American (94%), unmarried mothers (88%), with a mean age of 23.2 years. In multivariable analysis, children whose mothers experienced any gaps in coverage had 12.6 times greater odds of experiencing gaps when compared to children whose mothers were continuously enrolled. Use of varying thresholds to define coverage gaps resulted in similar odds ratios (> 14-day gap = 11.8, > 60-day gap = 16.8). Cash assistance receipt and maternal knowledge of differences between Temporary Assistance to Needy Families and Medicaid eligibility criteria demonstrated strong protective effects against child Medicaid disenrollment.ConclusionsMedicaid disenrollment remains a significant policy problem and maternal Medicaid retention patterns show strong effects on child Medicaid retention. Policymakers need to invest in effective outreach strategies, including family-friendly application processes, to reduce enrollment barriers so that all eligible families can take advantage of these coverage opportunities.
Introduction: Low-income child populations remain under-vaccinated. Our objective was to determine differences in the relative importance of maternal health literacy and socio-demographic characteristics that often change during early childhood on up-to-date (UTD) immunization status among a low-income population. Methods: We performed secondary data analysis of a longitudinal prospective cohort study of 744 Medicaid-eligible mother-infant dyads recruited at the time of the infant's birth from an inner-city hospital in the United States and surveyed every 6 months for 24 months. Our primary outcome was infant UTD status at 24 months abstracted from a citywide registry. We assessed maternal health literacy with the Test of Functional Health Literacy in Adults (short version). We collected socio-demographic information via surveys at birth and every 6 months. We compared predictors of UTD status at 3, 7, and 24 months. Results: The cohort consisted of primarily African-American (81.5%) mothers with adequate health literacy (73.9%). Immunizations were UTD among 56.7% of infants at 24 months of age. Maternal health literacy was not a significant predictor of UTD immunization status. Instead, adjusted results showed that significant predictors of not-UTD status at 24 months were lack of a consistent health care location or "medical home" (OR 0.17, 95%CI 0.18-0.37), inadequate prenatal care (OR 0.48, 95%CI 0.25-0.95), and prior not-UTD status (OR 0.31,. Notably, all upper confidence limits are less than 1.0 for these variables. Health care location type (e.g., hospital-affiliate, community-based, none) was a significant predictor of vaccine status at age 3 months, 7 months, and 24 months. Conclusions: Investing in efforts to support early establishment of a medical home to obtain comprehensive coordinated preventive care, including providing recommended vaccines on schedule, is a prudent strategy to improve vaccination status at the population level.
Addressing the health of communities involves collaboration within different sectors to achieve these goals. "Public health" and "population health" are two terms that are often used interchangeably, but there are differences between the two and it is important to understand these differences. Addressing health in communities also involves planning, by ensuring that the built environment, where people live, work, and play, also promotes healthy lifestyles. Each of these subject areas bring unique frameworks, processes, and strategies to address issues of health in communities. Public HealthThe philosophies and principles surrounding public health have been around since the Hippocratic physiology described the four humours (blood, black bile, yellow bile, and phlegm) in ancient Greece. 1 Civilizations, then scholars and journalists noted health impacts, attempted remedies, and identified results. By the 1800s, industrialization and urbanization brought the spread of cholera, smallpox, dysentery, and other infectious diseases to New York City, Boston, Philadelphia, and beyond. Early public health efforts 1 included identifying environmental improvement to prevent endemic disease (Lemuel Shattuck), reporting of maternal and fetal mortality rates (Lemuel Shattuck), and improving sanitation practices (C.E.A. Winslow) -all which evolved into the public health that we know today.Public health is the "science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private, communities, and individuals." 2 Public health focuses on the population's health as a whole, initiates prevention strategies, and identifies problems that may affect the larger population.According to the Centers for Disease Control and Prevention (CDC), the 10 great public health achievements of the 20th century 3 are: 1. Immunizations. There were dramatic declines in vaccine-preventable diseases and smallpox was eradicated.
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