Low-income Participants Research Articles

The ethics of uninsured participants accessing healthcare in biomedical research: A literature review.

Background/aims Sparse literature exists on the challenges and ethical considerations of including people with limited access to healthcare, such as the uninsured and low-income, in clinical research in high-income countries. However, many ethical issues should be considered with respect to working with uninsured and low-income participants in clinical research, including enrollment and retention, ancillary care, and post-trial responsibilities. Attention to the uninsured and low-income is particularly salient in the United States due to the high rates of uninsurance and underinsurance. Thus, we conducted a scoping review on the ethical considerations of biomedical clinical research with uninsured and low-income participants in high-income countries in order to describe what is known and to pinpoint areas of needed research on this issue. Methods MEDLINE/PubMed, Embase, and Scopus databases were searched using terms that described main concepts of interest (e.g., uninsured, underinsured, access to healthcare, poverty, ethics, compensation, clinical research). Articles were included if they met four inclusion criteria: (1) English, (2) high-income countries context, (3) about research participants who are uninsured or low-income, which limits their access to healthcare, and in biomedical clinical research that either had a prospect of direct medical benefit or was offered to them on the basis of their ill health, and (4) recognizes and/or addresses challenges or ethical considerations of uninsured or low-income participants in biomedical clinical research. Results The searches generated a total of 974 results. Ultimately, 23 papers were included in the scoping review. Of 23 articles, the majority (n = 19) discussed enrollment and retention of uninsured or low-income participants. Several barriers to enrolling uninsured and low-income groups were identified, including limited access to primary or preventive care; lack of access to institutions conducting trials or physicians with enough time or knowledge about trials; overall lack of trust in the government, research, or medical system; and logistical issues. Considerably fewer articles discussed treatment of these participants during the course of research (n = 5) or post-trial responsibilities owed to them (n = 4). Thus, we propose a research agenda that builds upon the existing literature by addressing three broad questions: (1) What is the current status of uninsured research participants in biomedical clinical research in high-income countries? (2) How should uninsured research participants be treated during and after clinical research? (3) How, if at all, should additional protections for uninsured research participants affect their enrollment? Conclusions This review reveals significant gaps in both data and thoughtful analysis on how to ethically involve uninsured research participants. To address these gaps, we propose a research agenda to gather needed data and theoretical analysis that addresses three broad research questions.

Fostering Low-Income Homeownership: A Longitudinal Randomized Experiment on Individual Development Accounts

For low-income families, homeownership represents an important strategy for promoting long-term social and economic development. Individual Development Account (IDA) programs facilitate saving toward assets such as a home through matching, financial education, and case management. Using longitudinal experimental data from the American Dream Demonstration, this study examines the impact of IDA participation on homeownership rates and on clearing old debts. Low-income participants were interviewed after 18 months (Wave 2) and after program completion at 48 months (Wave 3). Logistic regression results indicate that among those who were renters at baseline, IDA participation significantly increases the clearing of old debts at Wave 2 and homeownership rates at Wave 3. IDA participants with cleared debt activity had the highest probability of becoming homeowners at Wave 3 (32 percent), while those who were not IDA participants and did not have such activity had only a 9.6 percent probability.

Long-Term Follow-Up of Individual Development Accounts: Evidence from the ADD Experiment

This report presents findings from the fourth wave of the American Dream Demonstration (ADD) experimental study of Individual Development Accounts (IDAs). The ADD was a set of 14 privately funded local IDA programs initiated in the late 1990s. It was the first large-scale test of IDAs in the United States and used a variety of research methods in order to learn about IDAs. One of these programs, in Tulsa, Oklahoma, was implemented as a random assignment experiment. This report is based on a 10-year follow study of impacts at the Tulsa site.In total, 1,103 low-income participants were surveyed at baseline and randomly assigned to either the treatment or control group. Treatment group members received access to an IDA as well as financial education and case management. The IDA provided matched withdrawals at a 2:1 rate for home purchase and a 1:1 rate for home repair, small business investment, post-secondary education, or retirement savings. Participants who made the maximum matchable deposits throughout the 3 years of the program could accumulate $6,750 (plus interest) for a home purchase or $4,500 (plus interest) for the other qualified uses.In examining the five allowable uses, the study finds some impacts of IDAs on education, especially for males, and on home maintenance and repair 10-years after the program. However, we find no impact on homeownership, businesses, and retirement savings in the follow-up study. The positive findings for education and home maintenance and repair may suggest that IDAs are best suited to support asset purchases that can be accomplished incrementally over a period of time. Targeting IDAs for education and home maintenance and repair may be more effective than applying them to “all-or-nothing” purchases like a house.

Deviated from Welfare State Concept: Policymakers Should Reform Its Social Protection

Rapidly increase of food price, houses, transportation costs and other basic expenses in consecutive years, Malaysian citizens have endured their life for such a long time. The objectives of the study are to investigate the vulnerability faced by the low income participants in their life. The outcome of the study is to extend the social protection to the low income towards achieving the concept of welfare state. This is a qualitative method of study and the interviews were conducted in Klang, Selangor, Malaysia. Data was collected from the low income participants with different background of economic activities. Findings reveal that participants having difficulties in settling their medical expenses, lack of transportation facilities that made them immobility and suffering high cost of living. By tightened up the policies towards welfare state concept, government could ensure the citizens relish the wealth of the country and restore economic resilience of the citizens.

Evaluation of Healthy Fit: A Community Health Worker Model to Address Hispanic Health Disparities.

IntroductionHispanics in the United States have disproportionately high rates of obesity, hypertension, and diabetes and poorer access to preventive health services. Healthy Fit uses community health workers to extend public health department infrastructure and address Hispanic health disparities related to cardiovascular disease and access to preventive health services. We evaluated the effectiveness of Healthy Fit in 1) reaching Hispanic Americans facing health disparities, and 2) helping participants access preventive health services and make behavior changes to improve heart health.MethodsCommunity health workers recruited a sample of predominantly low-income Hispanic immigrant participants (N = 514). Following a health screening, participants received vouchers for breast, cervical, and colorectal cancer screening, and received vaccinations as needed for influenza, pneumonia, and human papillomavirus. Participants who were overweight or had high blood pressure received heart health fotonovelas and referrals to community-based exercise activities. Community health workers completed follow-up phone calls at 1, 3, and 6 months after the health screening to track participant uptake on the referrals and encourage follow-through.ResultsParticipants faced health disparities related to obesity and screening for breast, cervical, and colorectal cancer. Postintervention completion rates for breast, cervical, and colorectal cancer screening were 54%, 43%, and 32%, respectively, among participants who received a voucher and follow-up phone call. Among participants with follow-up data who were overweight or had high blood pressure, 70% read the fotonovela, 66% completed 1 or more heart health activities in the fotonovela, 21% attended 1 or more community-based exercise activities, and 79% took up some other exercise on their own.ConclusionHealthy Fit is a feasible and low-cost strategy for addressing Hispanic health disparities related to cancer and cardiovascular disease.

Investigation Analysis on Social Support Status of Female Migrant Workers

Objective: To study status of social support and its influencing factors in female migrant workers. Methods: Study participants were selected with a random cluster design from participants 16-60 years old in non-registered residents from 10 districts in one city. Social support revalued scale and general questionnaire were used to survey social support status of female migrant workers in August-December of 2016. Results: There was statistic difference in social support among different districts, occupations, and income of female migrant workers (P<0.05) . Results of multiple linear regression demonstrates that districts, occupations, and income of female migrant workers were associated with social support scale (district standarized β=0.03, occupations standarized β=-0.03, incorue standarized β=0.10, P<0.05) . Conclusion: We should be attentive to self-employed and Low-income participants among female migrant workers.

Late adulthood mortality among African-American and white American people with Type 1 diabetes according to age at diabetes diagnosis.

To estimate the overall and cause-specific mortality in a population of African-Americans and white Americans with a low socio-economic status who had young-onset insulin-treated diabetes and had survived beyond the age of 40 years, and to examine whether any excess risk varied according to age at diabetes onset. Using the Southern Community Cohort Study, we conducted a mortality follow-up of a cohort of mostly low-income participants aged 40-79 years (mean 50 years) at cohort entry with insulin-treated diabetes diagnosed before age 30 years (n=475) and without diabetes (n=62 266). Childhood onset was defined as diabetes diagnosed before age 20 years (n=162), while young-adulthood onset was defined as diabetes diagnosed between ages 20 and 29 years (n=313). Cause-specific mortality was based on both underlying and contributing causes of death, obtained from death certificates. Multivariable Cox analysis was performed. During follow-up (mean 9.5 years), 38.7% of those with and 12.9% of those without diabetes died. Compared with those without diabetes, increases in mortality rate were generally similar among those with childhood- and young-adulthood-onset diabetes for deaths from: all causes (childhood: hazard ratio 4.3, CI 3.3-5.5; young adulthood: hazard ratio 4.9, CI 4.0-5.8); ischaemic heart disease (childhood: hazard ratio 5.7, CI 3.5-9.4; young adulthood: hazard ratio 7.9, CI 5.6-11.0); heart failure (childhood: hazard ratio 7.3, CI 4.2-12.7; young adulthood: hazard ratio 5.4, CI 3.3-8.9); sepsis (childhood: hazard ratio 10.3, CI 6.1-17.3; young adulthood: hazard ratio 8.8, CI 5.7-13.5); renal failure (childhood: hazard ratio 15.1, CI 8.6-26.5; young adulthood: hazard ratio 18.2, CI 12.3-27.1); respiratory disorders (childhood: hazard ratio 3.9, CI 2.3-6.7; young adulthood: hazard ratio 5.3, CI 3.7-7.7); suicide/homicide/accidents (childhood: hazard ratio 2.3, CI 0.72-7.0; young adulthood: hazard ratio 5.8, CI 3.4-10.2); and cancer (childhood: hazard ratio 2.1, CI 0.98-4.4; young adulthood: hazard ratio 1.2, CI 0.55-2.5). We observed high excess long-term mortality for all-cause, renal failure, ischemic heart disease and heart failure mortality in African-American and white American people with early-onset insulin-treated diabetes.

The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia

BackgroundPriority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority.MethodsSynthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context.ResultsBased on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context.ConclusionWhile it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers’ understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability.

Narrowing the Early Mathematics Gap: A Play-Based Intervention to Promote Low-Income Preschoolers' Number Skills.

Preschoolers from low-income households lag behind preschoolers from middle-income households on numerical skills that underlie later mathematics achievement. However, it is unknown whether these gaps exist on parallel measures of symbolic and non-symbolic numerical skills. Experiment 1 indicated preschoolers from low-income backgrounds were less accurate than peers from middle-income backgrounds on a measure of symbolic magnitude comparison, but they performed equivalently on a measure of non-symbolic magnitude comparison. This suggests activities linking non-symbolic and symbolic number representations may be used to support children's numerical knowledge. Experiment 2 randomly assigned low-income preschoolers (M age = 4.7 years) to play either a numerical magnitude comparison or a numerical matching card game across four 15 min sessions over a 3-week period. The magnitude comparison card game led to significant improvements in participants' symbolic magnitude comparison skills in an immediate posttest assessment. Following the intervention, low-income participants performed equivalently to an age- and gender-matched sample of middle-income preschoolers in symbolic magnitude comparison. These results suggest a brief intervention that combines non-symbolic and symbolic magnitude representations can support low-income preschoolers' early numerical knowledge.

Aflatoxin and viral hepatitis exposures in Guatemala: Molecular biomarkers reveal a unique profile of risk factors in a region of high liver cancer incidence

Liver cancer is an emerging global health issue, with rising incidence in both the United States and the economically developing world. Although Guatemala experiences the highest rates of this disease in the Western hemisphere and a unique 1:1 distribution in men and women, few studies have focused on this population. Thus, we determined the prevalence and correlates of aflatoxin B1 (AFB1) exposure and hepatitis virus infection in Guatemalan adults. Healthy men and women aged ≥40 years (n = 461), residing in five departments of Guatemala, were enrolled in a cross-sectional study from May—October of 2016. Serum AFB1-albumin adducts were quantified using isotope dilution mass spectrometry. Multivariate linear regression was used to assess relationships between AFB1-albumin adduct levels and demographic factors. Biomarkers of hepatitis B virus and hepatitis C virus infection were assessed by immunoassay and analyzed by Fisher’s exact test. AFB1-albumin adducts were detected in 100% of participants, with a median of 8.4 pg/mg albumin (range, 0.2–814.8). Exposure was significantly higher (p<0.05) in male, rural, low-income, and less-educated participants than in female, urban, and higher socioeconomic status participants. Hepatitis B and C seropositivity was low (0.9% and 0.5%, respectively). Substantial AFB1 exposure exists in Guatemalan adults, concurrent with low prevalence of hepatitis virus seropositivity. Quantitatively, AFB1 exposures are similar to those previously found to increase risk for liver cancer in Asia and Africa. Mitigation of AFB1 exposure may reduce liver cancer incidence and mortality in Guatemala, warranting further investigation.

Social marketing for a farmer's market in an underserved community: A needs assessment.

The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide.Significance for public healthThis brief report establishes the need for local farmers’ markets (FM) in New Orleans, Louisiana to distribute information to increase the awareness of the markets, especially among low-income individuals. A variety of the FMs in New Orleans offer discounts to increase access to fresh produce among underserved individuals. However, there is a lack of knowledge of these markets, the ability to utilize Supplemental Nutrition Assistance Program benefits to purchase food, and of the discounts offered. Furthermore, this assessment demonstrates that low-income individuals have adequate access to the internet and a variety of social media channels. Based on these results, our research establishes that cost-effective and efficient, web-based marketing could be used as means help increase FM participation among low-income individuals. Increasing awareness of FMs and discounts offered to low-income individuals is one step in creating better access to affordable produce, which could lead to increased fruit and vegetable consumption and better health outcomes among at-risk populations.

Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial.

BackgroundNo existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan.ObjectiveThe aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults.MethodsIn this randomized controlled trial, participants were assessed at three time points—baseline, postintervention (5 weeks later), and a follow-up after 3 months—from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g).ResultsOut of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (η2=0.04, P=.01) and time (η2=0.01, P<.001), and a significant interaction (η2=0.01, P=.009). Middle-income participants also had a significant main effect of time (η2=0.01, P=.006) and a significant interaction (η2=0.01, P=.046).ConclusionsThis Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups.Trial RegistrationCurrent Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU)

Public opinion on the Eurozone fiscal union: evidence from survey experiments in Italy

ABSTRACTWe investigate public attitudes toward the fiscal union: a policy advocated in official European Union documents and designed to address asynchronous economic fluctuations in the eurozone. We employ survey questions and conjoint analyses embedded in population-based panel surveys in Italy, and draw expectations from theories of tax-and-transfer schemes, public insurance, ideology, diffuse support, identity and trust. High-income right-wing individuals with weak European identity and negative assessment of EU membership are more likely to oppose the measure. However, high-income respondents display greater willingness to pay, especially in order to keep the euro, whereas lower-income participants are readier to ditch the currency if the monetary union does not deliver good economic performance. The political feasibility of this policy seems therefore to rest on the willingness to contribute by the core constituency supporting the euro. We also investigate the preferences for the institutional design of the policy.

Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support.

Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.

Using a UK Virtual Supermarket to Examine Purchasing Behavior Across Different Income Groups in the United Kingdom: Development and Feasibility Study.

BackgroundThe majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups.ObjectiveThe aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups.MethodsParticipants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols.ResultsA total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%).ConclusionsThe UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS.

Evaluating Dietary Knowledge and Barriers to Self-Management of Type 2 Diabetes in Rural Kentucky: Cross-Sectional Interview Survey

To determine the challenges that residents of rural Kentucky face regarding diabetes self-management and to identify methods that may promote diabetes management based on a population’s needs, semistructured questionnaires were used to interview 71 adults with diabetes (40 food pantry customers and 31 grocery store customers). Although 70.1% reported following healthy diets, only 43.3% could correctly choose between pairs of healthy/unhealthy food options. Only 21% of food pantry customers (assumed low-income participants) ate healthy. Lower income participants had a 7.79 times greater chance of having a family history of diabetes and had lower perception of having proper weight than grocery store customer participants ( p = .036). Of all participants, 85.5% were motivated to manage their diabetes through diet, and 73.8% were interested in attending free healthy cooking classes. Participants who believed that diet is important in controlling diabetes revealed greater interest in attending cooking classes ( p = .017). To promote healthy diets, offering free healthy cooking classes may be an effective way of communication with patients with diabetes from lower socioeconomic and educational status.

Residential Air Pollution and Associations with Wheeze and Shortness of Breath in Adults: A Combined Analysis of Cross-Sectional Data from Two Large European Cohorts.

Background:Research examining associations between air pollution exposure and respiratory symptoms in adults has generally been inconclusive. This may be related in part to sample size issues, which also preclude analysis in potentially vulnerable subgroups.Objectives:We estimated associations between air pollution exposures and the prevalence of wheeze and shortness of breath using harmonized baseline data from two very large European cohorts, Lifelines (2006–2013) and UK Biobank (2006–2010). Our aim was also to determine whether the relationship between air pollution and respiratory symptom prevalence differed between individuals with different characteristics.Methods:Cross-sectional analyses explored associations between prevalence of self-reported wheeze and shortness of breath and annual mean particulate matter with aerodynamic diameter , , and (, , and , respectively) and nitrogen dioxide () concentrations at place of residence using logistic regression. Subgroup analyses and tests for interaction were performed for age, sex, smoking status, household income, obesity status, and asthma status.Results:All PM exposures were associated with respiratory symptoms based on single-pollutant models, with the largest associations seen for with prevalence of wheezing {odds ratio per [95% confidence interval (CI): 1.11, 1.21]} and shortness of breath [ per (95% CI: 1.45, 1.78)]. The association between shortness of breath and a increment in was significantly higher for individuals from lower-[ (95% CI: 1.52, 1.97)] versus higher-income households [ (95% CI: 1.11, 1.55); ), whereas the association between and wheeze was limited to lower-income participants [ (95% CI: 1.22, 1.38) vs. ; (95% CI: 0.96, 1.08); ]. Exposure to also showed positive associations with wheeze and shortness of breath.Conclusion:Exposure to PM and air pollution was associated with the prevalence of wheeze and shortness of breath in this large study, with stronger associations between and both outcomes among lower- versus higher-income participants. https://doi.org/10.1289/EHP1353

The effect of the WIC program on consumption patterns in the cereal category

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally-funded food assistance program for low income participants who are at nutritional risk. Beneficiaries receive vouchers for specific foods and brands, selected for their nutritional value. While the program is designed to improve nutrition, it may also induce changes in consumption behavior that persist beyond participation in the program. In this paper, we study how participation in WIC impacts the consumption patterns and preferences during and after the program. Our analysis focuses on the cereal category, in which the subsidized brands must meet certain nutritional guidelines. As expected, during the program households increase cereal consumption volume and shift their choices towards the WIC-approved brands. More interesting is that once households exit the program, the higher category consumption rate and elevated share of WIC brands persist. To understand the behavioral mechanism underlying these consumption patterns, we estimate a choice model and find an increased preference for WIC brands after controlling for state dependence. The evidence suggests that this targeted food subsidy program is effective in creating behavior change that persists even after the incentive is withdrawn.

Evidence for Opportunity Cost Neglect in the Poor.

People often neglect opportunity costs: They do not fully take into account forgone alternatives outside of a particular choice set. Several scholars have suggested that poor people should be more likely to spontaneously consider opportunity costs, because budget constraints should lead to an increased focus on trade‐offs. We did not find support for this hypothesis in five high‐powered experiments (total N = 2325). The experiments used different products (both material and experiential) with both high and low prices (from $8.50 to $249.99) and different methods of reminding participants of opportunity costs. High‐income and low‐income participants showed an equally strong decrease in willingness to buy when reminded of opportunity costs, implying that both the rich and the poor neglect opportunity costs. © 2017 The Authors Journal of Behavioral Decision Making Published by John Wiley & Sons Ltd.

Challenges to Engaging Diverse Participants in Community-Based Aging in Place Initiatives

ABSTRACTNaturally Occurring Retirement Community Social Service Programs (NORC programs) and Villages focus on strengthening community-based systems to support aging in place. This study examined data from a national survey of NORC program and Village leaders on participant diversity. Villages and NORC Programs are serving a majority of white participants on average. Initiatives implemented in urban locations, and with more full-time staff, reported greater proportions of non-White participants. Lesser reliance on membership dues was associated with a greater percent of lower-income participants. Respondents identified participants of color and younger older adults as groups they seek to engage more fully.