文章基本信息

标题：Effects of Welfare and Maternal Work on Recommended Preventive Care Utilization Among Low-Income Children
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作者：Jane L. Holl ; Elissa H. Oh ; Joan Yoo 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：12
页码：2274-2279
DOI：10.2105/AJPH.2012.300803
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services. Methods. We identified American Academy of Pediatrics–recommended preventive care visits from medical records of children in the 1999–2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics. Results. The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods. Conclusion. The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care. The Personal Responsibility and Work Opportunity Reconciliation Act was enacted in 1996, replacing Aid to Families With Dependent Children with a new program, Temporary Assistance for Needy Families (TANF). Sometimes called “welfare reform,” TANF is now in its 15th year, and another reauthorization is anticipated in 2013. Whereas Aid to Families With Dependent Children provided welfare cash assistance (“welfare”) for low-income mothers with young children and did not permit receipt of additional income through work, TANF requires most mothers receiving welfare to work or to participate in job-training programs. The impact of welfare reform on children’s health care access, utilization, and outcomes has been much debated. Several studies examined the consequences of welfare reform on children’s health and reported that TANF’s maternal employment requirements may negatively affect children’s health. 1–5 In a previous study, we found that mothers working during periods when mothers were receiving welfare resulted in negative effects on the timely administration of childhood immunizations. 6a We sought to understand the association of welfare receipt and maternal work with recommended preventive pediatric health care visits. The American Academy of Pediatrics (AAP) provides recommendations for the ages at which a child should receive preventive care visits and, for each recommended visit, a “window,” or period of time, when the visit should be received. 6b Preventive pediatric health care visits are critical during the vulnerable first years of a child’s life for monitoring growth and development and for providing timely immunizations. 7–9 Also, previous research has shown that receipt of preventive pediatric health care is associated with reduced avoidable hospitalizations, reduced emergency department visits, and better health outcomes. 10–12 Nevertheless, there is good evidence that many preventive care visits are delayed or missed entirely and, among low-income children, this is of particular concern because of their increased risks for poor growth and development. 13–15 We hypothesized that maternal work required for welfare receipt was associated with reduced preventive health care visits.