A randomized controlled trial to improve health among women receiving welfare in the US: The relationship between employment outcomes and the economic recession
A randomized controlled trial to improve health among women receiving welfare in the US: The relationship between employment outcomes and the economic recession
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DOI：
10.1016/j.socscimed.2012.08.011
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发表时间：
2013-03-01
影响因子：
5.4
通讯作者：
Sheely, Amanda L.
中科院分区：
文献类型：
--
作者：
Kneipp, Shawn M.;Kairalla, John A.;Sheely, Amanda L.
接受贫困家庭临时援助（TANF，或“福利”）的美国妇女的健康状况普遍存在，阻碍了该群体中许多人从“福利转向工作”的能力，而经济衰退可能加剧了这一问题。尽管如此，几乎没有制定干预措施，通过解决接受TANF的妇女的健康需求来改善就业成果，而且人们对经济衰退对这一群体就业轨迹的影响知之甚少。使用最近的随机对照试验（RCT）的数据，测试公共卫生护理（PHN）干预的有效性，以解决432名接受TANF的美国妇女的慢性健康状况的需求，我们检查干预和经济衰退暴露对就业的影响。我们进一步探讨了干预效果是否被选定的社会人口和健康特征修改。对于就业进入结果，干预效果既微弱又更强（任何就业，p = 0.05，就业时间，p = 0.01）。经济衰退暴露对就业进入有显著影响（任何就业，p = 0.002和就业时间，p < 0.001）。无论是干预还是经济衰退暴露都不会影响长期就业结果（就业率或最大连续就业）。干预效果没有修改年龄，教育，以前的TANF接收，功能状态，或经济衰退的曝光，这表明干预是同样有效的改善就业进入一个相当异质群体之前和之后的经济衰退开始。这些研究结果推进了我们对这组弱势妇女在可变的宏观经济条件下的健康和就业动态的理解，并对指导健康和TANF相关政策产生影响。(C)2012爱思唯尔有限公司保留所有权利。
The high prevalence of health conditions among U.S. women receiving Temporary Assistance for Needy Families (TANF, or 'welfare') impedes the ability of many in this group to move from 'welfare-to-work', and the economic recession has likely exacerbated this problem. Despite this, few interventions have been developed to improve employment outcomes by addressing the health needs of women receiving TANF, and little is known about the impact of economic downturns on the employment trajectory of this group. Using data from a recent randomized controlled trial (RCT) that tested the efficacy of a public health nursing (PHN) intervention to address the chronic health condition needs of 432 American women receiving TANF, we examine the effect of the intervention and of recession exposure on employment. We further explore whether intervention effects were modified by select sociodemographic and health characteristics. Both marginal and more robust intervention effects were noted for employment-entry outcomes (any employment, p = 0.05 and time-to-employment, p = 0.01). There were significant effects for recession exposure on employment-entry (any employment, p = 0.002 and time-to-employment, p < 0.001). Neither the intervention nor recession exposure influenced longer-term employment outcomes (employment rate or maximum continuous employment). Intervention effects were not modified by age, education, prior TANF receipt, functional status, or recession exposure, suggesting the intervention was equally effective in improving employment-entry across a fairly heterogeneous group both before and after the recession onset. These findings advance our understanding of the health and employment dynamics among this group of disadvantaged women under variable macroeconomic conditions, and have implications for guiding health and TANF-related policy. (C) 2012 Elsevier Ltd. All rights reserved.