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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Bhatt, Chintan B. ; Beck-Sagué, Consuelo M.
    Reference Type: Journal Article
    Year: 2018

    Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

    Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

    Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

    Conclusions....

    Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

    Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

    Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

    Conclusions. Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival. (Author abstract)

     

  • Individual Author: Singh, Gopal K. ; Kogan, Michael D. ; Slifkin, Rebecca T.
    Reference Type: Journal Article
    Year: 2017

    Appalachia—a region that stretches from Mississippi to New York—has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990–2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009–13, and the region’s deficit in life expectancy increased from 0.6 years in 1990–92 to 2.4 years in 2009–13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic...

    Appalachia—a region that stretches from Mississippi to New York—has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990–2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009–13, and the region’s deficit in life expectancy increased from 0.6 years in 1990–92 to 2.4 years in 2009–13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic obstructive pulmonary disease, diabetes, nephritis or kidney diseases, suicide, unintentional injuries, and drug overdose contributed to lower life expectancy in the region, compared to the rest of the country. Widening health disparities were also due to slower mortality improvements in Appalachia. (Author abstract)

  • Individual Author: Gutierrez, Florencia; Speer, Laura; Boughamer, Beau; Fox, Ryan; Hamilton, Lisa; Hodgins, John; Laracy, Michael; West, Norris; Cauthen, Nancy
    Reference Type: Report
    Year: 2017

    The 2017 KIDS COUNT Data Book urges policymakers not to back away from targeted investments that help U.S. children become healthier, more likely to complete high school and better positioned to contribute to the nation’s economy as adults. The Data Book also shows the child poverty rate in 2015 continued to drop, landing at 21%. In addition, children experienced gains in reading proficiency and a significant increase in the number of kids with health insurance. However, the data indicate that unacceptable levels of children living in poverty and in high-poverty neighborhoods persist. In this year’s report, New Hampshire ranked first among states for overall child well-being, moving up one from 2016. Massachusetts and Vermont filled out the top three. Louisiana, New Mexico and Mississippi were the three lowest-ranked states. (Author abstract)

    The 2017 KIDS COUNT Data Book urges policymakers not to back away from targeted investments that help U.S. children become healthier, more likely to complete high school and better positioned to contribute to the nation’s economy as adults. The Data Book also shows the child poverty rate in 2015 continued to drop, landing at 21%. In addition, children experienced gains in reading proficiency and a significant increase in the number of kids with health insurance. However, the data indicate that unacceptable levels of children living in poverty and in high-poverty neighborhoods persist. In this year’s report, New Hampshire ranked first among states for overall child well-being, moving up one from 2016. Massachusetts and Vermont filled out the top three. Louisiana, New Mexico and Mississippi were the three lowest-ranked states. (Author abstract)

  • Individual Author: Okoro, Catherine A.; Zhao, Guixiang; Fox, Jared B.; Eke, Paul I.; Greenlund, Kurt J.; Town, Machell
    Reference Type: Report
    Year: 2017

    The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18–64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e.,...

    The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18–64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. (Author abstract) 

  • Individual Author: Wiltshire, Jacqueline C.; Elder, Keith; Kiefe, Catarina; Allison, Jeroan J.
    Reference Type: Journal Article
    Year: 2016

    Objectives. To evaluate African American–White differences in medical debt among older adults and the extent to which economic and health factors explained these.

    Methods. We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education.

    Results. African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings.

    Conclusions. African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status,...

    Objectives. To evaluate African American–White differences in medical debt among older adults and the extent to which economic and health factors explained these.

    Methods. We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education.

    Results. African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings.

    Conclusions. African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status, income, and insurance disparities. Public health implications. In Medicare, low-income beneficiaries, especially low-income African Americans with poor health status, should be protected from the unintended financial consequences of cost-reduction strategies. (author abstract)

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