Angela Nannini

University of Massachusetts Lowell, Lowell, Massachusetts, United States

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Publications (34)53.42 Total impact

  • Dorothy Brewin · Angela Nannini
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    ABSTRACT: Introduction: This study examined relationships between health, social, environmental, and economic factors during adolescence and the subsequent risk of giving birth to a low-birth-weight (LBW) infant, to inform strategies for reducing racial disparities in LBW. Methods: Data were derived from the National Longitudinal Study of Adolescent Health. A sample of 1213 adolescents, reporting on first pregnancies, was created with 35% black, non-Hispanic (black) and 65% white, non-Hispanic (white) participants. Independent variables were from the domains of individual characteristics, health status, access to care, and social environment. The dependent variable was low birth weight. Overall and race-specific logistic regression models were estimated. Results: Black women had 1.9 times the odds of giving birth to an LBW infant as white women. Factors associated with LBW differed between black women and white women. Black women with a history of hypertension were 6 times more likely to have an LBW infant. Intimate partner support during prenatal care was protective for black women. Factors associated with an increased risk of giving birth to an LBW infant for white women included an intergenerational pattern of LBW, low body mass index during adolescence, and smoking during pregnancy. Socioeconomic factors during adolescence did not predict the odds of having an LBW infant for either group, except for white women whose parents had less than a high school education and black women living in medium-poverty neighborhoods. Discussion: Findings suggest that strategies to reduce racial disparities should address the specific needs of the population being served over the life course.
    Journal of midwifery & women's health 07/2014; 59(4):417-27. DOI:10.1111/jmwh.12110 · 1.07 Impact Factor
  • Angela Nannini · Hafsatou Diop · Karin Downs · Ruth Karacek
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    ABSTRACT: Background. Global comparisons of maternal mortality rates reveal a US rate far above many developed countries. The highest rates are associated with health and social disparities among poor women of color. The Massachusetts (MA) Mortality and Morbidity Review Study examines the causes pregnancy-associated (PA) deaths, defined as the death of a woman while pregnant or within the first year postpartum. Reviewing PA deaths enables the state to make public health recommendations that address women's health during the childbearing years. We will present epidemiologic analyses, case review findings, and recommendations by the MA Maternal Mortality Review Committee (MMRC). Methods. We identified PA deaths through case finding strategies including hospital mandatory reporting and vital records data linkage. During 2000-2007, 168 women died during the PA period. We calculated PA mortality ratio (PAMR) overall, by medical and injury causes, and PAMRs and relative risk (RR) for demographic characteristics. The MMRC conducted a qualitative review of medical records. We used the Health Impact Pyramid (Friedan, 2010) to frame MMRC individual, system and community level recommendations. Results. The overall PAMR was 26.1. Black non-Hispanic (RR: 1.9), younger women (RR: 2.0), women with public insurance (RR: 2.7) or lower education (RR: 2.3) were more likely to die than comparison groups. The MMRC determined that one in five deaths were preventable and developed recommendations that were classified using the 5-tier health impact pyramid. Conclusions. Using the Health Impact Pyramid to understand health disparities for pregnant and postpartum women provides a framework to improve women's health.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.
    10/2013; 45(5):288-293. DOI:10.1097/JNN.0b013e31829d8c8b
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    ABSTRACT: Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.
    Nursing research 09/2013; 62(5):325-334. DOI:10.1097/NNR.0b013e3182a131d2 · 1.36 Impact Factor
  • Traci L Alberti · Angela Nannini
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    ABSTRACT: To examine research published from 1995 to 2010, evaluating patient comprehension of discharge instructions from emergency department (ED) or urgent care (UC) settings. Specifically, we examined: (a) the interventions utilized to provide discharge instructions, (b) the methods used to assess patient comprehension, and (c) the most effective strategies for assuring patient comprehension of ED discharge instructions. A comprehensive literature review was conducted utilizing the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Reference Center Academic, Medline, Cochrane, and Ovid. English language peer-reviewed articles published between 1995 and 2010 were reviewed. Search terms included patient, comprehension, understanding, discharge instructions, health education, and emergency medicine. Increases in patient comprehension of ED discharge instructions are identified with alternative teaching interventions (multimedia) in comparison to traditional standardized written discharge instructions (usual care). Literature suggests clinicians seldom clarify patient comprehension in practice, though effective methods are noted in research. Future research is needed to explore innovative teaching interventions and their impact upon patient comprehension and patient outcomes. To ensure patient comprehension of discharge instructions, the simplification of discharge material is paramount. Nurse practitioners working in ED or UC settings can improve upon "usual care" by exploring more innovative teaching interventions.
    Journal of the American Association of Nurse Practitioners 04/2013; 25(4):186-94. DOI:10.1111/j.1745-7599.2012.00767.x
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    ABSTRACT: Revisiting scope of practice (SOP) policies for nurse practitioners (NPs) is necessary in the evolving primary care environment with goals to provide timely access, improve quality, and contain cost. This study utilized qualitative descriptive design to investigate NP roles and responsibilities as primary care providers (PCPs) in Massachusetts and their perceptions about barriers and facilitators to their SOP. Through purposive sampling, 23 NPs were recruited and they participated in group and individual interviews in spring 2011.The interviews were audio recorded and transcribed. Data were analyzed using Atlas.ti 6.0 software, and content analysis was applied. In addition to NP roles and responsibilities, three themes affecting NP SOP were: regulatory environment; comprehension of NP role; and work environment. NPs take on similar responsibilities as physicians to deliver primary care services; however, the regulatory environment and billing practices, lack of comprehension of the NP role, and challenging work environments limit successful NP practice.
    Policy Politics &amp Nursing Practice 03/2013; 14(1). DOI:10.1177/1527154413480889
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    ABSTRACT: Purpose: The purpose of this review is to investigate literature related to organizational climate, define organizational climate, and identify its domains for nurse practitioner (NP) practice in primary care settings. Data sources: A search was conducted using MEDLINE, PubMed, HealthSTAR/Ovid, ISI Web of Science, and several other health policy and nursingy databases. Conclusions: In primary care settings, organizational climate for NPs is a set of organizational attributes, which are perceived by NPs about their practice setting, emerge from the way the organization interacts with NPs, and affect NP behaviors and outcomes. Autonomy, NP-physician relations, and professional visibility were identified as organizational climate domains. Implications for practice: NPs should be encouraged to assess organizational climate in their workplace and choose organizations that promote autonomy, collegiality between NPs and physicians, and encourage professional visibility. Organizational and NP awareness of qualities that foster NP practice will be a first step for developing strategies to creating an optimal organizational climate for NPs to deliver high-quality care. More research is needed to develop a comprehensive conceptual framework for organizational climate and develop new instruments to accurately measure organizational climate and link it to NP and patient outcomes.
    Journal of professional nursing: official journal of the American Association of Colleges of Nursing 03/2013; 29(6):338-349. DOI:10.1016/j.profnurs.2013.07.005 · 0.95 Impact Factor
  • Dorothy Brewin · Angela Nannini
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    ABSTRACT: Currently, women's health care is receiving more attention in health policy discussions. This article reviews aspects of the Patient Protection and Affordable Care Act (PPACA) that seek to improve the health and health care services for older women. Increased access to evidence-based screening assessments for women with Medicare will enhance both the prevention and treatment of acute and chronic diseases. PPACA also contains provisions to expand the gerontological nursing workforce to meet the needs of the rapidly growing population of Medicare-eligible women. Evolving models of care, such as community-based care, shared financial risks, and care coordination, are the current focus of best practice research by the Center of Medicare & Medicaid Innovation. The financing and provision of long-term care is a major issue for women, who represent the majority of adults older than 85. The overarching aim of the new PPACA Medicare changes is to create affordable, quality health care systems that meet the needs of women as they age.
    Journal of Gerontological Nursing 02/2013; 39(3):1-6. DOI:10.3928/00989134-20120131-04 · 1.02 Impact Factor
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    ABSTRACT: Objective: To compare outcomes from uterine ruptures (UR) among women without versus with a prior cesarean. Method: This case-control study matched on gestational age +/- 1 week and birth year +/- 2 years using a variable numbers of controls (maximum = 4) for each case. All URs in Massachusetts between 1990 and 1998 were identified using ICD-9 codes from linked hospital discharge and birth/fetal death certificate files and confirmed by medical record review. Complete hospitalization records were abstracted. Maternal outcomes were hysterectomy, transfusion, ICU admission, shock, assisted ventilation, and hospital length of stay. Infant outcomes were 5 min Apgar less than 3 or need for ventilation at birth, death, or poor prognosis at discharge. Results: The UR incidence in women without a prior cesarean was 7 per 100,000 births. Of the 49 women without a prior cesarean and a UR, 36 women met study criteria and were matched to 140 controls. Women without a prior cesarean had more severe maternal morbidity (50% vs. 16%) (adj OR 3.28, 95% CI: 1.70, 6.32) with 47% of cases requiring transfusion and 33% requiring ICU admission. Their hospital stays were nearly two days longer. Among their infants, 14% died or had a poor prognosis at discharge compared to 7% of control infants (OR = 2.42, 95% CI 0.94, 6.28). Conclusion: Although UR in a woman without a prior cesarean is uncommon, providers should be prepared for more severe maternal morbidity which may be mitigated by prompt surgical intervention and heightened hemodynamic surveillance.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2012; 26(2). DOI:10.3109/14767058.2012.725790 · 1.37 Impact Factor
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    Journal of Obstetric Gynecologic & Neonatal Nursing 06/2012; 41(s1). DOI:10.1111/j.1552-6909.2012.01362_20.x · 1.02 Impact Factor
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    ABSTRACT: Objective:To describe maternal and perinatal morbidity and mortality associated with uterine rupture (UR) among women with prior cesarean/s, singleton term pregnancies and a trial of labor after cesarean (TOLAC).Study Design:Linked hospital discharge files and birth/fetal death certificates identified potential cases of UR in Massachusetts from 1990 to 1998 with definitive identification by medical record abstraction.Result:Among the 347 identified URs, severe outcomes occurred in 86 cases (25%), in 49 (14%) of mothers and 49 (14%) of infants. Of the infants, 25 were discharged with a good prognosis. Maternal age and interdelivery interval <18 months (relative risk (RR)=1.55; 95% confidence interval (CI): 1.05, 2.31) were associated with a severe outcome. The type of hospital and labor were not associated with the increased risk of a severe outcome.Conclusion:Assuming a 0.7% UR rate among women at term with a TOLAC, the increased rate of severe outcomes related to UR above the baseline risk of elective cesarean is estimated to be 1.3 per 1000 TOLACs.Journal of Perinatology advance online publication, 22 March 2012; doi:10.1038/jp.2012.2.
    Journal of perinatology: official journal of the California Perinatal Association 03/2012; 32(11). DOI:10.1038/jp.2012.2 · 2.07 Impact Factor
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    ABSTRACT: To assess the validity of probabilistic linkage (PL) in combining national surveillance data on assisted reproductive technology (ART) with Massachusetts birth and infant death data, for the purpose of monitoring maternal and child health outcomes of ART. A study conducted in 2006 utilized direct identifiers to match Massachusetts birth records with records on ART procedures performed to Massachusetts residents in fertility clinics located in Massachusetts and Rhode Island, achieving a linkage rate of 87.5%. The present study employed PL using the program Link Plus, without access to direct identifiers. The primary linking variables were maternal and infant dates of birth, and plurality. Ancillary variables such as maternal ZIP code and gravidity helped resolve duplicate matches and capture additional matches. PL linked 5,390 (87.8%) of 6,139 deliveries, correctly identifying 96.4% of the matches previously obtained using deterministic linkage methods. PL yielded a high linkage rate with satisfactory validity; this method may be applied in other states to help monitor the maternal and child health outcomes of ART.
    Maternal and Child Health Journal 09/2011; 16(8). DOI:10.1007/s10995-011-0877-7 · 2.24 Impact Factor
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    ABSTRACT: To clarify the risk of violence for women during pregnancy and the first year postpartum, we examined the timing of hospital visits for assault among a population cohort of women in Massachusetts. Using linked natality and hospital data from 2001 through 2007 for Massachusetts, we examined the timing of hospital (i.e., emergency, inpatient, and observation) visits for maternal assault during seven time periods: the three prenatal trimesters and four three-month postpartum periods. To describe the risk of assault for each of the time periods, we calculated the rate as the number of such visits per 100,000 person-weeks. We used the denominator of 100,000 person-weeks to adjust for variable lengths of gestation and for postpartum periods shortened by subsequent pregnancies. Rates of hospital visits for maternal assault were highest in the first trimester and lowest in the third trimester, with rates of 16.0 and 5.8 per 100,000 person-weeks, respectively. The four postpartum period rates were higher than the third trimester rate but never reached the levels observed in the first and second trimesters. These findings suggest a changing rate for assault visits during each prenatal trimester and postpartum period. In addition, the importance of violence prevention strategies as part of women's health care across the life span and the need for preconception care initiatives are reaffirmed.
    Public Health Reports 09/2011; 126(5):664-8. DOI:10.2307/41639417 · 1.55 Impact Factor
  • Angela Nannini
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    ABSTRACT: Spring 2010 marked the passage of the Patient Protection and Affordable Care Act; however, soon after this landmark legislation passed, legal and political challenges ensued to change key features of the law. In this environment of proposed changes to transform the U.S. health care system, the Institute of Medicine released its report titled The Future of Nursing: Leading Change, Advancing Health in October 2010. The groundbreaking consensus report calls for a transformation of nursing at practice, education, and leadership levels. This article briefly summarizes findings and key recommendations with an emphasis on areas most relevant to the future of gerontological nursing. In addition, various implementation actions promoted through the Robert Wood Johnson Foundation's Future of Nursing Campaign and the AARP Center to Champion Nursing are discussed to encourage gerontological nurses to participate in current and future debates.
    Journal of Gerontological Nursing 08/2011; 37(9):11-5. DOI:10.3928/00989134-20110802-01 · 1.02 Impact Factor
  • Anna Wiencrot · Angela Nannini · Susan E Manning · Joan Kennelly
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    ABSTRACT: Mental illness (MI), substance abuse (SA), and intentional injury (II) are known individual risk factors for adverse pregnancy outcomes. Their combined association with preterm birth (PTB) and low birth weight (LBW) remains relatively unexplored. We examined hospital utilization for the co-occurrence of II and MI or SA in pregnant women in Massachusetts and assessed their interactive association with PTB and LBW. This retrospective cohort study used ICD-9 and E-codes reported on linked birth and hospital utilization data to identify MI, SA, and II diagnoses during pregnancy for 176,845 Massachusetts resident women who delivered during 2002-2004. Adjusted odds ratios (OR) for the independent and joint associations of MI, SA, and II on PTB and LBW were calculated. Two thousand two hundred and eight women (1.6%) had a prenatal MI visit, 834 (0.5%) a prenatal SA visit, and 847 (0.5%) a prenatal II visit. Among them 163 women had MI and II visits and 69 had SA and II visits. SA, MI, and II were all significant predictors of LBW and PTB. Women with both SA and II had higher odds of PTB (OR 2.7 95% CI 1.3-5.7) and LBW (OR 5.3 95% CI 3.9-7.3) than women with neither diagnosis. Prenatal MI, SA, and II are risk factors for LBW and PTB. Women with SA and II co-diagnoses have greater risk of LBW and PTB than women with neither diagnosis. Screening, timely diagnosis, and treatment of women with co-occurring morbidities, particularly II and SA, should be incorporated into reproductive and perinatal health programs.
    Maternal and Child Health Journal 06/2011; 16(5):979-88. DOI:10.1007/s10995-011-0821-x · 2.24 Impact Factor
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    ABSTRACT: The objectives of this study were to determine risk factors for early (less than 34 weeks gestation) and late (34-36 weeks gestation) preterm singleton birth, by assisted reproductive technology (ART) status. We linked data from Massachusetts birth records and ART records representing singleton live births from 1997 through 2004. Using multinomial regression models, we assessed risk factors for early and late preterm birth by ART status. From 1997 to 2004 in Massachusetts, among non-ART births, risk factors for early and late preterm birth were similar and included women <15 and ≥ 35 years of age, those of non-white race or Hispanic ethnicity, those with ≤ 12 years of education, those with chronic diabetes, those with gestational diabetes, those with gestational hypertension, those who smoked during pregnancy, those who used fertility medications, and those who had not had a previous live birth. Among ART births, risk factors for early and late preterm birth differed and odds of early preterm birth were increased among women with ≤ 12 years of education while odds of late preterm birth were increased among women with gestational diabetes. Odds of both early and late preterm birth were increased among women of non-white race or Hispanic ethnicity and among women with gestational hypertension. Among non-ART births, increased risk for preterm birth was more strongly related to socioeconomic factors than among ART births. Medical conditions were associated with an increased risk for preterm birth regardless of women's ART status. Efforts to prevent preterm births should focus on reducing modifiable risk factors.
    Maternal and Child Health Journal 04/2011; 16(4):807-13. DOI:10.1007/s10995-011-0787-8 · 2.24 Impact Factor
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    ABSTRACT: To identify risk factors associated with uterine rupture among term pregnancies attempting a vaginal birth after a previous cesarean. A case-control study was done of 348 uterine ruptures in Massachusetts between 1991 and 1998, initially screened by ICD-9 code and confirmed by medical record review, with 424 control women with a trial of labor randomly selected proportional to cases on year of delivery. Multivariable regression was used to estimate odds ratios and 95% confidence intervals. Successful previous vaginal birth decreased risk for uterine rupture, and gestation > 40 weeks and macrosomia increased risk. Oxytocin for induction increased risk, with a slightly lower effect when used for augmentation. Prostaglandin use in conjunction with oxytocin did not have an additive uterine rupture risk. Women using epidural analgesia have an increased uterine rupture risk. Certain labor management practices increase the risk for uterine rupture 2-3 times, although the absolute increase is small from a baseline uterine rupture rate of 0.5% to 1.0-1.5%. The association between epidural analgesia and uterine rupture deserves further study.
    The Journal of reproductive medicine 01/2011; 56(7-8):313-20. · 0.70 Impact Factor
  • Angela Nannini · Susan Crocker Houde
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    ABSTRACT: Gerontological nurses who have received education and have experience in conducting systematic reviews may assume a key role in interpreting systematic reviews for policy makers. Systematic reviews offer evidence to determine the best policy and program solutions to a problem. To be successful in translating evidence from systematic reviews, gerontological nurses need to (a) understand the steps of the policy making process and where different kinds of reviews may be used, (b) assess the "technical" literacy and level of interest in gerontological issues of the intended policy maker, and (c) develop and practice skills in policy writing that distill information in policy briefs as well as shorter formats. Gerontological nurses can be powerful advocates for older adults using the systematic review of the literature as an instrument to educate policy makers.
    Journal of Gerontological Nursing 06/2010; 36(6):22-6. DOI:10.3928/00989134-20100504-02 · 1.02 Impact Factor
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    ABSTRACT: To evaluate the accuracy of assisted reproductive technology (ART) reporting on the Massachusetts birth certificate and to explore the individual and hospital-level characteristics associated with ART reporting. Validity analysis of population-based data. Live-birth deliveries by Massachusetts-resident mothers during 1997-2000. Live births and delivery mothers. The ART data maintained by the Centers for Disease Control and Prevention were linked with the live birth-infant death records in Massachusetts. Successfully linked records were used as the gold standard for ART-related deliveries in evaluating the validity of the ART information reported on the Massachusetts birth certificate. Sensitivity and specificity. The sensitivity of ART reporting on the birth certificate was 27% and the specificity >99%. Sensitivity of ART reporting was higher among women with multiple deliveries (twins: 32%; triplets+: 43%) and preterm deliveries (36%). During the period evaluated, reporting of ART information on the birth certificate was incomplete, and ART births identified through the birth certificate were a biased sample of the population of ART births. Using delivery hospital data as the sole source of ART information for the standard birth certificate may yield inaccurate information.
    Fertility and sterility 12/2009; 94(5):1657-61. DOI:10.1016/j.fertnstert.2009.10.059 · 4.59 Impact Factor
  • Lusine Poghosyan · E. Kelleher · Angela Nannini
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    ABSTRACT: Background. Despite the economic downturn and an unemployment rate likely reaching double digits, congressional efforts for national health care reform continue. This reform may be similar to landmark Massachusetts Legislation passed in better economic times. An investigation of the health and health care access of the growing population of unemployed will inform the national health reform debate. Purpose. To investigate self-rated physical and mental health, health care access and health care needs among unemployed in Massachusetts. Methods. Cross-sectional design to survey unemployed individuals residing in Massachusetts. A convenience sample was recruited from job fairs and career centers in spring 2009. Instrument questions were obtained from Current Population Survey, Behavioral Risk Factor Surveillance System, and the National Health Interview Survey. Descriptive and multivariate analyses were completed. Results*. 105 participants were interviewed. 21.1% did not have any health coverage. 27.9% did not have their annual check-ups. 21.2% reported they needed to see a doctor but could not afford. 19.2% could not afford medicine, 41.3% dental care, and 17.3% eye care. 32.6% and 16% reported more than a week of poor mental and physical health in the past 30 days, respectively. Discussion. Even in a state with near universal health coverage one in every five unemployed individuals is uninsured, with many reporting poor health and decreased health access. Conclusion. This study contributes to the void in social epidemiology about the impact of unemployment on health. To achieve universal coverage, strategies to cover the unemployed may need expansion in these difficult economic times.
    137st APHA Annual Meeting and Exposition 2009; 11/2009

Publication Stats

521 Citations
53.42 Total Impact Points


  • 2009–2013
    • University of Massachusetts Lowell
      • Department of Nursing
      Lowell, Massachusetts, United States
  • 2006–2009
    • Northeastern University
      • School of Nursing
      Boston, Massachusetts, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2004
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States