269418 How recession-proof are PHN interventions? Recession exposure, health, and employment outcome findings from a recent RCT

Tuesday, October 30, 2012 : 8:30 AM - 8:50 AM

Shawn M. Kneipp, PhD , School of Nursing, The University of North Carolina Chapel Hill, Chapel Hill, NC
John Kairalla, PhD , Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
Amanda Sheely, PhD, MSW, MPH , School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: The high prevalence of health conditions among women receiving Temporary Assistance for Needy Families (TANF, or ‘welfare') impedes the ability of this group to move from ‘welfare-to-work', and the economic recession has likely exacerbated this problem. Despite this, few studies have tested interventions to improve health outcomes for women receiving TANF, and it remains unclear how the recession has influenced employment in this group.

Methods: We tested a public health nursing (PHN) intervention with 432 women who were receiving TANF and had one or more chronic health conditions using a randomized controlled trial (RCT) design. We report on four employment outcomes by group assignment and recession exposure, and examined whether select baseline sociodemographic and health characteristics predicted employment. The Kaplan-Meier method, a zero-inflated negative binomial model, and general linear model were used to analyze data.

Results: Women in the intervention group were marginally more likely to become employed (p=0.05), and there were significant main effects for median time-to-employment by group assignment (intervention and control group: 72 vs. 107 days, p=0.01) and recession exposure (no and full exposure: 70 vs. 122 days, p<0.001). Age, education, race, and functional status at baseline predicted different dimensions of employment over the 9 month study period.

Conclusions: These findings have direct policy relevance for understanding health and employment dynamics among this group of highly disadvantaged women. A public health nursing case-management intervention to improve employment outcomes was equally effective among this group under highly variable macroeconomic conditions.

Learning Areas:
Public health or related nursing

Learning Objectives:
1. Describe the prevalence of chronic health conditions among women receiving TANF. 2. Compare the effectiveness of a public health nursing intervention in improving employment outcomes for this group over different macroeconomic conditions. 3. Discuss the implications of these findings for program and policy development related to public health nursing.

Keywords: Health Disparities, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified because I the principal investigator on the study that | am presenting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.