Abstract: Policies aimed at reducing welfare use focus solely on adults, yet welfare users very often report experiences of childhood abuse. Such abuse is known to have long-term psychological effects and may set the stage for later welfare use. This study uses a random sample of poor women to determine how a history of childhood abuse relates to the probability of receiving cash and in-kind assistance over a five-year period. It also investigate whether childhood abuse correlates with the length of receipt among program users. Women experiencing both physical and sexual abuse during childhood were 1625 percentage points more likely than others to use both cash and in-kind programs as adults. Conditional on program use, there was no relation of childhood abuse to the extent of program use during the study period.

This issue of CHP/PCOR's quarterly newsletter covers developments from the spring 2005 quarter. It includes articles about:

• research on HIV/AIDS in Russia -- presented in May at an international conference -- which shows that in order to contain the country's rapidly expanding HIV/AIDS epidemic, Russia must aggressively treat HIV-positive injection drug users;
• a CHP/PCOR-hosted discussion session with Edward Sondik, director of the National Center for Health Statistics;
• an ongoing CHP/PCOR study that examines older adults' preferences about health states in which they would need help with basic tasks like bathing or eating;
• a panel discussion on "International Responses to Infectious Diseases," led by CHP/PCOR at the Stanford Institute for International Studies' first annual conference, featuring the World Health Organization's chief of infectious diseases;
• a widely publicized study by CHP/PCOR researchers which found that obese workers are paid less than non-obese workers in similar jobs, but only when they have employer-sponsored health insurance -- a finding suggesting that the wage gap is due to obese workers' higher medical costs, rather than outright prejudice; and
• an update on the Center on Advancing Decision Making for Aging, including two new seed projects and a lecture given by economics and psychology professor George Loewenstein.

This issue of CHP/PCOR's quarterly newsletter covers news and developments from the fall 2004 quarter. It features articles about:

• the newly created Center on Advancing Decision Making for Aging (CADMA), a multidisciplinary research collaboration administered by CHP/PCOR that will explore how older Americans make decisions about their health and well-being;
• a roundtable discussion with healthcare and biotech industry leaders, sponsored by CHP/PCOR and led by Sean Tunis, MD, chief medical officer at the Centers for Medicare and Medicaid Services;
• groundbreaking research on the health needs and health status of China's elderly, conducted by trainees in CHP/PCOR's China-U.S. Health and Aging Research Fellowship;
• research by CHP/PCOR faculty and affiliates on racial disparities in the use of implantable cardioverter-defibrillators (ICDs), the drug industry's marketing of low-dose forms of hormone replacement therapy, and the long-term risks of surgery and anesthesia; and
• renewed funding and seed projects for CHP/PCOR's Center on the Demography and Economics of Health and Aging.

Income, education, occupation, age, sex, marital status, and ethnicity are all correlated with health in one context or another. This paper reflects on the difficulties encountered in deriving robust scientific conclusions from these correlations or drawing reliable policy applications. Interactions among the variables, nonlinearities, casual inference, and possible mechanisms of action are discussed. Strategies for future work are suggested, and researchers are urged to pay special attention to possible interactions among health, genes, and socio-economic variables.

Variability in demand for hospital services may have important effects on hospital costs, but this has been difficult to examine because data on within-year variations in hospital use have not been available for large samples of hospitals. We measure daily occupancy in California hospitals and examine variation in hospital utilization at the daily level. We find substantial day-to-day variation in hospital utilization, and noticeable differences between hospitals in the amount of day-to-day variation in utilization. We examine the impact of variation on hospital costs, showing that increases in variance are associated with increases in hospital expenditures, but that the effects are qualitatively modest