Skipping doses, splitting pills in southeastern Michigan

December 6, 2010

Metro Detroit residents have made difficult decisions to weather the "Great Recession" that began in December 2007—in some cases, to the detriment of their own health. That is one of the early findings from the Michigan Recession and Recovery Survey (MRRS), conducted by the Ford School-based National Poverty Center (NPC).

Researchers found a correlation between economic hardship and behaviors to prolong prescription supplies. For example, 23 percent of unemployed persons did not adhere to their medication as prescribed by their doctors, compared with just 10 percent of those still working. Taking a less potent or less frequent dosage than prescribed not only adversely affects one's health, said NPC faculty research affiliate and assistant professor of sociology Sarah Burgard, but has been documented to raise health care costs over time.

"For chronic diseases like hypertension and diabetes, consistently skipping doses or splitting pills can lead to higher blood pressure and higher blood glucose," said Richard Wong, who visited the NPC during a summer program sponsored by the Michigan Institute for Clinical and Health Research (MICHR).

The MRRS survey, first conducted in late 2009 and early 2010, included a random sample of 915 adults between the ages of 18 and 64 who reside in the Detroit Metropolitan area. The study focuses on changes in employment and unemployment, debt and assets, and hardships such as housing instability, as well as health and mental health problems. A second wave of the survey will be fielded in spring 2011; a third wave is planned for fall 2012.

"Our findings illustrate how the deep recession can compound problems for people under the current health care system," said Tedi Castelli, NPC survey research assistant. Stressors such as experiencing a layoff or falling behind on housing payments had strong correlations with nonadherence. "We're looking at very different sorts of factors than people simply forgetting or choosing not to take their medications, and that's going to change the type of policy options we consider down the road," Castelli said.

The first round of interviews documents that many families, not just low-income families, were negatively affected by the recession. At the time of the survey, 12.3 percent of respondents were unemployed. However, 31 percent had been unemployed for at least one month since the recession began, a number that surprised NPC director and Henry J. Meyer Distinguished University Professor of Public Policy Sheldon Danziger.

"I obviously knew unemployment was high. I just hadn't realized the extent to which it was so widespread," Danziger said.

Research is underway to examine how respondents coped with the rising unemployment and falling housing and stock prices. For instance, 18 percent of respondents who were unemployed for at least six months since January 2007 made early withdrawals or cashed out completely from their pension or retirement plan.

Subsequent analyses should give researchers an idea of how many respondents were able to stay in their homes, along with other housing-related outcomes. In the 12 months prior to the survey, seven percent of respondents moved in with others to cut expenses, while 14 percent had others move in with them to reduce housing costs.

MRRS is one of the few studies being carried out across the nation that will evaluate the full range of effects of the Great Recession on workers and families. Subsequent waves of the study will examine the extent to which the American Recovery and Reinvestment Act (the 2009 stimulus) offset some of the negative effects of the economic crisis.

Funding for the study has been provided by the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, and U-M's Office of the Vice President for Research.


Below is a formatted version of this article from State & Hill, the magazine of the Ford School. View the entire Fall 2010 State & Hill here.

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