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PubMed2004

A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population.

INTRODUCTION: Research indicates that low fruit and vegetable intake is a risk factor for many chronic diseases. Despite large-scale education campaigns, the great majority of Americans do not consume recommended levels. We tested the ability of a single brief interactive experience of the Little by Little CD-ROM to increase fruit and vegetable intake in low-income women. METHODS: A randomized placebo-controlled, parallel-group trial included 481 low-income, female participants: mean age 50.1 years, 48.4% African American, 51.6% non-Hispanic white, and 92.5% below 185% of the federally designated poverty level. Participants received one of three conditions: 1) a one-time experience with the Little by Little CD-ROM, 2) the Little by Little CD-ROM plus two reminder telephone calls, or 3) a stress management CD-ROM (control condition). We assessed baseline and follow-up dietary intake with a modified 24-hour recall. RESULTS: Two months after the one-time experience with the CD-ROMs, both intervention groups reported significantly higher intakes of fruits and vegetables than the control group. The Little by Little group with reminder calls increased daily intake by 1.32 fruits/vegetables, an 86% greater increase than the control group (P = .016). The Little by Little group without reminder calls increased daily intake by 1.20 fruits/vegetables, a 69% greater increase than the control group (P = .052). Significantly greater movement in Stage of Readiness for Change also occurred in the Little by Little groups compared with the control group. CONCLUSION: The Little by Little CD-ROM may be useful in public health and clinical situations to increase fruit and vegetable intake.

CD-ROM↗
PubMed1990

Macrosomia: influence of maternal overweight among a low-income population.

Macrosomia (birth weight greater than 4000 gm) is associated with a wide variety of adverse intrapartum and perinatal outcomes. To evaluate the effect of pregravid obesity on infant birth weight, we examined data from a low-income population of women (n = 127,879). The population was divided into five groups on the basis of pregravid body mass index (weight/height) designated by the National Health and Nutrition Examination Survey II reference population (less than 25th percentile, 25th to less than 75th percentile, 75th to less than 85th percentile, 85th to less than 95th percentile, and greater than or equal to 95th percentile). The prevalence of infant macrosomia ranged from 5% for the lowest group to 17% for the highest group. With the use of the second group (25th to less than 75th percentile) as a reference, odds ratios (adjusted for maternal age, smoking status, race, height, parity, gestational age, and infant sex) for macrosomia for the five sequential weight groups were 0.6, 1.0, 1.3, 1.6 and 2.2. We conclude that pregravid overweight had a significant independent effect on birth weight outcome.

Adolescent↗
PubMed1993

Risk factors associated with low Apgar scores in a low-income population.

The purpose of this study was to identify risk factors associated with Apgar scores of less than 7 in newborns scored at 5 minutes after birth. All newborns were delivered at Grady Memorial Hospital, Atlanta, Georgia, which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985-89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 newborns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37 weeks) were each significantly associated with low Apgar scores. Race was not a significant risk factor for low Apgar scores in this low socio-economic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.

Adolescent↗
PubMed1994

Contraceptive risk-taking in a medically-underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the non-use of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking, and also compared levels of contraceptive knowledge and pregnancy histories of non-contraceptors versus barrier method contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger and for those whose knowledge of the fertility cycle is incorrect, but was found to be only weakly related to the women's marital status. Non-contraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to non-use of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a sub-group of the medically-underserved low-income population.

Adolescent↗
PubMed1999

The U.S. Medicaid reform: the current state and policy implications for low-income population.

Medicaid is the health care program that is financed jointly by the federal and state governments. Many states are seeking ways to contain the increased budgetary strain that has resulted from the increases in Medicaid spending. For many states, managed care has been viewed as the means to hold down costs for some of the population served by Medicaid. This article examines the origins and status of Medicaid and the options available to extend coverage to the low-income population.

Cost Control↗
PubMed2001

Obesity and undernutrition in a very-low-income population in the city of Maceió, northeastern Brazil.

Obesity is the nutritional disorder which has shown the greatest increase in prevalence, even in those countries in which deficiency diseases represent a severe public health problem. The goal of the present study was to analyse the anthropometric profile of a community living in the outskirts of Maceió, capital of Alagoas (northeastern Brazil), and to investigate the hypothesis of a coexistence of undernutrition and obesity in a very low-income population. The survey was conducted on 315 families (1247 individuals). Among the children (aged < or =10 years), the prevalence of wasting, stunting and wasting plus stunting was 3.8, 8.3 and 8.7 % respectively. Wasting (10.2 %) was the most prevalent form of undernutrition among adolescents; nonetheless, a higher frequency of stunting (11 %) and overweight-obesity (5.5 %) was seen specifically in girls, in agreement with trends found in other studies. Adults exhibited a high prevalence of overweight-obesity (25 %), but stunting was also present (22 %). Of the stunted individuals, 30 % were overweight-obese and 16.3 % were underweight. There were eighty-six families with at least one parent who was underweight (27 %) and 104 families with at least one parent who was overweight (33 %). Underweight and overweight-obesity were both present in ninety-six households (30 %). These results may indicate that better living conditions in urban areas in a population 'adapted' to chronic famine might increase the susceptibility to obesity. Considering the harm caused by the cumulative effect of these two conditions (undernutrition in childhood and obesity in adult life) there is a clear need for new studies to uncover the determinant factors so that preventive measures can be implemented.

Adolescent↗
PubMed1992

Nutrition education for cardiovascular disease prevention among low income populations--description and pilot evaluation of a physician-based model.

Low income Americans are at greatest risk for coronary heart disease but have least access to health promotion programs for life style modification. Primary care physicians may represent one of the few sources of preventive care available to the poor. However, the majority of physicians feel unprepared to help patients achieve dietary change, and few existing nutrition intervention programs address the special needs of low literacy populations. The Food for Heart Program was developed to facilitate dietary counseling experienced by primary care physicians who care for low literacy patients and to overcome barriers to behavior change faced by patients. The program consists of three components: (1) a validated dietary risk assessment that rapidly identifies atherogenic eating habits and requires no nutritional expertise to administer or interpret, (2) a structured diet treatment program that is culturally specific for a southern patient population and links practical behavior change recommendations with results of the diet assessment, and (3) a system for monitoring and reinforcement that prompts physicians to review progress, reinforce prior messages, and reward positive change. Behavior change theory is used to guide the intervention and readability of the material has been assessed at the 5-6th grade level. An evaluation study of the Food for Heart Program suggests that it has a positive impact on physician counseling and that patients are responding favorably to these efforts.

Cardiovascular Diseases↗
PubMed1995

Breast-feeding in a low-income population. Program to increase incidence and duration.

OBJECTIVE: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population. DESIGN: A randomized, nonblinded clinical control trial. Patients were followed up through pregnancy, delivery, and the first year of the infant's life or until the time of weaning from the breast, whichever came first. SETTING: The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income, inner-city population. PATIENTS: There were a total of 108 patients: 51 were randomized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant, and 57 were randomized to the control group that received the standard of care at the institution. Patients in the control group were not seen by the lactation consultant. The two groups were similar demographically. INTERVENTION: This program consisted of individual prenatal lactation consultation, daily rounds by the lactation consultant on the postpartum unit, and outpatient follow-up at 48 hours after discharge, at the time that the infant was 1 week of age, and at all future health supervision visits for infants up to 1 year of age. MAIN OUTCOME MEASURES: The incidence and duration of breast-feeding. RESULTS: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P = .002). The duration of breast-feeding was also significantly longer in the intervention group (P = .005). CONCLUSIONS: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.

Adult↗
PubMedDate not supplied

Wheezing during the first year of life in infants from low-income population: a descriptive study.

BACKGROUND: Recurrent wheezing (RW) plays an important role in the morbidity and mortality of children during the first year of life in developing regions and its actual incidence in those areas is virtually unknown. METHODS AND RESULTS: This study describes the occurrence of wheezing during the first year of life in a birth cohort of 188 infants followed monthly and living in a poor urban area in Santiago de Chile. This study showed that 80.3 % of the infants in the cohort had one or more wheezing episode during the first year of life, 43.1 % had RW (3 or more wheezing episodes), 44.1 % had their first wheezing within the first three months of life and 13.3 % had pneumonia (PN). Having one or more episode of wheezing in the first three months of life was the main risk factor for suffering from RW during the first year and RW was a significant risk factor for having PN. CONCLUSIONS: This study found a high prevalence of RW in infants from a low-income population during the first year of life with the disease starting very early in their lives, progressing with more frequent episodes and being significantly associated to PN, particularly in the first 6 months of life.

Age of Onset↗
PubMedDate not supplied

Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes.

OBJECTIVES: We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients. METHODS: We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added. RESULTS: Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p < 0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold. CONCLUSIONS: In a low-income population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.

Diabetes Mellitus↗
PubMed2005

Medication patterns for attention-deficit/hyperactivity disorder and comorbid psychiatric conditions in a low-income population.

The aims of this study were two-fold: (1) to describe the patterns of comorbid psychiatric diagnosis and psychotropic drug therapy for children enrolled in a Medicaid-managed care program and diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 2000 and (2) to examine child and provider characteristics associated with psychotropic medication patterns for this population. Multivariate logistic regression models were used to examine correlates of stimulant and seven nonstimulant psychotropic medication classes (alpha-agonists, mood stabilizer/anticonvulsant, antianxiety, standard antipsychotic, atypical antipsychotic, and tricyclic antidepressant (TCA)/other antidepressant and selective serotonin reuptake inhibitor (SSRI) antidepressant). With the exception of conduct disorders (odds ratio, 1.22; 95% confidence interval, 1.06-1.40), comorbid disorders had a significant protective effect (odds ratio less than 1) on dispensing stimulants. After adjusting for covariates, stimulant dispensing was strongly correlated with the interactions of geographic region with race/ethnicity and provider type. Children residing in the upstate New York region had an approximately ten-fold greater chance of being dispensed a stimulant compared to similar children in New York City. Utilizing a mental health provider increased the chance of being dispensed a stimulant by factor of two for children from New York City of any race/ethnicity group. Models predicting nonstimulant drug dispensing were distinct from the stimulant model. After adjusting for covariates, nonstimulant psychotropic medication dispensing was correlated with clinical factors, including comorbid disorder category and use of a mental health provider, as well as notable sociodemographic factors. Complex psychotropic medication and comorbid psychiatric disorder patterns were evident for this low-income population of children with ADHD. The roles of clinical, patient, and provider factors need to be better understood to explain these patterns of stimulant and nonstimulant psychotropic medications dispensed.

Adolescent↗
PubMed2006

Lead levels in blood and saliva in a low-income population of Detroit, Michigan.

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

Adolescent↗
PubMed2004

[Determinants of malnutrition in a low-income population: hierarchical analytical model].

To investigate the determinants of malnutrition among low-income children, the effects of socioeconomic, environmental, reproductive, morbidity, child care, birthweight and breastfeeding variables on stunting and wasting were studied. All 354 children below two years of age living in two urban slum areas of Pelotas, southern Brazil, were included. The multivariate analyses took into account the hierarchical structure of the risk factors for each type of deficit. Variables selected as significant on a given level of the model were considered as risk factors, even if their statistical significance was subsequently lost when hierarchically inferior variables were included. The final model for stunting included the variables education and presence of the father, maternal education and employment, birthweight and age. For wasting, the variables selected were the number of household appliances, birth interval, housing conditions, borough, birthweight, age, gender and previous hospitalizations.

English Abstract↗
PubMed2000

School-based identification of asthma in a low-income population.

The increase in the prevalence, morbidity, and mortality of asthma among children over the last decade has been well documented, especially among low-income minority children. Hypotheses for the increases in morbidity and mortality include limited access to primary care services and the failure to recognize the presence and severity of asthma. The University of Miami Pediatric Mobile Clinic (Mobile Clinic) Asthma Intervention Program is designed to identify underserved asthmatic children at school and offer them culturally sensitive care. Nine elementary schools with low income, predominantly Hispanic and African-American populations regularly served by the Mobile Clinic, were chosen for study participation. All 5,800 students who were enrolled in kindergarten through third grade were given letters at the time of registration by their homeroom teachers about the asthma program. Caretakers who returned the questionnaire and reported that the student had asthma symptoms were invited to have the student undergo a medical evaluation in the Mobile Clinic. Over a 2-year period, caretakers of 423 students (7.3% of all students) expressed an interest in further evaluating their child's respiratory health. Of these, we enrolled and evaluated 154 in the Mobile Clinic's Asthma Intervention Program. The Mobile Clinic physicians identified 145 of the enrollees as having asthma. These results indicate that in elementary schools serving predominantly low-income minority populations, a large fraction of the asthmatic population (estimated prevalence, 6-10%) can be identified by a school-based letter. Further, in a subset of asthmatic students (children of interested caretakers), there is good agreement between caretaker responses and physician diagnosis of asthma. Since school attendance is mandatory, school-based methods may be an effective method for identifying low-income children with asthma.

Black or African American↗
PubMed1996

Prevalence of gallbladder disease and associated clinical variables in a low income population of Mexico City.

We present the results of a population-based survey carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were age eligible (35-64 year-old men and non-pregnant women). Home interviews were obtained in 2810 (80.2%). A physical and laboratory examination was performed in 2282 individuals (65.1%; 941 men and 1341 women). The prevalence of CSGD in men was 2.0% (95% confidence intervals 1.1-2.9%) and 9.2% in women (95% confidence intervals 7.7-10.7%). Patients with CSGD were older, men (p < 0.003) and women (p < 0.001). Women with CSGD had higher waist to hip circumference ratio (p < 0.06), higher fasting glucose (p < 0.03) as well as 2 h post challenge glycemia (p < 0.04) and insulinemia (p < 0.03). In the multiple logistic regression model only age (p < 0.001) and sex (p < 0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. It is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it could generate the information needed to implement a preventive program to diminish the impact of this condition.

Adult↗
PubMed2000

Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program.

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.

Breast Neoplasms↗
PubMed1991

Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians.

Infant feeding was examined in 492 children in a population-based survey conducted in a low-income, urban county of St Paul, Minn. Of 41 Southeast Asian infants who were foreign born, 93% (38) had been breast-fed compared with 10% (12) of Southeast Asian infants born in the United States (n = 116). Among non-Southeast Asian infants, 73% (173) of whites (n = 237), 63% (27) of blacks (n = 43) and 65% (36) of other ethnic groups (n = 55) had been breast-fed. Among the non-Southeast Asian infants, the initiation of breast-feeding was associated with higher parental education and with being married. Ethnic group, level of poverty, and participation in the Supplemental Food Program for Women, Infants, and Children during pregnancy did not appear to influence the initiation of breast-feeding. The findings indicate a higher incidence of breast-feeding than in previous surveys of low-income black and white women; however, this may reflect the higher educational level of the non-Southeast Asian study population. In contrast, the sharp decline in the incidence of breast-feeding among Southeast Asian infants who were born in the United States compared with those who were foreign born indicates the need for public health approaches to strengthen traditional breast-feeding practices.

Black or African American↗
PubMed2003

The use of focus groups to plan poison prevention education programs for low-income populations.

Children younger than 5 are at greatest risk for unintentional poisonings. Children in low-income situations are particularly vulnerable for exposures to potential poisons. Focus groups were conducted at a Women, Infants, and Children (WIC) program located in a large urban public hospital in New York City to gain information from low-income parents of young children about real and perceived barriers to calling the local poison control center, resources for poison prevention messages, and ideas about public awareness campaigns. All focus group members were low-income parents of young children. Most participants reported that they would call 911 in the event of a poisoning due to child welfare and self-efficacy issues. Health education theory using the social-cognitive theory provides a framework for developing future poison prevention programs to address identified issues with parents of young children.

Adolescent↗