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PubMed2000

Injury-producing events among children in low-income communities: the role of community characteristics.

STUDY PURPOSE: Injury remains the leading cause of death in children aged 1 to 4 years. Past studies of determinants of injuries among young children have most often focused on the microlevel, examining characteristics of the child, parent, family, and home environments. We sought to determine whether and how selected neighborhood economic and physical characteristics within these low-income communities are related to differences in risk of events with injury-producing potential among infants and young children. METHODS: Our study used both individual-level data and information on the characteristics of the neighborhood of residence to describe the prevalence of events with injury-producing potential among infants and young children in three low-income communities in Baltimore City, Maryland. Our sample was 288 respondents who participated in a random household survey. Information on respondent (age, employment, and length of residence in the neighborhood) and neighborhood characteristics (average per capita income, rate of housing violations, and crime rate) were available. Methods of multilevel Poisson regression analysis were employed to identify which of these characteristics were associated with increased risk of experiencing an event with injury-producing potential in the month prior to the interview. RESULTS: Although all three communities were considered low income, considerable variation in neighborhood characteristics and 1-month prevalence rates of events with injury-producing potential were observed. Younger age of respondent and higher rates of housing violations were associated significantly with increased risk of a child under 5 years old in the household experiencing an event with injury-producing potential. CONCLUSIONS: Information on community characteristics was important to understanding the risks for injuries and could be used to develop community-based prevention interventions.

Adolescent↗
PubMed2005

Gender differences in factors associated with psychological distress among immigrants from low- and middle-income countries--findings from the Oslo Health Study.

OBJECTIVE: Despite the high rate of migration from low- and middle-income countries to high-income countries, there is still a lack of comprehensive studies of gender-specific differences in psychological distress in a diverse group of immigrants. We compared psychological distress between male and female immigrants from low- and middle-income countries living in Oslo, and identified factors associated with distress for men and women, separately. METHOD: A cross-sectional survey with self-administered questionnaires was conducted among 1536 immigrants from low- and middle-income countries living in Oslo. The Hopkins Symptom Checklist (HSCL-10) was used to measure psychological distress. Data on their sociodemographic characteristics, negative and traumatic life events, and social integration and possible discrimination in the Norwegian society were also collected. RESULTS: One-fourth of the study population was found to be psychologically distressed, with almost equal levels among men and women. Lack of salaried job and recent negative life events were independently associated with psychological distress for both genders. Furthermore, experience of denial of job and past traumatic experiences were other associated negative factors among men, while visits made by Norwegians appeared as a protective factor against distress among men. Older age, Middle East background, living without a partner, and experiencing denial of housing were other associated negative factors among women. CONCLUSION: Our findings show that, except for adverse living conditions, there are gender differences with regard to factors associated with psychological distress among immigrants living in Oslo. Such gender issues are relevant for assisting immigrants in the integration process as well as for future research in migration and health.

Adult↗
PubMed2002

Surgical indications and strategies for necrotizing enterocolitis in low income countries.

In high income countries, mortality of neonates due to necrotizing enterocolitis (NEC) is decreasing due to advances in early detection and sepsis management. Surgical strategies, by and large, are becoming less relevant as the sophistication of intensive care facilities increases in those countries. Management of septic neonates with NEC in low income countries, however, due to inherent resource constraints cannot achieve the same standards as those reported from high income countries. Surgeons therefore play an important role because they can offer different surgical strategies in line with the deficiency of their environment. Over a 4-year period, 172 neonates who had surgery for NEC in a single institution were prospectively followed up. Standard surgical practices of the high income countries were compared to those adopted by the authors. The end point was early mortality, taking into account the anatomical zones of the involved intestine. Survival was increased from 21% to 84% by early surgery and by extending the length of colon resected in cases of ileocolic NEC. In this approach, a short resuscitative period is followed by intestinal resection including most of the diseased colon as well as the perforated/dead bowel. A more modest improvement in survival was noted with a planned re-look laparotomy in neonates with generalized NEC.

Developing Countries↗
PubMed2006

On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women.

OBJECTIVES: As both employed and breastfeeding mothers increase, more women are facing the decision of whether and how to combine the behaviors. This paper examines three hypotheses for a sample of low-income women: 1) Mothers who expect to return to work after the birth of their baby will be less likely to initiate breastfeeding; 2) The timing of the return to work and quitting breastfeeding will coincide; 3) Mothers in professional jobs and Stay-at-Home (SAH) Moms will breastfeed for longer durations than mothers with other types of jobs. METHODS: The Fragile Families and Child Wellbeing Study, a sample of mostly low-income, unmarried U.S. mothers, offers a unique opportunity to study this issue, as there is reason to believe that employment may impact breastfeeding differently for low-income women. Logistic regression determines the relationship between the expectation of work and breastfeeding initiation, and discrete-time logit models examine breastfeeding duration, the timing of the return to work, and occupation type. RESULTS: Expecting to work in the year after the baby's birth does not impact breastfeeding initiation. The timing of quitting breastfeeding and the return to work are closely and powerfully linked, and mothers in administrative and manual positions quit earlier than other women. Interestingly, women in service occupations do not differ in breastfeeding duration from SAH mothers or professionals. CONCLUSIONS: This research demonstrates that low-income women are having difficulty combining work and breastfeeding, which has important health implications for their infants, and that women working in administrative and manual occupations may face special constraints.

Adult↗
PubMed1990

Barriers and motivators to prenatal care among low-income women.

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.

Adult↗
PubMed2004

Fast food, race/ethnicity, and income: a geographic analysis.

BACKGROUND: Environmental factors may contribute to the increasing prevalence of obesity, especially in black and low-income populations. In this paper, the geographic distribution of fast food restaurants is examined relative to neighborhood sociodemographics. METHODS: Using geographic information system software, all fast-food restaurants within the city limits of New Orleans, Louisiana, in 2001 were mapped. Buffers around census tracts were generated to simulate 1-mile and 0.5-mile "shopping areas" around and including each tract, and fast food restaurant density (number of restaurants per square mile) was calculated for each area. Using multiple regression, the geographic association between fast food restaurant density and black and low-income neighborhoods was assessed, while controlling for environmental confounders that might also influence the placement of restaurants (commercial activity, presence of major highways, and median home values). RESULTS: In 156 census tracts, a total of 155 fast food restaurants were identified. In the regression analysis that included the environmental confounders, fast-food restaurant density in shopping areas with 1-mile buffers was independently correlated with median household income and percent of black residents in the census tract. Similar results were found for shopping areas with 0.5-mile buffers. Predominantly black neighborhoods have 2.4 fast-food restaurants per square mile compared to 1.5 restaurants in predominantly white neighborhoods. CONCLUSIONS: The link between fast food restaurants and black and low-income neighborhoods may contribute to the understanding of environmental causes of the obesity epidemic in these populations.

Eating↗
PubMed2005

Income, family characteristics, and physical violence toward children.

OBJECTIVE: This paper discusses the ways in which existing microeconomic theories of partner abuse, intra-family bargaining, and distribution of resources within families may contribute to our current understanding of physical child abuse. The empirical implications of this discussion are then tested on data from the 1985 National Family Violence Survey (NFVS) in order to estimate the effects of income, family characteristics, and state characteristics on physical violence toward children. METHODOLOGY: The sample consists of 2,760 families with children from the NFVS. Probit and ordered probit models are used to explore relationships between income, family characteristics, state characteristics, and physical violence toward children among single-parent and two-parent families. RESULTS: In both single-parent and two-parent families, depression, maternal alcohol consumption, and history of family violence affect children's probabilities of being abused. Additionally, income is significantly related to violence toward children in single-parent families. CONCLUSIONS: These results reinforce earlier findings that demographic characteristics, maternal depression, maternal alcohol use, and intra-family patterns of violence may largely contribute to child abuse. This research also suggests that income may play a substantially more important role in regard to parental violence in single-parent families than in two-parent families.

Adult↗
PubMed2005

Equity in utilization of cancer inpatient services by income classes.

Equity in health care services has been prioritized on the Korean government's policy agenda since the government-driven national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiaries. The purpose of this study is to identify disparities in the utilization of health care services, especially cancer inpatient services among different income groups in Jeju Island of South Korea. We analyzed the national health insurance data about qualification of beneficiaries and utilization of health care services consumed by Jeju Island's residents for 1 year of period (from January to December 2000) and acquired their utilization features of cancer inpatient services. The independent variable was 10 different income levels according to the national health insurance fee imposed on each household in 2000. The dependent variable was the volume of cancer inpatient services utilized, that was measured by admission days and costs for treatment. The utilization of cancer inpatient services in the 10 different income groups was analyzed in three geographical categories of medical institutions: (1) within Jeju Island; (2) outside Jeju Island; (3) South Korea in total. We calculated the concentration-indices of cancer inpatient services utilization in admission days and cost as a pair amongst these three geographical categories each. Both of the concentration-indices were negative for the category of 'within Jeju Island', positive for that of 'outside Jeju Island', and positive for that of 'South Korea in total'. These results suggest the relatively poor experience considerable inequality in the utilization of cancer inpatient services in Jeju Island, because lower income groups have higher incidence rates in most cancers and inevitably have more needs in health services.

Cancer Care Facilities↗
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↗
PubMed2005

Relative validity and reliability of a food frequency questionnaire for a triethnic population of 1-year-old to 3-year-old children from low-income families.

OBJECTIVE: To develop and validate a food frequency questionnaire (FFQ) for low-income, 1- to 3-year-old Hispanic, African-American, and white children. DESIGN: A convenience sample of low-income mothers provided dietary data for their child via FFQs and 3-day diet records. SUBJECTS/SETTING: Participants (N=77) were recruited from Special Supplemental Program for Women, Infants, and Children clinics and public health clinics. All subjects were Hispanic, African-American, or white mothers of children 1 to 3 years old, 18 years of age or older, income less than 200% of the federal poverty level, and were literate in English. Statistical analyses performed Wilcoxon signed-ranks tests were used for comparisons of food group servings on time 1 and time 2 FFQs and to examine differences in food group servings between the FFQ and diet records. Spearman correlations were calculated to assess test-retest reliability and the relative validity. Contingency tables were used to determine the degree of association between the FFQ and diet records. RESULTS: Reliability correlations were significant for all nine food categories ( =0.69), ranging from 0.53 (soups) to 0.84 (nonstarchy vegetables). Validity correlations were significant for all food groups ( =0.41) except starchy vegetables. Thirty-six percent of children were classified into the same quartile of food group intake and 78% into the same or within one quartile. CONCLUSIONS: The FFQ yielded excellent reliability and acceptable validity and can be used to assess food choices in a triethnic sample of low-income 1- to 3-year-old children.

Adult↗
PubMed2005

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum.

OBJECTIVES: The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance. SUBJECTS/SETTING: Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum. DESIGN: At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized. RESULTS: For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity. CONCLUSIONS: Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.

Adult↗
PubMed2005

Low-income neighborhood barriers and resources for adolescents' physical activity.

PURPOSE: To investigate factors of low-income neighborhoods and households on physical activity with a sample of adolescents from low-income neighborhoods. METHODS: Middle-school-aged youth (n = 74) from a low-income neighborhood completed self-report surveys. Measures include vigorous exercise frequency, neighborhood hazards, after-school time demands, availability of facilities, quality of facilities, and perceived safety. Hierarchical multiple linear regression and Pearson product moment correlations were conducted to test hypotheses that more frequent physical activity would be associated with more available locations, better quality facilities, fewer time demands, more after-school programs, more perceived safety, and more hazards. RESULTS: Results indicate that more physical activity was associated with more hours spent in after-school programs (r = .50, p < .001) and perception of higher quality of local facilities (r = .28, p < .05). Perception of safe adults at local facilities accounted for more variance than perception of neighborhood hazards in the association with physical activity even after accounting for gender, age, and socioeconomic status. CONCLUSIONS: Future health promotion programs should consider factors of after-school programs such as quality, cost, and presence of safe adults when attempting to increase and maintain youth physical activity in lower income areas.

Activities of Daily Living↗
PubMed2005

The causal effect of income on health: evidence from German reunification.

We investigate whether there was a causal effect of income changes on the health satisfaction of East and West Germans in the years following reunification. Our data source is the German Socio-Economic Panel (GSOEP) between 1984 and 2002, and we fit a recently proposed fixed-effects ordinal estimator to our health measures and use a causal decomposition technique to account for panel attrition. We find evidence of a significant positive effect of income changes on health satisfaction, but the quantitative size of this effect is small. This is the case with respect to current income and a measure of 'permanent' income.

Adult↗
PubMedDate not supplied

Better breathing or better living? A qualitative analysis of the impact of asthma medication acquisition on standard of living and quality of life in low-income families of children with asthma.

INTRODUCTION: Purchasing children's asthma medications places a burden on low-income families. The objective of this study was to explore how purchasing children's asthma medications influenced household purchasing behavior and quality of life in low-income families with no drug insurance. METHOD: Seventeen parents residing in the Greater Toronto Area with no drug plan and with household incomes below 45,000 US dollars (twice the U.S. poverty level) participated. Semi-structured interviews were conducted, emphasizing the topics of prescription drugs used and cost versus effectiveness; purchasing behavior and drug administration; effects of medication purchasing on the family; and payment assistance. Transcribed narratives were coded and analyzed thematically. RESULTS: Annual expenditures for asthma drugs were 300 US dollars to 3000 US dollars. Because asthma management was a high priority, foregone expenditures included paying for other family members' health needs, essentials (clothing, food, better housing), and nonessentials (recreation, vacations) and long-term investments, such as their child's future education and their retirement. Respondents believed quality of life was negatively affected. DISCUSSION: Not addressing the health concerns of family members, making sacrifices, and modifying investment decisions created sustained anxiety in families of children with asthma. Access to medication benefits would have a positive impact on quality of life. Health care providers can help to ensure that low-income families receive available assistance.

Adolescent↗
PubMed2006

Evaluations of community mental health care in low- and middle-income countries: a 10-year review of the literature.

Community-based models of providing mental health services are widely considered effective ways of serving individuals diagnosed with mental illness, but more comprehensive literature on these models in low- and middle-income countries is needed. This study is a systematic review of the effects of community-based models on health outcomes of adults with depression, schizophrenia, panic disorder, or bipolar disorders in middle- and low-income countries. PubMed, PsycINFO, and Cochrane Reviews were searched, returning 500 articles. The seventeen interventions included in this review in 14 countries show us that community-based mental health services can provide improvements in mental health outcomes, and the limited cost analyses suggest cost savings associated with community models of care. These findings are in line with much of the research on higher income countries. In addition, the studies also point to the gaps in the literature on costs, rural areas, bipolar disorders, and panic disorders, and note the need for further reviews of interventions targeting additional diseases, children, and adolescents as well as studies published in languages other than English. This review of the literature serves as a stepping stone for further research in community-based mental health services in low- and middle-income countries. The works reviewed here provide a base of knowledge that will assist us in taking the important next steps in program implementation and evaluation.

Adult↗
PubMed2005

Increasing mammography screening among low-income African American women with limited access to health information.

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.

Adult↗
PubMed2005

Predictors of fecal occult blood test (FOBT) completion among low-income adults.

BACKGROUND: Fecal occult blood testing (FOBT) can reduce colorectal cancer (CRC) mortality. Unfortunately, CRC screening is underutilized. Sociocultural mediators of FOBT adherence have not been extensively studied in lower income, minority populations. This study prospectively studied FOBT return in a low-income, multiethnic population. METHODS: Participants (N = 298), aged > or =40 years, were surveyed and given FOBT kits with instructions. Those not returning kits within 30 days received a reminder telephone call. Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days. RESULTS: Participants (median age = 48) were predominately African American (69%), without private insurance (88%), and of low income. The largest group of participants preferred FOBT alone (46%), followed by whatever my doctor recommends (19%), endoscopy + annual FOBT (16%), endoscopy alone (14%), and no screening (5%). In multivariate analyses, FOBT return was predicted by age (OR = 1.05) and lack of reported FOBT barriers (OR = 3.81). Among those > or =50 and not up-to-date with screening, FOBT return was predicted by cancer fatalism (OR = 0.83). FOBT barriers were associated with age (OR = 0.96), less than high school education (OR = 2.05), and less physician trust (OR = 2.12). Endoscopy barriers were associated with age (OR = 0.93), less physician trust (OR = 1.95), and female gender (OR = 3.45). CONCLUSIONS: Younger individuals and those with less education, less trust in health care providers, and more fatalistic beliefs are at risk for CRC screening non-adherence. Strategies addressing common misconceptions should improve CRC screening rates in low-income, multiethnic populations.

Adult↗
PubMed1998

Literacy and body fatness are associated with underreporting of energy intake in US low-income women using the multiple-pass 24-hour recall: a doubly labeled water study.

OBJECTIVE: The accuracy of the multiple-pass 24-hour recall method for estimating energy intake in low-income women in the United States was ascertained by comparing the method with measurements of total energy expenditure. The multiple-pass 24-hour recall is designed to provide respondents with multiple cues and opportunities to report their food intake. It consists of 3 distinct passes: the quick list, detailed description, and review. Predictors of energy intake misreporting (energy intake--total energy expenditure) in the sample were determined. DESIGN: Four multiple-pass 24-hour recalls (2 in person, 2 by telephone) were obtained over a 14-day period to estimate energy intake. Total energy expenditure was measured over the same 14-day period using the doubly labeled water method. Body composition was measured using dual energy x-ray absorptiometry, and literacy was measured by the Wide Range Achievement Test (WRAT) for reading and spelling. SUBJECTS/SETTINGS: Thirty-five low-income women between the ages of 19 and 46 years were tested at the General Clinical Research Center at the University of Vermont, Burlington. Low income was defined as a household income at or below 130% of the federal poverty level. STATISTICAL ANALYSIS: Pearson product moment correlation coefficients, t tests, paired t tests, and stepwise multiple regression analysis were used to test the relationships among study variables. RESULTS: Mean energy intake was significantly lower than mean total energy expenditure (2,197 +/- 607 vs 2,644 +/- 503 kcal, P = .001) and the correlation between the 2 measures was poor (r = .22, P = .20). Percentage body fat and the combined age-adjusted reading and spelling WRAT scores were the best predictors of misreporting of energy intake (R = .52, P = .006). CONCLUSIONS: The multiple-pass 24-hour recall did not generate a group measure of energy intake that was accurate or unbiased in this sample. Underreporting was strongly associated with increased body fatness. The ability to read and spell as measured by the WRAT improved the accuracy of the women's recall of their food intake. APPLICATIONS: Dietetics professionals should take into consideration the problem of underreporting whenever conclusions are made about associations between diet and health and/or when evaluating the impact of food assistance programs on dietary intake.

Adipose Tissue↗