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Integrating family planning with other social services.
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The Bangladesh experience in family planning and health.
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What influences health behavior? Learning from caregivers of young children in Viet Nam.
Globally, the caregiving behaviors that contribute to good nutritional status are well understood; but it is not clear why some caregivers perform these behaviors while others do not. This formative qualitative research was designed to improve understanding about what distinguishes caregivers who practice optimal behaviors from those who do not. This study is a one-time, cross-sectional baseline assessment of factors that affect nutrition-related behavior change. It took place in a rural northern province in Viet Nam. One hundred caregivers of children 6 to 17.9 months of age from five communes were interviewed. None of the five communes were included in the larger prospective study designed to test the impact of the Community Empowerment and Nutrition Program (CENP). Four behaviors were examined: feeding the child "positive deviant" foods, feeding the child during diarrheal episodes, washing the child's hands, and taking the child to the health center when ill. Results indicate that for all four behaviors, favorable social norms distinguished those who practiced each behavior from those who did not. Positive, reinforcing beliefs and attitudes were important determinants of every behavior except handwashing Likewise, self-efficacy differentiated doers from non-doers for all behaviors except feeding during diarrheal episodes. Findings from this research suggest that fathers and in-laws of non-doers are more likely to fail to advise mothers about infant feeding and health than they are to provide negative advice. By discovering what distinguishes those who practice optimal behaviors from those who do not, researchers, program planners, and others are better equipped to develop targeted interventions that lead to positive behavior change.
Case management and access to services for homeless women.
Previous research on case management for homeless persons has not sufficiently addressed access to services for women of reproductive age. This cross-sectional study estimates the proportion of homeless women with case managers and the associations of case management with access to shelter; food stamps; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and general medical care. Nine hundred seventy-four homeless women were sampled in Los Angeles County in 1997 and asked about their use of services and whether they had case managers. Approximately 56 percent of respondents had case managers. Having a case manager was associated with greater odds of using food stamps and of finding shelter without difficulty in the previous 30 days, but not with use of WIC or with unmet needs for medical care. More assertive forms of outreach may be necessary to link this population to case managers and a broader range of services.
Racial differences in birth outcomes and costs in relation to prenatal WIC participation.
Wide disparities in birth outcomes persist between Black and non-Black women giving birth in the United States, despite medical and social interventions. This research, which examines birth outcomes and cost for infant hospitalization at delivery for Black and non-Black Medicaid clients in relation to the level of prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), lead to the conclusion that prenatal WIC participation was associated with lower costs to Medicaid and better birth outcomes, particularly for Blacks.
Maternal characteristics associated with vaccination of young children.
OBJECTIVE: Mothers can be instrumental in gaining access to vaccination services for their children. This study examines maternal characteristics associated with vaccination in US preschool children. METHODS: We analyzed data from 21 212 children aged 19 to 35 months in the National Immunization Survey. Bivariate and multivariate analyses were used to identify maternal characteristics associated with completion of all recommended vaccinations in these children. RESULTS: Factors most strongly associated with undervaccination included having mothers who were black; had less than a high school education; were divorced, separated, or widowed; had multiple children; were eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but not participating; or had incomes below 50% of the federal poverty level. CONCLUSION: Because most mothers play an important role in their children's vaccination, it is important to address maternal concerns and barriers when developing public health interventions for promoting childhood vaccinations. Encouraging eligible women and their children to participate in the WIC program and providing support and encouragement for immunization to mothers with multiple children may improve early childhood vaccination coverage.
Prevalence and correlates of obesity and central obesity among Omani adults.
OBJECTIVE: Overweight, particularly obesity is a major risk factor for several important diseases, especially hypertension, coronary heart diseases and diabetes mellitus. Our aim is to determine the prevalence of obesity and central obesity among Omani adults aged > or =20 years, and to identify the socio-demographic and health variables that correlate to obesity and central obesity in a community based survey (National Health Survey, 2000). METHODS: A community based cross-sectional survey representing all parts of Oman was designed in the year 2000. A part of the survey was a door to door interviews including demographic data, weight, height, hip and waist measurements, blood pressure and fasting blood glucose and serum cholesterol for adults aged > or =20 years. RESULTS: The crude prevalence of overweight and obesity (body mass index >25 kg/m2) was 47.9% for the whole sample, and 46.2% for males, 49.5% for females. The crude prevalence of central obesity (abnormal weight hips ratio) was 49.3% for the whole sample, 31.5% for males, and 64.6% for females. Obesity and central obesity were less prevalent among younger age groups and highly educated subjects. Both obesity and central obesity increased the odds of having diabetes, hypertension and hyperchlostremia. CONCLUSION: The prevalence of obesity and central obesity is quietly high in Oman. Launching nutritional programs and promotional life style modification programs are recommended.
Effectiveness of service learning and learning through service in dietetics education.
Positive assessments of service learning as a teaching methodology have stimulated colleges and universities to adopt service learning in their curricula. This study was undertaken to determine whether service learning could be implemented effectively as a teaching methodology in dietetics education. A total of 49 undergraduate students who were enrolled in Nutrition for the Aging course participated in a service learning project. During 5 weeks of the service learning project, students interacted with and assisted clients of the federal Elderly Nutrition Program (Title IIIc). Orientation to the project, reflection on the experience, and evaluation were important components of this project. Evaluation indicated that service learning was an effective teaching method in the dietetics curriculum. Students reported that they were able to integrate the classroom content with real-life experience and learned more while doing so. Service learning had a positive effect on learning by bringing additional personal, professional, and spiritual context to the subject content taught in the classroom and on an understanding of community resources and needs.
Pesticides and your children: a randomized controlled evaluation of a pamphlet.
BACKGROUND: Maternal and pediatric residential pesticide exposure has been identified as a risk factor for birth defects, pediatric cancers, and neurological damage, and it may play a role in other disease processes. OBJECTIVE: To examine whether the use of a pamphlet with a brief educational message in a clinic setting would increase the knowledge and/or change the attitudes of pregnant women and mothers about pesticide use and alternatives, as well as promote pesticide safety. METHODS: A group of 103 women currently pregnant and/or with children less than 6 years of age were recruited at 2 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics for the study. Participants were given a 16-question true/false oral survey testing their baseline knowledge about pesticide safety and safer alternatives to pesticide use. Participants were then randomly assigned to a control group or to the intervention group, which received the pamphlet and a 2-minute scripted overview of its contents. Approximately 2 to 3 weeks later, all participants received a follow-up telephone call by a researcher blinded to the original group assignment, and the original survey questions were repeated. RESULTS: Follow-up assessments were completed for 73 (71%) of the participants. The mean improvement in correct responses on the follow-up survey was +0.39 for the control group and +3.1 for the intervention group (P<.001). Item analysis revealed that the intervention produced a significantly higher number of correct answers to 9 of the 16 survey questions. Providing mothers and pregnant women CONCLUSIONS: Providing mothers and pregnant women with a pamphlet and a brief message about pesticide safety and safer alternatives to pesticides in a clinic setting may be effective in improving knowledge and beliefs about pesticides.
Insurance status and vaccination coverage among US preschool children.
BACKGROUND: Insurance status has been shown to have an impact on children's use of preventive and acute health services. The objective of this study was to determine the relationship between insurance status and vaccination coverage among US preschool children aged 19 to 35 months. METHODS: We linked data from 2 national telephone surveys, the National Immunization Survey and the National Survey of Early Childhood Health, conducted during the first half of 2000. Children were considered up to date (UTD) when they had received at least 4 diphtheria-tetanus-acellular pertussis/diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 MMR vaccine, 3 Haemophilus influenza vaccines, and 3 hepatitis B vaccines at the time the interview was conducted. RESULTS: Among the 735 children in our study sample, 72% were UTD. The vast majority (94%) reported some type of health insurance at the time of the survey. Children with private insurance were more likely to be UTD (80%) than those with public insurance (56%) or no insurance (64%). In a multivariate analysis that controlled for child's race/ethnicity; household income; maternal age/marital status/educational level; location of usual care; and Special Supplemental Nutrition Program for Women, Infants, and Children participation, insurance was no longer an independent predictor of vaccination. CONCLUSIONS: The disparity in vaccination coverage among publicly, privately, and uninsured children is dramatic, underscoring its importance as a marker for underimmunization, despite the multivariate findings. The Vaccines for Children Program, a partnership between public health and vaccination providers who serve uninsured children and those enrolled in Medicaid, is well suited to target and improve vaccination coverage among these vulnerable children.
[Argentine Consensus of Respiratory Rehabilitation].
A group of pulmonologists and physical therapists from the Asociacion Argentina de Medicina Respiratoria revised the scientific literature on Respiratory Rehabilitation (RR) to elaborate evidence-based national recommendations to promote its use. RR is a multidisciplinary program of care for patients with chronic respiratory impairment, individually tailored, designed to optimize physical and social performance and autonomy of patients. It is particularly indicated in patients with Chronic Obstructive Pulmonary Disease (COPD) with exercise intolerance. Inclusion and exclusion criteria, guidelines for initial evaluation and follow up have been defined. The resources needed were defined. It was recommended a hospital ambulatory program with domiciliary complement. A pulmonologist and physical therapist were required for the program as minimum. Aerobic training was recommended for lower limb (LL) (Evidence A) and upper limb (UL) (Evidence B), strength training for LL and UL (Evidence C), as well as respiratory muscles training by resistive inspiratory threshold load (Evidence D) and other physiotherapy techniques were recommended for specific patients. In addition recommendations have been made for educational objectives of the program, nutritional and psychological support. The positive impact of RR on health care was analyzed through the reduction in exacerbation of COPD, length of hospital stay and cost. RR is a key component in the treatment of COPD patients. This evidenced-based consensus statement was prepared to provide recommendations to be implemented nationally.
Attitudes toward breast-feeding and infant feeding among Iranian, Afghan, and Southeast Asian immigrant women in the United States: implications for health and nutrition education.
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Statistical methodology of the National Immunization Survey, 1994-2002.
OBJECTIVES: Since 1994 the National Immunization Survey (NIS) has monitored progress toward the Healthy People 2000 and 2010 vaccination goals. The NIS collects data in two phases: first, a random-digit-dialing (RDD) telephone survey to identify households with children 19-35 months old and, second, a mail survey to vaccination providers to obtain vaccination histories used to estimate vaccination coverage rates. This report reviews the methodologies used in the 1994-2002 NIS to obtain official estimates of vaccination coverage and describes the methodology used for the first three topical modules of the NIS. METHODS: From 1994 to 1997 the NIS used a variation of a two-phase estimator to compensate for missing provider-reported vaccination histories. Between 1998 and 2001 a weighting-class estimator was used. In 2002 and thereafter the weighting-class approach was refined to account for households that do not have telephones and for unvaccinated children. To collect data on immunization-related topics, the NIS sample was randomized among three topical modules: health insurance and ability to pay for vaccinations (HIM); parental knowledge and experiences about vaccinations (PKM); and daycare attendance, breastfeeding practices, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (DCM). RESULTS: In 2001 among children with completed RDD interviews, 0.3 percent were entirely unvaccinated. Together, the new nontelephone adjustment and the refinement for unvaccinated children yielded revised estimates that were within 1.5 percentage points of the original estimates obtained using the 1998-2001 methodology. Over the six quarters during which the first three topical modules were fielded (from mid-2001 through 2002), 21,163 children were randomized to the HIM, 3576 to the PKM, and 3511 to the DCM.
The Public Health Service action plan to improve access to immunization services. The Interagency Committee to Improve Access to Immunization Services.
The Public Health Service's Interagency Committee to Improve Access to Immunization Services (ICI) has responsibility for improving the immunization protection of the nation's children and other vulnerable populations. ICI's Action Plan to Improve Access to Immunization Services sets 14 goals with 120 action steps for improving immunization services nationwide by (a) increasing coordination among Federal health, income, housing, education, and nutrition programs; (b) reducing policy and management barriers that limit access to delivery systems, and (c) strengthening the delivery infrastructure. To accomplish the goals of the plan, there is a $72.0 million increase in funding appropriated in fiscal year 1992 specifically for this purpose. The President's Budget for fiscal year 1993 includes a $24.5 million increase for continued program implementation. The additional resources will be used to address delivery and access problems, which have been determined to be the primary factors limiting immunization for many children.