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PubMed2003

Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices.

This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey--the Person-Level File, Sample Adult File, and Sample Adult Prevention File--were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.

Community Health Centers↗
PubMed2004

Predictors of breastfeeding intention among low-income women.

OBJECTIVE: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. METHODS: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. RESULTS: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. CONCLUSIONS: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in one's ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women.

Adult↗
PubMed1996

Assessing dissimulation among Social Security disability income claimants.

Social Security disability income programs have been tested by increasingly politicized concerns regarding widespread fraud among claimants. This study was an initial investigation of malingering among claimants in Los Angeles seeking disability income on psychological grounds. After a review of 100 disability income applications, a population-appropriate instrument was developed from established psychometric indices of malingering. The Composite Disability Malingering Index was completed by 167 disability claimants (possible malingerers), a sex, age and IQ cognate group of 63 psychologically disabled individuals without incentive to malinger (disabled nonmalingerers), and 45 disability examiners with instructions to malinger (instructed malingerers). The mean score of instructed malingerers and the score at the 95th percentile of the disabled nonmalingerers converged, indicating 8 as the critical score. This cutting score found 32 (19%) of disability claimants to be malingering. Self-reported substance abuse history was the only participant variable that significantly predicted higher malingering scores.

Adult↗
PubMed2004

Galvanizing mental health research in low- and middle- income countries: the role of scientific journals.

The Department of Mental Health and Substance Abuse, World Health Organization, organized a meeting on Mental Health Research in Developing Countries: Role of Scientific Journals in Geneva on 20 and 21 November 2003 that was attended by twenty-five editors representing journals publishing mental health research. A number of other editors reviewed and contributed to the background and follow-up material. This statement is issued by all participants jointly (see Appendix B for the list of journals/organizations and their representatives). Research is needed to address the enormous unmet mental health needs of low- and middle-income (LAMI) countries. Scientific journals play an important role in production and dissemination of research. However, at present, only a minute proportion of research published in widely accessible mental health and psychiatric journals is from or about these countries. Yet over 85% of the world's population lives in the 153 countries categorized as low and middle income, according to World Bank criteria. Even more worrying is the observation that the gap between these and high-income countries may be widening in terms of their number of publications. The meeting was aimed at finding ways of resolving this unsatisfactory situation.

Developing Countries↗
PubMed2004

Maternal, family, and work correlates of role strain in low-income mothers.

Welfare reform brought large numbers of low-income mothers into the labor force, yet little research has examined how low-income mothers manage the multiple demands of parenthood and employment. Using Hobfoll's conservation of resources (COR) theory (Hobfoll, 1989, 2001) to guide hypotheses, the authors examined correlates of role strain in a racially diverse sample of low-income mothers (N = 276) combining work/school with family responsibilities. Results from regression analyses indicate that characteristics that deplete resources, particularly family factors (e.g., more young children, having a child with a disability) and work characteristics (e.g., long work hours, work transitions), related to higher maternal role strain, whereas greater work flexibility predicted lower role strain. Findings suggest that interventions directed toward increasing women's resources may help reduce role strain.

Adolescent↗
PubMed2006

Maternal feeding strategies, child eating behaviors, and child BMI in low-income African-American preschoolers.

OBJECTIVE: To test the hypothesis that low-income African-American preschool children would have a higher BMI if their mothers reported greater "restriction" and "control" in feeding and if mothers reported that children showed greater "food responsiveness" and "desire to drink." In addition, to test whether higher maternal "pressure to eat" would be associated with lower child BMI. RESEARCH METHODS AND PROCEDURES: A questionnaire was completed by 296 low-income African-American mothers of preschool children. It assessed three constructs on maternal feeding strategies ("restriction," "pressure to eat," and "control") and two on child eating behaviors ("food responsiveness" and "desire to drink"). Children's BMI was measured, and mothers' BMI was self-reported. RESULTS: The mean (standard deviation) BMI z-score of the children was 0.34 (1.5), and 44% of the mothers were obese (BMI > or =30 kg/m(2)). Only maternal "pressure to eat" had a significant overall association with child BMI z-score (r = -0.16, p < 0.01). Both maternal "restriction" and "control" were positively associated with children's BMI z-score in the case of obese mothers (r = 0.20, p = 0.03 and r = 0.24, p = 0.007, respectively), but this was not so in the case of non-obese mothers (r = -0.16, p = 0.05 and r = -0.07, p = 0.39, respectively). DISCUSSION: Among low-income African Americans, the positive association between maternal restriction and control in feeding and their preschoolers' BMI was limited to obese mothers. Relations between parent feeding strategies and child weight status in this population may differ on the basis of maternal weight status.

Adult↗
PubMed2004

Feasibility of a partial meal replacement plan for weight loss in low-income patients.

BACKGROUND: Low-income patients are disproportionately affected by obesity. Routine care is available to this population at the Venice Family Clinic (VFC) in Los Angeles. The current study examined the effectiveness of nutrition clinic utilizing meal replacements (Slim-Fast, Slim-Fast Foods Co., FL, USA) in low-income patients over a 6-month period compared with the routine care by their primary care physician (PMD) prior to enrolling in the nutrition clinic at similar time intervals. METHODS: In total, 63 patients (51 F; 49+/-0.8 yo) who had been followed at the VFC by their PMD for at least 6 months were enrolled in this study. Patients had a body mass index (BMI) of 40+/-1.1 kg/m2, were 72% Hispanic, 25% Caucasian, and 3% African American. They had the following co-morbidities: hypertension (HTN) 45%, diabetes mellitus II (DM II) 50%, gastroesophageal reflux disease (GERD) 34%, osteoarthritis 51%, and hypercholesterolemia 48%. All patients were provided with meal replacements to be taken twice a day and were instructed to consume one complete low calorie meal per day. Weights at the first visit to the nutrition clinic, 1, 3, and 6 months after enrollment in nutrition clinic were compared to their weights at the same time intervals during routine visits to their PMD prior to enrollment in the nutrition clinic. RESULTS: There was no significant weight change during the 6 months prior to enrollment in the nutrition program despite receiving care by a PMD. At 6 months after participating in the nutrition program, there was a mean decrease of 7% body weight with a reduction in BMI from 40-37 kg/m2 (P< or =0.05). CONCLUSION: Implementation of nutrition clinic utilizing meal replacements in this low-income patient population was effective in achieving a significant reduction in weight over 6 months of treatment..

Adult↗
PubMed1998

Volunteer peer counselors increase breastfeeding duration among rural low-income women.

BACKGROUND: The purpose of this demonstration project was to test the effectiveness of a volunteer peer counseling program for promoting breastfeeding in a community. METHODS: The two-year project was conducted in Iowa from September 1994 to September 1996. Both intervention and control groups were rural low-income pregnant and postpartum women who qualified for the Women, Infants and Children's (WIC) nutritional program. The intervention was initiated in two counties with 143 clients, of whom 72 completed the project. The control group was drawn from six counties that had received no significant breastfeeding promotion programs during the previous three years. The intervention was the assignment of trained volunteers with previous successful personal experience with breastfeeding as peer counselors to low-income pregnant women. Both before and after the baby was born, the volunteers taught a series of in-home, one-to-one lessons about healthy diet and breastfeeding, and maintained informal contact to answer questions or help with concerns. RESULTS: Women in the intervention group improved dietary intake when compared with the control group. Knowledge of breastfeeding and good nutrition improved slightly. Eighty-two percent of intervention compared with 31 percent of control group women initiated breastfeeding. Mean duration of breastfeeding for intervention and control group women was 5.7 and 2.5 weeks, respectively. At 4 weeks, 56 percent of intervention and 10 percent of control group women were still breastfeeding. CONCLUSION: A volunteer peer counseling program that provides low-income women with role models, accurate information, support, and encouragement can increase the duration of breastfeeding, and thus contribute to healthier infants.

Adult↗
PubMedDate not supplied

Prevention strategies other than male condoms employed by low-income women to prevent HIV infection.

This study sought to determine HIV prevention strategies other than male condom use employed by low-income women who have sex with men (WSM) and to identify variables that predict use of these strategies. A cross-sectional survey of nearly 4,000 women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties was conducted. The response rate was 58%, with 2,256 completed questionnaires returned. Women were asked to indicate one or more of nine methods they had ever used to prevent HIV infection. Women were also asked about their use of male condoms, preference for male condoms versus female condoms, and which partner usually made decisions about STD/HIV prevention. Of the 2,256 questionnaires returned, 1,325 WSM indicated use of at least one HIV prevention strategy other than condom use. Strategies were: being tested for HIV (68.2%), partner being tested for HIV (44.1%), asking partner about his sex history (41.1%), using oral contraceptives (18.8%), asking him if he has HIV (13.7%), douching (11.8%), withdrawal (9.4%), and having anal or oral sex (6.6%). Common predictors of these strategies were race, education, history of STD, condom use, and marital status. Basic misunderstandings about HIV prevention are common in specified subpopulations of low-income women. HIV prevention programs for low-income WSM should capitalize on women's efforts to prevent HIV by designing programs to help women replace ineffective prevention strategies with effective prevention strategies.

Adult↗
PubMedDate not supplied

Diet and exercise in low-income culturally diverse middle school students.

It is important to understand constructs essential to low-fat-diet and physical-activity behaviors of low-income culturally diverse middle-school-age students, because ethnicity and socioeconomic status influence body weight status, and these groups are most at risk for obesity later in life. In this descriptive study, constructs important in low-fat diet and physical activity in low- to middle-income, culturally diverse middle school students were examined. Revised for cultural/developmental appropriateness and reading level, instruments incorporating constructs from the Health Promotion and Transtheoretical Models were tested with 221 youth. Results demonstrated that percentage of fat in diet, total number of strategies used for a low-fat diet, access to low-fat food, and total number of exercise processes varied significantly (p < 0.05) across stages of change for low-fat diet. We concluded that interventions should foster access to low-fat foods and processes for diet and activity change. Despite significantly lower income and higher grade level (both of which are risks for poor health behaviors), students in the private school demonstrated significantly lower fat in diet, higher perception of benefits, and better access to low-fat food. These findings warrant additional study.

Adolescent↗
PubMed1998

Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers.

OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household. DESIGN: Case-control study. SETTING: Community of Worcester, Massachusetts. PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare. MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p = .10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38). CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services.

Adult↗
PubMed2003

Qualitative research-enhanced understanding of patients' beliefs: results of focus groups with low-income, urban, African American adults with asthma.

BACKGROUND: Qualitative research is an important research methodology for understanding the health beliefs and attitudes of patients. These beliefs and attitudes have been proposed as partial explanations for low adherence to medical therapy and the consequent high burden of morbidity from asthma among low-income urban minorities. OBJECTIVE: The purpose of this study was to explore barriers to adherence to inhaled corticosteroids (ICSs), health beliefs regarding asthma and its treatment, and opinions about providers and clinical research among low-income groups. METHODS: Three focus groups were conducted with 15 low-income, urban, African American adults with persistent asthma. These focus group sessions were audiotaped, transcribed verbatim, and coded by using qualitative analytic techniques. RESULTS: Health beliefs that influenced adherence included patients' reliance on their assessment of asthma control over that of the health provider and concern over the adverse effects of ICS therapy. Adherence was also adversely affected by social obligations and insurers' approval policies and restricted formularies. Although mistrust of the medical establishment was evident, members generally expressed a willingness to participate in nonpharmacologic clinical research and the belief that research was beneficial. However, they had strong preferences for where the research should be conducted. CONCLUSIONS: Although barriers exist to ICS adherence in patient populations, many of these can be addressed during patient-clinician interactions. Qualitative research is an important tool for formulating hypotheses for improving ICS adherence that can then be tested in the future by using quantitative research methods.

Administration, Inhalation↗
PubMed2003

Do responses to an intimate partner violence screen predict scores on a comprehensive measure of intimate partner violence in low-income black women?

STUDY OBJECTIVES: Screening for intimate partner violence has been advocated as an emergency department (ED) procedure. This study aimed to ascertain whether a 5-item intimate partner violence screening questionnaire could be used effectively in the ED with low-income black women to accurately predict partner abuse status. METHODS: Data were collected from 200 black women who answered in the affirmative to at least 1 item on the intimate partner violence screener questionnaire, the Universal Violence Prevention Screening Protocol. The women completed a comprehensive battery of measures, including the Index of Spouse Abuse, a commonly used and psychometrically sound measure of intimate partner violence. RESULTS: Bivariate logistic regression analyses revealed that, compared with women below the physical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on physical-intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to Universal Violence Prevention Screening Protocol screening questions related to physical, sexual, and emotional abuse; threats to be harmed physically; and being afraid. Compared with women below the nonphysical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on nonphysical intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to each screening question on the Universal Violence Prevention Screening Protocol. The 2 Universal Violence Prevention Screening Protocol screening items related to physical abuse best predicted the 2 Index of Spouse Abuse scales. Accurate prediction of physical and nonphysical abuse on the Index of Spouse Abuse required affirmative responses to 4 or more screening questions on the Universal Violence Prevention Screening Protocol. CONCLUSION: A brief intimate partner violence screening device in the emergency care setting can identify abused, low-income, black women. The study is limited by the fact that universal screening was not conducted, the inclusion of only women who acknowledged some form of intimate partner violence, a reliance on retrospective self-reports, and the questionable generalizability of the findings to groups other than low-income black women.

Adolescent↗
PubMed2004

Escherichia coli DNA polymerase I (Klenow fragment) uses a hydrogen-bonding fork from Arg668 to the primer terminus and incoming deoxynucleotide triphosphate to catalyze DNA replication.

Interactions between the minor groove of the DNA and DNA polymerases appear to play a major role in the catalysis and fidelity of DNA replication. In particular, Arg668 of Escherichia coli DNA polymerase I (Klenow fragment) makes a critical contact with the N-3-position of guanine at the primer terminus. We investigated the interaction between Arg668 and the ring oxygen of the incoming deoxynucleotide triphosphate (dNTP) using a combination of site-specific mutagenesis of the protein and atomic substitution of the DNA and dNTP. Hydrogen bonds from Arg668 were probed with the site-specific mutant R668A. Hydrogen bonds from the DNA were probed with oligodeoxynucleotides containing either guanine or 3-deazaguanine (3DG) at the primer terminus. Hydrogen bonds from the incoming dNTP were probed with (1 'R,3 'R,4 'R)-1-[3-hydroxy-4-(triphosphorylmethyl)cyclopent-1-yl]uracil (dcUTP), an analog of dUTP in which the ring oxygen of the deoxyribose moiety was replaced by a methylene group. We found that the pre-steady-state parameter kpol was decreased 1,600 to 2,000-fold with each of the single substitutions. When the substitutions were combined, there was no additional decrease (R668A and 3DG), a 5-fold decrease (3DG and dcUTP), and a 50-fold decrease (R668A and dcUTP) in kpol. These results are consistent with a hydrogen-bonding fork from Arg668 to the primer terminus and incoming dNTP. These interactions may play an important role in fidelity as well as catalysis of DNA replication.

Arginine↗
PubMed2004

Prevalence and predictors of food insecurity among low-income households in Los Angeles County.

OBJECTIVES: To assess the prevalence and identify the predictors of food insecurity among households in Los Angeles County with incomes below 300% of the federal poverty level. METHODS: The Six-Item Short Form of the US Department of Agriculture's Household Food Security Scale was used as part of a 1999 county-wide, population-based, telephone survey. RESULTS: The prevalence of food insecurity was 24.4% and was inversely associated with household income. Other independent predictors of food insecurity included the presence of children in the household (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2-2.3) and a history of homelessness in the past five years (OR 5.6, 95% CI 3.4-9.4). CONCLUSION: Food insecurity is a significant public health problem among low-income households in Los Angeles County. Food assistance programmes should focus efforts on households living in and near poverty, those with children, and those with a history of homelessness.

Adult↗
PubMed2005

Reducing the digital divide for low-income women with breast cancer: a feasibility study of a population-based intervention.

A fundamental challenge to helping underserved women and their families cope with breast cancer is providing them with easily accessible, reliable health care information and support. This is especially true for low-income families living in rural areas where resources are few and frequently distant as well as low-income families in urban areas where access to information and support can be complex and overwhelming. The Internet is one mechanism that has tremendous potential to help these families cope with breast cancer. This article describes a feasibility test of the potential for the National Cancer Institute's (NCI's) Cancer Information Service (CIS) to provide access to an Internet-based system that has been shown to improve quality of life for underserved breast cancer patients. The test was conducted in rural Wisconsin (low socioeconomic status [SES] Caucasian women) and in Detroit, Michigan (low SES African American women), and compares the effectiveness of several different dissemination strategies. Using these results we propose a model for how CIS telephone and partnership program services could efficiently disseminate such information and support systems. In doing so we believe that important steps can be taken to close the digital divide that separates low-income families from the resources they need to effectively face cancer. This is the first of two articles coming from this study. A companion article reports on an evaluation of the use and impact of this system on the women who were given access to it.

Breast Neoplasms↗
PubMed1996

Sexually transmitted diseases: experience and risk factors among urban, low income, African American and Hispanic youth.

OBJECTIVES: The objectives of this study were to assess: (1) ethnic and gender differences in reporting of diagnoses of sexually transmitted diseases (STDs), symptoms related to STDs and sexual behavior and (2) behavioral risk factors for STDs in a probability sample of low income African American and Hispanic youth. METHODS: Data were analyzed from a household probability sample of youth. The study collected data on self reported STDs, symptoms of STDs and sexual behavior. The sample was drawn from households in low income areas of urban Detroit: 1435 African American and Hispanic low income youth age 15-24 living in Detroit were interviewed face to face in 1991. RESULTS: Patterns of sexual activity as well as experience with STDs differ by ethnicity and gender. Within ethnic groups, women report more symptoms of STDs. Risk factors for diagnosed STDs included age, a young age at first intercourse, numbers of sexual partners, oral intercourse and anal intercourse. CONCLUSIONS: The data underscore the importance of development of effective safer sex intervention programs for these youth as well as careful assessment of STD risks in medical clinics serving these youth.

Adolescent↗
PubMed2026

Lifestyle interventions to prevent gestational and type 2 diabetes among migrant women from low- and middle-income countries: a systematic review.

Migrant women from low- and middle-income countries (LMICs) living in high-income settings experience disproportionately high risk of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM). This review aimed to identify and synthesise culturally adapted lifestyle interventions for preventing or managing GDM and T2DM among migrant women from LMICs, focusing on intervention components, cultural adaptation strategies, and behavioural and metabolic outcomes. Five databases (PubMed, Embase, Scopus, CINAHL, Cochrane Central) were searched using Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 guidelines. Eligible studies included experimental designs involving lifestyle interventions delivered to migrant women from LMICs in high-income countries, reporting outcomes related to GDM or T2DM targeting behaviour change. Data were synthesised narratively; study quality was appraised using RoB2 for RCTs and a structured narrative approach for non-randomised designs. Certainty of evidence was evaluated using GRADE. Eight studies met the inclusion criteria. Sample sizes ranged from 28 to 641 participants. Intervention duration varied from 6&#x2009;weeks to 12&#x2009;months. Most interventions incorporated atleast one culturally tailored component, such as bilingual delivery, culturally adapted dietary education, or community-based engagement. Improvements were reported across dietary behaviours, physical activity, glycaemic measures, or diabetes-related knowledge; however, effect sizes were modest and inconsistent. Interventions combining dietary modification, physical activity, and culturally adapted delivery demonstrated greater improvements than exercise-only or digital-only programmes. Overall certainty of evidence ranged from low to moderate. Culturally adapted, multi-component lifestyle interventions show promise for improving behavioural and metabolic outcomes among migrant women from LMICs; however, the evidence base remains limited.

Humans↗