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PubMed2003

Prevalence of childhood asthma and associated morbidity in Los Angeles County: impacts of race/ethnicity and income.

Racial/ethnic and socioeconomic disparities in the prevalence of childhood asthma have been reported nationally but few population-based studies in local and regional settings have been reported. To assess variation in the prevalence of childhood asthma and associated morbidity across race/ethnic and income groups in the Los Angeles County population, we analyzed data on a random sample of 6004 children (< or = 17 years old) enrolled in a countywide health survey from September 1999 through April 2000. The prevalence of childhood asthma was highest in blacks (15.8%), intermediate in whites (7.3%) and Asians (6.0%), and lowest in Latinos (3.9%; p < 0.001). These differences persisted after controlling for income, measures of health care access, and other covariates. Asthma prevalence was inversely related to income in all racial/ethnic groups except Latinos from Spanish-speaking households. Among children with asthma, blacks and Latinos were more likely than whites to report asthma-related limitations in physical activity and need for urgent medical services. These findings indicate marked disparities in asthma prevalence and related morbidity in this large urban child population and highlight the importance of efforts to identify high-risk subpopulations for focused prevention and treatment interventions.

Adolescent↗
PubMed1999

Racial and income differences in use of the hospice benefit between the medicare managed care and medicare fee-for-service.

OBJECTIVE: To examine whether use of the Medicare Hospice Benefit between health maintenance organization (HMO) and Fee-For-Service (FFS)-enrolled beneficiaries varies by income or race. DATA SOURCE: Medicare enrollment and claims data for South Florida. RESULTS: In the FFS system, rate of death in hospice varied by income. In the HMO system, it did not. Time spent in hospice varied by income in the HMO system and not in the FFS system. There was little evidence that racial differences in hospice use differed between FFS and HMO options. CONCLUSIONS: These differences raise questions about whether some hospice use may be in response to system-level incentives.

Journal Article↗
PubMed1999

Assessing perceived health promotion needs and interests of low-income older women.

This study focuses on an assessment of perceived health promotion needs and interests among predominantly older low-income women (76%) in the state of Pennsylvania. A questionnaire was completed by a convenience sample of 140 individuals attending four senior centers and two nutrition sites. In addition, 14 focus groups with an average of 8 members per group were conducted for a total of 105 people from two of the four senior centers. The health topics of greatest interest to women were exercise (57.6%), making friends (50.9%), nutrition (37.5%), losing weight (33.6%), and home safety (34.6%). Compared with women, men were significantly more interested in exercise and its effect on mood (41.3% versus 24.0%) and love and sex after 60 (44.8% versus 18.2%) and significantly less interested in nutrition (17.2% versus 37.5%). The fitness activities of greatest interest to women were walking (63.1%), back exercises (37.5%), toning to music (22.1%), and self-defense (18.2%), none of which was significantly different from the men in the sample. Results suggest that many of the key health needs perceived by low-income older women could be addressed by a combination of fitness activities and health education, especially if they are also designed to facilitate social interactions. The barriers to participation in such programs most often cited were transportation, scheduling, and cost factors. Fortunately, many communities already have the resources to offer low-cost interventions in the areas of need, such as walking groups, self-defense, and home safety. Communities interested in serving low-income older women should more closely examine the barriers and the unmet needs of this group when designing intervention programs.

Aged↗
PubMed1981

Differential fatness gain of low income boys and girls.

As shown in 564 girls and 553 boys followed for a period of 18 yr, long-term gain in both subscapular and triceps skinfold thickness was higher in children of lower family income level than those of higher family incomes. This differential fatness gain accounts for the socioeconomic "reversal" of fatness in the female shown in cross-sectional studies and newly extends the phenomenon to both sexes. The finding that low-income children show a greater long-term increase in fatness bears on the prevention and control of obesity.

Adipose Tissue↗
PubMed2005

Obesity and risk factors for the metabolic syndrome among low-income, urban, African American schoolchildren: the rule rather than the exception?

BACKGROUND: Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. OBJECTIVE: The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. DESIGN: A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capillary finger-stick samples. RESULTS: Age- and sex-specific BMI percentiles were assessed in 385 students, 90 of whom were full participants in this study (participants) and 295 of whom had only height and weight measurements taken (other students). Risk factors of the metabolic syndrome were assessed in the 90 participants (23%). No significant differences in BMI percentiles were found between the participants and the other students. Overall, 44% of the participants had BMIs at or above the 85th percentile, and 59% had an elevated BMI or one metabolic syndrome risk factor. The metabolic syndrome was present in 5.6% of all participants, in 13.8% of participants with BMIs at or above the 95th percentile, and in 0% of participants with BMIs below the 95th percentile. CONCLUSIONS: Most of the African American children attending 2 urban schools in low-income neighborhoods were overweight or had one or more risk factors for the metabolic syndrome. School-based screening programs in high-risk populations may provide an efficient venue for the screening of obesity and related risk factors.

Black or African American↗
PubMed2005

Association between chronic diseases and disability in elderly subjects with low and high income: the Leiden 85-plus Study.

BACKGROUND: Disability in activities of daily living (ADL) might be more prevalent among elderly with low income due to higher prevalence of chronic diseases and impairments, as well as stronger associations of these factors with ADL-disability. METHODS: In the Leiden 85-plus Study, we defined disability as being unable to perform one or more basic ADL activities. Presence of chronic diseases was obtained from medical records, impairments were assessed with performance-tests. RESULTS: Elderly with low income had higher prevalence of ADL-disability (23% versus 12%; odds ratio 2.0; 95% confidence interval 1.3-3.2), higher prevalence of impairments and equal prevalence of chronic diseases, except for dementia and co-morbidity. Associations of these factors with ADL-disability were not stronger. CONCLUSIONS: We conclude that ADL-disability is more prevalent in elderly with low income. Neither prevalence of chronic diseases nor the association with disability could explain this.

Activities of Daily Living↗
PubMed2004

Providing health care to low-income women: a matter of trust.

BACKGROUND: Trust is an important indicator of quality in patient-provider relationships and predicts adherence to certain protective health behaviours. It has been relatively unexplored among low-income or minority women. OBJECTIVES: We explored health care experiences that influence patient trust among low-income women in the USA with respect to professionals and lay health workers (LHWs). METHODS: Focus groups were conducted with 33 prenatal and postpartum women, aged 18-45 years, recruited from community-based public prenatal care programmes. Focus groups were audio-recorded, transcribed, and independently coded by readers. A model of factors associated with trust was developed based on the major thematic categories. RESULTS: Most women were Black (67%) and had completed high school (85%). Factors related to greater trust specific to patient-provider relationships were: continuity of the patient-provider relationship, effective communication, demonstration of caring and perceived competence. Women with less trust in their physicians reported an unwillingness to follow his/her advice. Most women reported having more trusting relationships with LHWs and nurses than with physicians, probably due to greater contact with these staff. Several women with a low level of trust reported experiences of discrimination due to lack of insurance. CONCLUSIONS: Prenatal care presents a unique opportunity for providers to contribute to the elimination of health disparities among low-income women. Improving continuity with public health prenatal care providers and building strong relationships with LHWs may enhance quality of care and contribute to achieving this goal. Better patient-provider communication is also a practical area of focus towards improving patient trust.

Delivery of Health Care↗
PubMed1999

Understanding the intention to permanently follow a high folate diet among a sample of low-income pregnant women according to the Health Belief Model.

Despite folate fortification of the US food supply beginning January 1, 1998, evidence indicates that a substantial proportion of women of child-bearing age will continue to have folate intakes inadequate for the prevention of neural tube defects (NTDs). Therefore, health education remains an essential component of this public health campaign. The purpose of this study was to determine the applicability of the Health Belief Model (HBM) to understanding the intention to permanently follow a high folate diet among low-income pregnant women. A convenience sample of 251 low-income pregnant women participated in individual 15 min interviews assessing their folate attitudes and beliefs according to the model. Correlations consistent with the HBM were found between the perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy and cues to action constructs, and participants' intention to permanently follow a high folate diet (folate intention). In regression analyses, the perceived benefits construct was consistently the most predictive of folate intention. Participants were generally unfamiliar with and had many misperceptions concerning both folate and NTDs. The HBM may offer an effective foundation for development of tailored educational interventions promoting permanent consumption of a high folate diet among low-income women.

Adolescent↗
PubMed1998

Firearm-related deaths in the United States and 35 other high- and upper-middle-income countries.

BACKGROUND: The Forty-Ninth World Health Assembly recently declared violence a worldwide public health problem. Improved understanding of cross-national differences is useful for identifying risk factors and may facilitate prevention efforts. Few cross-national studies, however, have explored firearm-related deaths. We compared the incidence of firearm-related deaths among 36 countries. METHODS: Health officials in high-income (HI) and upper-middle-income countries (UMI) with populations greater than one million were asked to provide data using ICD-9 codes on firearm-related homicides, suicides, unintentional deaths and deaths of undetermined intent, as well as homicides and suicides for all methods combined. Thirty-six (78%) of the 46 countries provided complete data. We compared age-adjusted rates per 100,000 for each country and pooled rates by income group and geographical location. RESULTS: During the one-year study period, 88,649 firearm deaths were reported. Overall firearm mortality rates are five to six times higher in HI and UMI countries in the Americas (12.72) than in Europe (2.17), or Oceania (2.57) and 95 times higher than in Asia (0.13). The rate of firearm deaths in the United States (14.24 per 100,000) exceeds that of its economic counterparts (1.76) eightfold and that of UMI countries (9.69) by a factor of 1.5. Suicide and homicide contribute equally to total firearm deaths in the US, but most firearm deaths are suicides (71%) in HI countries and homicides (72%) in UMI countries. CONCLUSIONS: Firearm death rates vary markedly throughout the industrialized world. Further research to identify risk factors associated with these variations may help improve prevention efforts.

Adolescent↗
PubMed1997

High prevalence of obesity in low income and multiethnic schoolchildren: a diet and physical activity assessment.

The objective of the study was to assess the prevalence of obesity and/or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population. A cross-sectional survey of 498 children aged 9-12 y from 24 schools in low income multiethnic neighborhoods in Montreal, Canada was undertaken. Height, weight, dietary intake, physical activity record, and lifestyle and demographic characteristics were measured. There was no evidence of undernutrition because linear growth was appropriate for age, but 39.4% of children were overweight (>85th percentile NHANES II). Dietary fat intake was higher in children from single-parent families (P < 0.001) and those with mothers born in Canada. Intake of vitamins A, C, iron and folate was directly related to income sufficiency. Children who did more physical activity had significantly higher intakes of energy, calcium, iron, zinc and fiber but were not heavier. Dietary intake was systematically underreported among overweight children, i.e., their reported intakes did not meet calculated energy needs. This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure.

Anthropometry↗
PubMed2005

Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women.

In the United States, the prevalence of third trimester anemia among low-income pregnant women is 29% and has not improved since the 1980s. Although low adherence has been linked to the ineffectiveness of iron supplementation programs, data regarding adherence to supplementation in low-income women are currently lacking. Hence this study was conducted to better understand the factors associated with adherence to the use of iron-containing prenatal multivitamin/mineral supplements among low-income pregnant women. Adherence to supplement use was assessed by pill counts among 244 pregnant women of 867 women who were initially randomized to receive 1 of 3 prenatal supplements. All women received care at a public prenatal clinic. Maternal characteristics associated with adherence were identified using predictive modeling. Women took 74% of supplements as prescribed. Adherence was higher among non-Hispanic white women than among non-Hispanic black women (79% vs. 72%, P </= 0.01). Interactions of ethnicity with age group, smoking status, and prior supplement use were significant. Multivariate regression analysis stratified by ethnicity revealed that among the white women education beyond high school, unmarried status, nulligravidity, and smoking were positively associated with adherence. In contrast, among the black women, supplement use 3 mo prior to current pregnancy and no loss of appetite were positively associated with adherence. Further research investigating the influence of cultural factors is necessary to better understand adherence to supplement use and the differences in adherence among ethnic groups.

Adolescent↗
PubMed1996

Trends along the debt-income axis: implications for medical students' selections of family practice careers.

PURPOSE: To examine whether medical students' levels of debt have an influence on selection of family practice careers, independent of other factors. METHOD: Data from the Jefferson Longitudinal Study were analyzed for 1,350 graduates from the classes of 1987-1993 at Jefferson Medical College of Thomas Jefferson University; a focused analysis for 326 graduates from the classes of 1992 and 1993 was specifically performed to identify recent trends. A binary logistic regression equation was used to predict the probability of a graduate's entrance into a family practice residency based on first-year preference for family practice, income expectation, debt level, age, and gender. RESULTS: A high level of indebtedness (at least $75,000) was a significant independent predictor of specialty choice (away from family practice); first-year preference for family practice and income expectation were also significant independent predictors. Combining these three factors (debt, specialty preference, and income expectation) led to a greater than 12-fold difference in specialty selection of family practice. Notably, 36% of the students graduating in 1992-1993 had debts of at least $75,000, more than three times the percentage in the classes graduating in 1987-1989. CONCLUSION: High levels of debt had a significant negative effect on family practice specialty, choice among recent Jefferson graduates. An increase in the number of students with such debt carries strong implications for the selection of careers in family practice.

Career Choice↗
PubMed1994

Behavior problems in 5- to 11-year-old children from low-income families.

OBJECTIVE: The aims of the present study were to survey the Child Behavior Checklist (CBCL) scores (behavioral section) in a nonclinical population of US urban children from low-income families and to compare the distribution and pattern of scores with the normative data in the CBCL manual (1991). METHOD: The sample consisted of 890 low-income children and a mother or female guardian selected randomly from among Seattle public school students aged 5 to 11 years. RESULTS: In this sample the total CBCL score as well as all subscale scores were significantly higher than the norms. The proportion of children who scored in the clinical/borderline range was also higher than the norm. CONCLUSIONS: These findings support previous work showing that poverty is a risk factor for mental distress in children. They also raise questions about the validity of the CBCL norms for screening or research purpose for low-income families.

Child↗
PubMedDate not supplied

Lessons learned: providing a mindfulness-based stress reduction program for low-income multiethnic women with abnormal pap smears.

Although the incidence rate of cervical cancer has decreased over the last several years, low-income ethnic minority women remain at increased risk for morbidity and mortality from cervical cancer. We conducted a pilot study to examine the feasibility and acceptability of mindfulness-based stress reduction (MBSR) program among multiethnic low-income women with abnormal Pap smears. Spanish- and English-speaking women recruited through convenience sampling participated in MBSR classes 2 hours each week over 6 consecutive weeks. State anxiety and self-compassion were measured before and after the MBSR program. Focus groups and surveys were used to evaluate the program. Although 51 women were initially recruited, pre- and post-MBSR data were available only for 8 women. There was a significant reduction in anxiety and a trend toward increased self-compassion in this group of women. The participants evaluated the MBSR program very positively. The high attrition rate highlights the challenges of conducting MBSR research with this demographic of women. Potential strategies for improving recruitment and retention of low-income multiethnic women are discussed.

Adult↗
PubMed1983

Patterns of physician use among low-income, chronically ill persons.

The authors present new results from the 1978 National Health Interview Survey concerning the use of physician services by the least healthy segment of the low-income population: those who are limited in their activities due to chronic conditions. Poor and nonpoor persons with chronic activity limitations report similar levels of physician visits. However, lower-income persons report more severe chronic conditions and hence appear to use less physician care relative to their needs. In addition, low-income persons with chronic activity limitations report more visits in hospital outpatient clinics and emergency rooms and fewer in doctor's offices compared with others with such limitations, and they are more likely to report hospital outpatient departments as their usual source of care. Unfortunately, hospital-based ambulatory care is often more episodic and fragmented than care provided in other settings. The authors concluded that care for this population could be improved greatly by restructuring responsibility for the care of the chronically ill within hospital outpatient departments.

Adolescent↗
PubMed1992

Factors in the utilization of prenatal services by low-income black women.

Research indicates that low-income black women tend to receive inadequate prenatal care. To gain greater insight into why only some of these women initiate early prenatal care, this article's study investigated factors in the utilization of prenatal care, with race, residence and income as controlled variables. Using a convenience sample of 69 low-income, pregnant black women, interviews revealed that seeking early and frequent prenatal care may be determined primarily by need factors, such as the presence of risk factors or symptoms. Enabling factors, specifically financial barriers, did not have as great an influence on the use of services as expected. An unanticipated finding was that many women delayed care because they were not aware of the pregnancy. This study indicates that clinicians may need to provide more education about prenatal care to women at risk of delaying care.

Adolescent↗
PubMed1999

Perceived monogamy and type of clinic as barriers to seeking care for suspected STD or HIV infection: results from a brief survey of low-income women attending Women, Infants, and Children (WIC) clinics in Missouri.

BACKGROUND AND OBJECTIVES: Barriers to seeking care for sexually transmitted diseases (STDs) have not been assessed for low-income women. We sought to determine barriers to seeking care for STDs among women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties. GOAL OF THIS STUDY: Provide information for promoting care-seeking behavior among low-income women suspecting STD infection. STUDY DESIGN: A survey of 2,256 women was conducted; 491 reported a history of at least one STD. These women indicated possible barriers to seeing a doctor about a suspected STD and preference for type of clinic providing STD services. RESULTS: More than one fifth (21.3%) of those reporting an STD also reported at least one barrier to seeing a doctor about suspected STD or human immunodeficiency virus infection. Among those reporting barriers, the most common barrier was "I only have sex with my steady" (36.2%) followed by being asymptomatic (33.3%), embarrassment (22.8%), and cost (25.7%). Most (63.8%) preferred seeing their own doctor, with others reporting preference for community health centers (14.8%), family planning clinics (16.8%), and STD clinics (4.6%). CONCLUSIONS: Low-income women experience multiple barriers to seeking care including perceptions about a protective value of monogamy. Also, STD services in locations providing other health services for women were preferred.

Adolescent↗
PubMed2000

Prevalence and correlates of herpes simplex virus type 2 infection in a population-based survey of young women in low-income neighborhoods of Northern California. The Young Women's Survey Team.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections and may enhance transmission of HIV. However, population-based estimates of HSV-2 prevalence and correlates of infection are rare. GOALS: To obtain population-based estimates of HSV-2 prevalence and to identify demographic and sexual behavioral correlates of infection among women in low-income communities of Northern California. STUDY DESIGN: A randomized, single-stage, cluster sample, cross-sectional survey of women age 18 to 29 years who reside in 1990 US Census block groups at the lowest tenth percentile for household income. RESULTS: The survey-weighted prevalence of HSV-2 infection was 34.8% (95% CI, 30.4-39.2). Factors independently associated with HSV-2 seropositivity were black race, older age, lower income, parity, greater number of lifetime male sexual partners, earlier onset of sexual intercourse, sex work, history of sexually transmitted disease (STD), and cocaine use. CONCLUSION: The high prevalence of HSV-2 and the strong correlation with sexual risk underscores the potential for further spread of STD, including HIV, in this young population.

Adolescent↗