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PubMed1998

The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers.

OBJECTIVES: This study describes the development status of 127 homeless and 91 low-income housed infants and toddlers. METHODS: The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. RESULTS: There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older children on most summary scores. CONCLUSIONS: Homeless and low-income housed children did not differ in their cognitive and motor skills. However, older children scored lower than younger children on most measures of development status, suggesting that the cumulative effects of poverty may increase with time.

Adaptation, Psychological↗
PubMed2002

Timing of insurance coverage and use of prenatal care among low-income women.

OBJECTIVES: This study examined the relationship between timing of insurance coverage and prenatal care among low-income women. METHODS: Timeliness of prenatal care initiation and adequacy of number of visits were studied among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994-1995. RESULTS: Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester. Rates of untimely care were highest (> or =64%) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester; rates were lowest (about 10%) among women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy were at low risk of having too few visits. CONCLUSIONS: Timing of prenatal coverage should be considered in research on the relationship between coverage and care use among low-income women. Earlier studies that relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about lack of coverage as a barrier to prenatal care.

Adolescent↗
PubMed2001

The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The Center for Epidemiologic Studies-Depression.

OBJECTIVE: Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics. METHOD: Low-income women attending public primary care clinics (n = 179, ages 20-77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). RESULTS: The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45). CONCLUSION: Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.

Adult↗
PubMed2004

Closing the gap: effect of diabetes case management on glycemic control among low-income ethnic minority populations: the California Medi-Cal type 2 diabetes study.

OBJECTIVE: Disparities exist in the diabetes health status of ethnic minority and/or low-income populations relative to other groups. A primary objective of diabetes management is to improve glycemic control. The feasibility of implementing intensive diabetes case management in disparate populations remains largely untested. RESEARCH DESIGN AND METHODS: Clinical sites in three southern California counties serving low-income, ethnic minority populations participated in our study. We randomized 362 Medicaid (called Medi-Cal in California) recipients with type 2 diabetes for at least 1 year to intervention (diabetes case management) or control (traditional primary care treatment) groups. Fifty-five percent of participants were minorities. Participants with HbA(1c) levels less than 7.5%, serious diabetes-related complications, or other serious medical conditions were excluded. We assessed the effect of the intervention (ongoing diabetes case management added to primary care) on glycemic control using serial HbA(1c) measurements over several years. RESULTS: The mean duration of follow-up was 25.3 months. HbA(1c) decreased substantially in both groups from an average of 9.54-7.66% (a reduction of 1.88%) in the intervention group and from an average of 9.66-8.53% (a reduction of 1.13%) in the control group. This improvement was sustained throughout the study. The reduction in HbA(1c) was consistently greater in the intervention group at each time point (P < 0.001), ranging between 0.65 at 6 months and 0.87 at study end. CONCLUSIONS: Diabetes case management, added to primary care, substantially improved glycemic control compared with the control group. Diabetes case management can help reduce disparities in diabetes health status among low-income ethnic populations.

Blood Glucose↗
PubMed1995

Selected health-fitness rankings of low-income youth.

Two parameters, tricep skinfold and one-mile walk/run, from the American Alliance for Health, Physical Education, Recreation and Dance health-related fitness test were assessed in 226 low-income children, ages 10 through 14 years. Group means by age and sex were compared with state and national norms. As a whole, on both fitness parameters, this low-income sample fell in the bottom quartile for the state of Maine. The group's national ranking was even lower. Not only are low-income families burdened financially, it appears from this study that the children are also at health risk.

Adolescent↗
PubMedDate not supplied

The content of a low-income, uninsured primary care population: including the patient agenda.

BACKGROUND: Poor and uninsured people have increased risk of medical and psychiatric illness, but they might be more reluctant to seek care than those with higher incomes. Little information exists about the biopsychosocial problems and concerns of this population in primary care. METHODS: We surveyed 500 consecutive patients (aged 18 to 64 years) in a primary care clinic serving only uninsured, low-income patients. We used self-report questions about why patients were coming to the clinic, a chronic illness questionnaire, the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, and items from the Childhood Trauma Questionnaire. Providers completed a questionnaire naming problems elicited from patients. RESULTS: Patients reported their most common chronic medical problems to be headaches, chronic back problems, and arthritis. The most common concerns patients wanted to discuss with providers and that providers elicited from patients were problems with mood. Compared with patients without current major mental illness, patients with a current major mental illness reported significantly (P <.001) more concerns, chronic illnesses, stressors, forms of maltreatment and physical symptoms. CONCLUSION: The illness content of this uninsured, low-income population is dominated by emotional distress and physical pain. These needs place a serious burden on providers and can complicate management of chronic medical illnesses. Recommendations for specialized interview training and integrating mental health services are discussed.

Adolescent↗
PubMed2004

Predictors of the utilization of oral health services by children of low-income families in the United States: beliefs, cost, or provider?

PURPOSE: This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. METHODS: In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. RESULTS: The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. CONCLUSION: The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.

Adult↗
PubMed2005

Prevalence of maternal depressive symptoms in low-income Hispanic women.

BACKGROUND: Maternal depression can have significant repercussions for the health and well-being of mothers and children. In primarily white middle-income populations, approximately 15% of mothers experience depression. Among ethnically and socioeconomically diverse populations, the prevalence of maternal depression has not been as well established. However, the highest rates have been observed among low-income women. Because information about minority, underserved women is particularly sparse, we utilize data from the San Mateo County, California, Prenatal to Three project to describe the prevalence and self-recognition of depressive symptoms among low-income Hispanic mothers of infants and toddlers. METHOD: Telephone interviews of a random sample of women who received Medicaid and gave birth in San Mateo County provided our sample of 218 nonpregnant Hispanic mothers. High levels of depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed descriptive analyses and analyses of variance. RESULTS: Twenty-three percent of mothers reported high levels of depressive symptoms. Half of them recognized a need for help with depression. CONCLUSIONS: High levels of maternal depressive symptoms were prevalent among the Hispanic women on Medicaid, but only half of the women experiencing these symptoms identified themselves as needing help with depression.

Adolescent↗
PubMedDate not supplied

A systematic review of mammography educational interventions for low-income women.

OBJECTIVE: We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. DATA SOURCES: Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. STUDY INCLUSION AND EXCLUSION CRITERIA: Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. DATA EXTRACTION: The search yielded 242 studies; 24 met all inclusion criteria. DATA SYNTHESIS: Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. RESULTS: Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. CONCLUSIONS: Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.

Female↗
PubMedDate not supplied

A stage-targeted physical activity intervention among a predominantly African-American low-income primary care population.

PURPOSE: To examine the efficacy of a stage-targeted physical activity intervention among low-income African-Americans. METHODS: 207 participants were randomly assigned to groups and administered baseline measures. Intervention participants were mailed stage-targeted physical activity information, whereas control participants received low-sodium diet brochures. Measures were readministered by phone 1 and 6 months later, with response rates of 69% and 46%, respectively. RESULTS: 69% of participants were African-American and 64% had a monthly household income of < $1000. A doubly-multivariate analysis of variance indicated that intervention participants reported more physical activity than control participants at 1 month (F(1, 204) = 4.03, p < .05). Unlike control participants, intervention participants reported significant stage progression at 1 month, according to a McNemar chi2 test. Gains attenuated by 6 months. CONCLUSIONS: The current study supports the use of this intervention among low-income African-Americans. Limitations include use of self-report measures and small sample size.

Black or African American↗
PubMed2004

A framework for evaluating safety-net and other community-level factors on access for low-income populations.

The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.

Ambulatory Care↗
PubMed2006

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries.

PURPOSE: To review the evidence basis of international aid and health policy. CONTEXT OF CASE: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. DATA SOURCES: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. CONCLUSIONS AND DISCUSSION: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions--causing health care disintegration--which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.

Journal Article↗
PubMed1991

Good neighbors. A collaborative effort develops housing for the low-income elderly on Chicago's southeast side.

On Chicago's southeast side, the Claretian missionaries--in collaboration with the Oblates of Mary Immaculate, members of the local community, and local business interests--will soon open Villa Guadalupe, a housing project for low-income seniors. Recent developments have combined to make the creation of low-income housing for the elderly more compelling than ever from a mission perspective and more feasible from a structuring and financing perspective. Since 1925, the Claretians have served a predominantly Hispanic population in south Chicago. The neighborhood suffered economic devastation in the 1960s with the collapse of the local steel industry. A 1985 needs assessment determined that nearly one in five elderly residents in the area lives at or near the poverty level. As a result of the assessment, the Claretians decided to develop the Villa Guadalupe project. For assistance in managing and financing the project, the Claretians drew on the resources and expertise of the Oblates of Mary Immaculate, who have a history of ministering to the elderly. The project also had to overcome legal obstacles to securing property tax exemption from the state of Illinois. The project cleared another hurdle when it secured financing by issuing tax-exempt bonds secured by a letter of credit issued by a commercial bank. In addition, interest in monies from an endowment fund will make up the difference between funds Villa Guadalupe will receive through rents and the income that is required to support the project.

Aged↗
PubMed1990

Access to Medicaid and Medicare by the low-income disabled.

The most pervasive eligibility-related problems encountered by low-income disabled persons in gaining access to Medicaid and Medicare are reviewed in this article. A series of options for restructuring program eligibility requirements are presented, with particular attention to improving the plight of the low-income disabled worker during the 24-month waiting period for Medicare. Options for Medicaid involve nationwide income eligibility levels at 100 percent of poverty and mandatory buy-in provisions to Medicaid in all States. For Medicare, the reforms range from altering the waiting period for Medicare by the disabled who are expected to die within 24 months after benefit award to eliminating the waiting period altogether.

Adolescent↗
PubMed1999

Prevalence of high-risk behaviors and obesity among low-income patients attending primary care clinics in Louisiana.

This study examined the prevalence of the most prominent high-risk behaviors that contribute to mortality in the United States (i.e., sedentary lifestyle, cigarette smoking, and high dietary fat intake) and obesity among low-income patients attending primary care clinics in Louisiana. The sample consisted of 1,132 patients attending primary care clinics that were randomly selected and administered a demographic questionnaire, the 1994 Behavioral Risk Factor Surveillance System, and the Eating Patterns Questionnaire. Participants consisted predominantly of African-American (67.7%), uninsured (73.3%), low-income, middle-aged females. Prevalence of high-risk behaviors included sedentary lifestyle (47.1%), cigarette smoking (26.2%), and high dietary fat intake (61.3%). Prevalence of obesity was 63.5%. In conclusion, low-income patients attending primary care clinics in Louisiana display a high frequency of important high-risk behaviors that contribute to mortality in this country. Obesity is also extremely prevalent in this population. Clinical implications and directions for future studies are discussed.

Adult↗
PubMed1999

After-school programs for low-income children: promise and challenges.

Children's out-of-school time, long a low-level source of public concern, has recently emerged as a major social issue. This, in turn, has heightened interest in the heterogeneous field of after-school programs. This article provides a profile of after-school programs for low-income children, focusing on supply and demand, program emphases, and program sponsors and support organizations. It also discusses the major challenges facing the field in the areas of facilities, staffing, and financing. Details and examples are drawn from the ongoing evaluation of a specific after-school program initiative called MOST (Making the Most of Out-of-School Time), which seeks to strengthen after-school programs in Boston, Chicago, and Seattle. Looking ahead, the article highlights the pros and cons of options for increasing coverage to reach more low-income children, strengthening programs, expanding funding, and articulating an appropriate role for after-school programs to fill in the lives of low-income children.

Child↗
PubMed2000

Low-income women's priorities for primary care: a qualitative study.

BACKGROUND: Because of their challenging social and economic environments, low-income women may find particular features of primary care uniquely important. For this qualitative study we explored which features are priorities to women fiumi low-income settings and whether those priorities fit into an established primary care framework. METHODS: We performed a qualitative analysis of 4 focus groups of women aged 40 to 65 years from 4 community health clinics in Washington, DC. Prompted by semistructured open-ended questions, the focus groups discussed their experiences with ambulatory care and the attributes of primary care that they found important. The focus groups were audiotaped, and the tapes were transcribed verbatim and coded independently by 3 readers. RESULTS: The comments were independently organized into 5 content areas of primary care service delivery plus the construct of patient-provider relationship in the following order of frequency: accessibility (37.4%), the physician-patient relationship (37.4%), comprehensive scope of services (11.5%), coordination between providers (6.8%), continuity with a single clinician (3.7%), and accountability (3.2%). Commonly reported specific priorities included a sense of concern and respect from the clinicians and staff toward the patient, a physician who was willing to talk and spend time with them (attributes of the physician-patient relationship), weekend or evening hours, waiting times (attributes of organizational accessibility), location in the inner city and on public transport routes (an attribute of geographic accessibility), availability of coordinated social and clinical services on-site; and, availability of mental health services on-site (attributes of comprehensiveness and of coordination). CONCLUSIONS: All attributes of care that were priorities for low-income women fit into 1 of 6 content areas. Specific features within the content areas of accessibility, physician-patient relationship, and comprehensiveness were particularly important for these women.

Adult↗
PubMed2000

Recent trends in children's health insurance coverage: no gains for low-income children.

The percentage of low-income children who have health insurance has not changed over the last few years, despite expansions in public coverage through Medicaid and the State Children's Health Insurance Program (SCHIP). Data from 1996-1997 and 1998-1999 from the Center for Studying Health System Change (HSC) find that while the proportion of low-income children with public coverage has increased, the percentage with private insurance coverage has decreased sharply, resulting in no net change in the percentage who are uninsured. This Issue Brief describes these recent changes in public and private coverage. Possible factors that may explain these changes are discussed, including increases in private insurance premiums, substitution of public for private coverage and changes in the characteristics of low-income persons. The study did not determine conclusively the causes of the changes in coverage.

Child↗