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PubMed2000

A review of the research on the health of low-income Canadian women.

Reducing health inequities associated with poverty is an important public health nursing role. This article describes the scope of research on the health of low-income Canadian women. The research included was published in English-language peer-reviewed journals between 1990 and 1997. The 26 articles retrieved are summarized according to the focus of the study and the composition of the sample. Most addressed personal health practices and health status. Only one intervention study was identified. The studies and the findings of this analysis are discussed in relation to three recommendations for research on women's health: an emphasis on social context, including the structural conditions affecting women's health; active participation of women in the research process; and recognition of diversity among low-income women. Suggested priority areas for future research are: intervention studies; studies addressing the structural context of the lives of low-income women; research strategies that enhance the participation of women in the research process; and increased involvement of diverse groups of women such as homeless women and women of varied ethnic backgrounds, including First Nations women.

Canada↗
PubMed2001

Psychometric assessment of the Adult-Adolescent Parenting Inventory in a sample of low-income single mothers.

The Adult-Adolescent Parenting Inventory (AAPI) is a 32-item inventory widely used to identify adolescents and adults at risk for inadequate parenting behaviors. It includes four subscales representing the most frequent patterns associated with abusive parenting: (a) Inappropriate Expectations; (b) Lack of Empathy; (c) Parental Value of Corporal Punishment; and (d) Parent-Child Role Reversal. Although it has been used in a variety of samples, the psychometric properties of the AAPI have not been examined in low-income single mothers. The purposes of this study were to: (a) examine the reliability and validity of the Adult-Adolescent Parenting Inventory (AAPI) in a sample of 206 low-income single mothers; (b) assess the mother's risk for inadequate parenting by comparing their AAPI subscale scores with normative subscale scores on the AAPI; (c) assess the construct validity of the AAPI by testing the hypothesis that mothers with lower AAPI scores have a higher level of depressive symptoms and lower self-esteem in comparison to mothers with higher AAPI scores; and (d) determine whether the 4-factor structure proposed by Bavolek (1984) could be replicated. AAPI scores indicated these mothers were at high risk for child abuse when compared with normative data for parents with no known history of abuse. Higher risk for abusive parenting was associated with a higher level of depressive symptoms, less education, and unemployment. The subscales, Inappropriate Expectations and Parental Value of Corporal Punishment demonstrated poor internal consistency with Cronbach's alphas of .40 and .54, respectively. Hypothesis testing supported the construct validity of the AAPI. Bavolek's 4-factor structure was not supported. A 19-item modified version of the AAPI with three dimensions was identified. This modified version of the AAPI may provide a more efficacious tool for use with low-income single mothers.

Adolescent↗
PubMed2002

Extension of the behavioral model of healthcare utilization with ethnically diverse, low-income women.

OBJECTIVE: Psychosocial vulnerabilities were added to a model of healthcare utilization. This extension was tested among low-income women with ethnicity addressed as a moderator. DESIGN: Structured interviews were conducted at 2 points in time, approximately 1 year apart. The constructs of psychosocial vulnerability, demographic predisposing, barriers, and illness were measured by multiple indicators to allow use of Structural Equation Modeling to analyze results. The models were tested separately for each ethnic group. SETTING: Community office. PARTICIPANTS: African-American (N = 266), Euro-American (N = 200), and Mexican-American (N = 210) women were recruited from the Dallas Metropolitan area to participate in Project HOW: Health Outcomes of Women, a multi-year, multi-wave study. Face-to-face interviews were conducted with this sample. Participants had been in heterosexual relationships for at least 1 year, were between 20 and 49 years of age, and had incomes less than 200% of the national poverty level. MAIN OUTCOME MEASURES: Healthcare utilization, defined as physician visits and general healthcare visits. RESULTS: Illness mediated the effect of psychosocial vulnerability on healthcare utilization for African Americans and Euro-Americans. The model for Mexican Americans was the most complex. Psychosocial vulnerability on illness was partially mediated by barriers, which also directly affected utilization. CONCLUSIONS: Psychosocial vulnerabilities were significant utilization predictors for healthcare use for all low-income women in this study. The final models for the 2 minority groups, African Americans and Mexican Americans, were quite different. Hence, women of color should not be considered a homogeneous group in comparison to Euro-Americans.

Adult↗
PubMed2002

Interventions to reduce tuberculosis mortality and transmission in low- and middle-income countries.

Tuberculosis is among the top ten causes of global mortality and affects low-income countries in particular. This paper examines, through a literature review, the impact of tuberculosis control measures on tuberculosis mortality and transmission, and constraints to scaling-up. It also provides estimates of the effectiveness of various interventions using a model proposed by Styblo. It concludes that treatment of smear-positive tuberculosis using the WHO directly observed treatment, short-course (DOTS) strategy has by far the highest impact. While BCG immunization reduces childhood tuberculosis mortality, its impact on tuberculosis transmission is probably minimal. Under specific conditions, an additional impact on mortality and transmission can be expected through treatment of smear-negative cases, intensification of case-finding for smear-positive tuberculosis, and preventive therapy among individuals with dual tuberculosis-HIV infection. Of these interventions, DOTS is the most cost-effective at around US$ 5-40 per disability-adjusted life year (DALY) gained. The cost for BCG immunization is likely to be under US$ 50 per DALY gained. Treatment of smear-negative patients has a cost per DALY gained of up to US$ 100 in low-income countries, and up to US$ 400 in middle-income settings. Other interventions, such as preventive therapy for HIV-positive individuals, appear to be less cost-effective. The major constraint to scaling up DOTS is lack of political commitment, resulting in shortages of funding and human resources for tuberculosis control. However, in recent years there have been encouraging signs of increasing political commitment. Other constraints are related to involvement of the private sector, health sector reform, management capacity of tuberculosis programmes, treatment delivery, and drug supply. Global tuberculosis control could benefit strongly from technical innovation, including the development of a vaccine giving good protection against smear-positive pulmonary tuberculosis in adults; simpler and shorter drug regimens for treatment of tuberculosis disease and infection; and improved diagnostics for tuberculosis infection and disease.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Diet in low-income families: adult working population].

The epidemiological research of the nutrition and health status of the low-income people was held in five regions of the Russian Federation. The analyze of the nutrients, energy, micronutrients and of the main groups of foods consumption in the families with the different level of income was executed. The estimation of the nutrition status was made with using body mass index. The results of this work showed the need of the development of nutrition support in social service and using the medical criteria for this support in low-income people.

Adolescent↗
PubMedDate not supplied

Food insecurity of low-income lone mothers and their children in Atlantic Canada.

OBJECTIVE: To examine the occurrence and predictors of hunger and food insecurity over the past year and month among low-income mother-led households in Atlantic Canada. METHOD: The Cornell-Radimer Questionnaire to Estimate the Prevalence of Hunger and Food Insecurity was administered weekly for a month, with modifications, to a community sample of 141 lone mothers who took part in a larger dietary intake study. Eligible women included those living alone with at least two children under the age of 14 years in the four Atlantic Provinces and having an annual income less than or equal to Statistics Canada's low-income cut-off. RESULTS: Food insecurity over the past year occurred in 96.5% of households. Child hunger was similar to maternal hunger over the one-month study period (23%), however, it was lower than maternal hunger over the past year. On multiple logistic regression analysis, maternal hunger over the past year was predicted by maternal age over 35 years (p < 0.0005), and Nova Scotia residence (p = 0.03). Child hunger over the past year was also predicted by maternal age over 35 years (p = 0.009). Families from New Brunswick experienced less food insecurity over the past month at both the household (p = 0.01) and maternal levels (p < 0.0005). DISCUSSION: Provincial policies that might contribute to the regular occurrence of food insecurity in these families should be investigated.

Adolescent↗
PubMedDate not supplied

Telephone social support for low-income pregnant women.

OBJECTIVE: To assess whether social support can be provided to low-income pregnant women by telephone. DESIGN: A qualitative pilot study. SETTING: Nonurban prenatal clinics. PARTICIPANTS: Convenience sample of 20 pregnant women who were eligible for Medicaid, spoke English, were at least 24 weeks gestation, and had a telephone or access to a telephone. RESULTS: The Baby-Beep pilot program provides strong evidence that a telephone social support intervention is feasible and highly acceptable to a group of low-income pregnant women. Through the use of the telephone, a strong rapport appeared to develop between the health care provider and the women because nonverbal cues were eliminated. The study also found that collaboration between mental health nurses and prenatal care providers could help create safe, cost-effective psychosocial care for pregnant women. CONCLUSION: The Baby-Beep pilot study provides important information about one way to deliver social support to low-income women who may have little or no social support and feel alienated in a clinical setting.

Adult↗
PubMed2003

Do low-income lone mothers compromise their nutrition to feed their children?

BACKGROUND: Women who live in disadvantaged circumstances in Canada exhibit dietary intakes below recommended levels, but their children often do not. One reason for this difference may be that mothers modify their own food intake to spare their children nutritional deprivation. The objective of our study was to document whether or not low-income lone mothers compromise their own diets to feed their children. METHODS: We studied 141 low-income lone mothers with at least 2 children under the age of 14 years who lived in Atlantic Canada. Women were identified through community organizations using a variety of recruitment strategies. The women were asked weekly for 1 month to recall their food intake over the previous 24 hours; they also reported their children's (n = 333) food intake. Mothers also completed a questionnaire about "food insecurity," that is, a lack of access to adequate, nutritious food through socially acceptable means, during each interview. RESULTS: Household food insecurity was reported by 78% of mothers during the study month. Mothers' dietary intakes and the adequacy of intake were consistently poorer than their children's intake overall and over the course of a month. The difference in adequacy of intake between mothers and children widened from Time 1, when the family had the most money to purchase food, to Time 4, when the family had the least money. The children experienced some improvement in nutritional intake at Time 3, which was possibly related to food purchases for them associated with receipt of the Child Tax Benefit Credit or the Goods and Services Tax Credit. INTERPRETATION: Our study demonstrates that low-income lone mothers compromise their own nutritional intake in order to preserve the adequacy of their children's diets.

Adolescent↗
PubMed2003

Health insurance and the poor in low income countries.

This short paper is not by an economist. It is by a public health doctor who has spent the last ten years working with development agencies and governments to strengthen public health systems in poor and middle-income countries. It is becoming increasingly obvious that while this still needs to be done, the focus of attention must shift to private expenditure and private providers. In most poor and middle income counties--even the most aid dependant--by far the biggest source of finance in the health sector is out of pocket expenditure and the poor in many of these countries spend disproportionately more than the rich as a % of household income on health care. This expenditure is primarily in the private sector or on unofficial user fees in the public sector. This expenditure does not protect the poor from the economic costs of catastrophic illness nor do they appear to get good value for treatment in the primary care setting. This paper is not a detailed synthesis of current knowledge but an overview for those who are not specialists in this area. It gives references to key publications, which have done that synthesis, and draws from them.

Developing Countries↗
PubMed2005

Ethnic variation in health-related quality of life among low-income men with prostate cancer.

OBJECTIVE: To describe and compare health-related quality of life (HRQOL) among Hispanic, African-American, and Caucasian men with localized prostate cancer. DESIGN: Observational study of low-income, ethnically diverse men with non-metastatic prostate cancer. SETTING: Statewide public assistance program in California. PARTICIPANTS: 208 men (51 Caucasian, 115 Hispanic, and 42 African-American men) with non-metastatic disease. INTERVENTIONS: Radical retropubic prostatectomy, radiation therapy, and hormonal therapy. MAIN OUTCOME MEASURES: Validated instruments measured general and disease-specific HRQOL, anxiety and fear of recurrence, spirituality, symptom distress, and self-efficacy. RESULTS: Hispanic men with prostate cancer were less educated, more often in significant relationships, and had more variable incomes compared with men of other ethnic/racial backgrounds. In univariate analyses, Caucasian men reported better physical function but less spirituality, while Hispanic men reported worse sexual function. Multivariate analysis revealed that Hispanic men had significantly worse physical function, bowel function, and bowel bother. African-American men experienced greater anxiety over recurrence. African-American and Hispanic men were more spiritual than Caucasian men. CONCLUSIONS: Greater attention to demographic variations in HRQOL may allow physicians to improve outcomes across ethnicities in low-income men with prostate cancer by offering more specialized counseling and providing referral to social support systems.

Adaptation, Psychological↗
PubMed2001

[Educational level, occupation and income of those who became disability pensioners in Iceland in the year 1997.].

INTRODUCTION: All claims for disability benefits in Iceland are managed by the State Social Security Institute of Iceland. The decision to grant a claimant disability benefits was until September 1999 mainly based on medical certificates but social and economic factors were also taken into consideration. As information on social and economic conditions in medical certificates is limited it was decided to investigate these factors particularly. In this paper a comparison of educational level, employment, and income is made between new recipients of disability benefits and a random sample of the Icelandic nation. MATERIAL AND METHODS: All new recipients of disability benefits (full disability pension, partial disability pension and rehabilitation pension) in 1997 were contacted by phone and asked to answer a questionnaire. Their answers were compared with those obtained in a national survey carried out by the Institute of Social Sciences at the University of Iceland in 1996 and 1997 with a sample representing accurately the Icelandic population in terms of gender, age and place of residence. Information about average income of disability pensioners was obtained and compared to that of people in employment. RESULTS: Educational level of those receiving disability benefits was considerably lower than expected in comparison with the population and unskilled workers were overrepresented. Contrary to what might be expected a larger proportion of the recently disabled have been employed at some time than is the case for the national sample, even though 63.6% of the new disability pensioners were women. Considerable number of those receiving disability benefits were still in employment, particularly those with partial disability pension. Mean monthly income of Icelanders participating in the labour market was almost twice that received by those on disability benefits. CONCLUSIONS: Since lower educational level and more restricted employment opportunities characterize disability pensioners as compared to the nation, it seems likely that more varied occupational rehabilitation and educational opportunities could improve the situation of those who have had to leave the labour market because of ill health, lack of education and poor working conditions.

English Abstract↗
PubMed2006

Exercise and pregnancy outcome among urban, low-income, black women.

Few studies have focused on the association between maternal exercise and outcomes of pregnancy among low-income, Black women. The analysis reported here examines the associations between exercise before and during pregnancy and pregnancy outcomes of preterm birth and low birth weight among a sample of urban, low-income, Black women. Women (N=922) were enrolled in this prospective cohort study during their first prenatal visit at five hospital-based prenatal clinics located in Baltimore City, Maryland, from 1993 to 1995. A questionnaire was used to ask women about their participation in strenuous and non-strenuous exercise before and during pregnancy. Nearly two thirds of the women reported participating in exercise during pregnancy; most women participated in non-strenuous exercise (56%). The risks of both low birth weight (12.2%) and preterm birth (13.7%) were not significantly different whether women reported exercising or not, either before or during pregnancy. For women who were considered high risk because of chronic diseases or previous poor pregnancy outcome, stratified analysis indicated no significant difference in preterm birth or low birth weight between those who exercised and those who did not. Our analysis failed to identify any association between exercise and pregnancy outcomes among low-income, urban, Black women.

Adolescent↗
PubMed2006

Rules for the issuance of work report receipts, payment of benefits for trial work period service months after a fraud conviction, changes to the student earned income exclusion, and expansion of the reentitlement period for childhood disability benefits. Final rules.

We are revising our rules to reflect and implement sections 202, 208, 420A, and 432 of the Social Security Protection Act of 2004 (the SSPA). Section 202 of the SSPA requires us to issue a receipt each time you or your representative report a change in your work activity or give us documentation of a change in your earnings if you receive benefits based on disability under title II or title XVI of the Social Security Act (the Act). Section 208 changes the way we pay benefits during the trial work period if you are convicted by a Federal court of fraudulently concealing your work activity. Section 420A changed the law to allow you to become reentitled to childhood disability benefits under title II at any time if your previous entitlement to childhood disability benefits was terminated because of the performance of substantial gainful activity. Section 432 changes the way we decide if you are eligible for the student earned income exclusion. We will also apply the student earned income exclusion when determining the countable income of an ineligible spouse or ineligible parent. We are also changing the SSI student policy to include home schooling as a form of regular school attendance.

Adolescent↗
PubMed1991

Nutrient intake of low-income Southeast Asian pregnant women.

Dietary nutrient intakes of 91 Cambodian, 37 Laotian, and 59 Vietnamese low-income pregnant women attending a university teaching hospital outpatient clinic in Southern California were measured. The nutrient intakes of the Southeast Asian groups were compared with one another as well as with the intakes of a group of 165 low-income non-Southeast Asian pregnant women of similar height, weight, and age from the same outpatient clinic population. Computerized analysis of the 24-hour recall data showed that there were few differences in nutrient intake between the Southeast Asian groups, except that the Cambodian group consumed significantly less fat, riboflavin, vitamin D, and calcium than the Vietnamese group. However, there were a number of differences between the nutrient intakes of the Southeast Asian groups and those of the non-Southeast Asian group. These included significantly lower intakes of fat, riboflavin, folate, vitamins D and E, calcium, phosphorus, potassium, and magnesium and significantly higher intakes of thiamin, niacin, sodium, and selenium. These findings suggest that low-income Southeast Asian pregnant women have some good dietary habits that dietitians need to reinforce and other dietary habits that need improvement.

Adult↗
PubMed1990

Breast-feeding rates among black urban low-income women: effect of prenatal education.

Many factors are associated with low breast-feeding rates among black low-income women. This study examines whether, despite such factors, health professionals' prenatal education of black poor women is associated with increased breast-feeding rates. Black women born in the United States who attended a midwives prenatal clinic (N = 159) were randomly assigned to two types of prenatal education or were followed up in a control group. All women were interviewed on entry into the study and after delivery of their infants. Women assigned to group classes attended at least one session discussing myths, problems, and benefits of breast-feeding. Women assigned to individual prenatal counseling spoke with a pediatrician or nurse practitioner, who discussed breast-feeding topics similar to those covered in the classes. Women in the control group received no additional prenatal education. The three study groups had significantly different percentages of women who breast-fed (controls 22%, classes 46%, individual sessions 53%). Higher percentages of women in the study groups carried out their prenatal plans to breast-feed (controls 50%, classes 86%, individual sessions 62%) or breast-fed despite prenatal plans to bottle-feed (controls 10%, classes 26%, individual sessions 48%). After multivariable analysis controlling for age, prenatal plans to breast-feed, prior breast-feeding experience, perceived support for breast-feeding, education, gravidity, and employment plans, women in intervention groups had a higher likelihood of breast-feeding than control subjects. These findings suggest that an increase in relatively simple, not-too-time-consuming educational efforts in institutions and offices serving black low-income women might yield significant narrowing of the gap in breast-feeding rates between white affluent women and black low-income women.

Adult↗
PubMed1990

Low-income pregnant adolescents and their infants: dietary findings and health outcomes.

Dietary and other health-related data were obtained for 99 low-income, pregnant adolescents aged 13 to 19 years and their infants who were enrolled in the Teen Pregnancy Service (TPS). The dietetic services provided through TPS are highlighted for this sample of teens, 97% of whom were eligible for the WIC program. Average gestational age at time of enrollment for prenatal care was 18 weeks; 59% of the sample was anemic (hemoglobin value less than 120 gm/L). The average number of servings teens consumed each day from the four food groups was as follows: bread/grain, 5.0; milk, 2.8; meat, 2.8; and fruit/vegetable, 2.3. Teens who were overweight before pregnancy had heavier infants (mean = 3,344 gm) than their underweight peers (mean = 2,770 gm). Teens who gained 24 lb or less during pregnancy and who gave birth to full-term infants had infants with significantly lower birth weights (mean = 3,094 gm, p less than .008) than those who gained at least 25 lb (mean = 3,356 gm). Teens who smoked also had infants with lower birth weights than teens who did not smoke. Most teens bottle-fed their infants (82%). On the basis of our data, we conclude that low-income pregnant teens are likely to be at dietary risk. Dietary work with low-income pregnant adolescents is challenging and requires a thorough knowledge base about adolescent pregnancy, coupled with the ability to adapt traditional dietary counseling practices to meet the unique needs of these clients.

Adolescent↗
PubMed1989

[Family income, demand and use of dental health care among Norwegian adult population 1983-1987].

The aim of this study was to describe changes in demand and utilization of dental services according to family income among adults in Norway from 1983 to 1987. The analysis was performed on two sets of national data, which were representative of the Norwegian population aged 20 years and above. The sample size was 1,289 individuals in 1983 and 1,166 individuals in 1987. The data were analyzed according to a two-part model. The first part determined the probability of whether the consumer had demanded the services or not during the last year. The second part estimated how expenditure depended on income, given some expenditure. Family size, number of teeth present, age, gender and education were entered into the analysis as control variables. For edentulous people, and people with few remaining teeth, there were marked differences in demand and utilization of dental services according to family income both in 1983 and in 1987. During this period, there has been an increase in demand, while utilization has stayed constant. In the population as a whole, the turnover of dental services has increased by the equivalent of 80 "dentists' years work" from 1983 to 1987 due to the increase in demand.

Adult↗
PubMed1989

Development of immunity to incoming radiolabelled larvae in lambs continuously infected with Ostertagia circumcincta.

Infective larvae of Ostertagia circumcincta were radiolabelled with 75selenium by a method which did not affect their viability. Three groups of five-month-old lambs were infected daily with 1000 unlabelled infective larvae for four, eight and 12 weeks, respectively. After each period one of these groups and a group of worm-free controls were challenged with three consecutive daily doses of 1000 radiolabelled third stage larvae. The lambs were killed 13 days after the first dose of challenge larvae and their worm burdens examined. The first indication of immunity was retardation of developing worms observed at four weeks. Resistance to the establishment of incoming worms developed between four and eight weeks and a brief period of population turnover probably took place at this time. Simultaneously a greater inhibition of worm development occurred resulting in an increase in the number of parasites recovered as early fourth stage larvae. By 12 weeks the animals were almost completely immune to incoming worms. The development of resistance to incoming worms correlated with a rise in serum antibody titre and an increase in the number of intraepithelial globule leucocytes in the gastric mucosa.

Animals↗