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PubMed2006

Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?

OBJECTIVES: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. METHODS: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. RESULTS: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. CONCLUSIONS: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.

Adult↗
PubMed2005

Nature and correlates of SF-12 physical and mental quality of life components among low-income HIV adults using an HIV service center.

OBJECTIVES: This study describes health-related quality of life (HRQOL) among low-income HIV adults using an HIV service center, compares participants' scores to US published norms for the general population and persons with chronic conditions, and examines relationships between patient characteristics, nonadherence, and HRQOL. METHODS: A cross-sectional survey of individuals on antiretroviral therapy was conducted. The Medical Outcomes Study SF-12 was used to assess HRQOL. Medication nonadherence was assessed using the 9-item Morisky Adherence Scale. Data also were collected on social support, CD4 cell count, and time since diagnosis. RESULTS: Approximately 84% of the 86 participants were male, 50% were white, and 39% were black. The mean +/- SD Physical component summary (PCS-12) score of 41.0 +/- 12.5 and Mental component summary (MCS-12) score of 41.9 +/- 11.0 were lower than US general population norms (p < 0.001). PCS-12 scores were similar to those of patients with other chronic conditions. Respondents reported lower MCS-12 scores than patients with hypertension and diabetes (p < 0.006). Employment and higher social support had positive associations with PCS-12 scores and nonadherence had a negative association with MCS-12 scores (p < 0.05). CONCLUSIONS: HRQOL in this sample of low-income HIV adults was comparable to other HIV populations. Identifying strategies for increasing social support and medication adherence for economically disadvantaged persons with HIV/ AIDS may improve their HRQOL.

Adolescent↗
PubMed2007

Colorectal cancer screening among low-income African Americans in East Harlem: a theoretical approach to understanding barriers and promoters to screening.

African Americans (AAs) have the highest incidence rates of colorectal cancer (CRC) among all races in the US. These disparities may be attributed to lower participation in CRC prevention and control activities [e.g., flexible sigmoidoscopy (FS), fecal occult blood testing (FOBT)]. This is a current issue in East Harlem where less than half the residents in this area participate in CRC screening and mortality rates due to CRC are higher than the national average. We examined correlates of FS and FOBT screening among AAs based on the transtheoretical model (TTM) of behavior change. One hundred and eleven AA men and women, 50 years and older (51-92), low-income, and at average risk for CRC were recruited at an ambulatory care center in East Harlem. Assessments focused on sociodemographic, medical, psychosocial and TTM variables. The first logistic regression model showed that higher levels of education (p < 0.05), greater knowledge of FS (p < 0.05), and greater endorsements of Thinking Beyond Oneself (p < 0.05) were associated with adherence to FS screening guidelines. The second model showed that only greater knowledge of FOBT (p < 0.05) and receiving a physician's recommendation (p < 0.01) were significant correlates of adherence to FOBT screening guidelines. This study supported the application of components of the TTM for FS and FOBT screening among low-income AAs receiving care in an urban medical center and illustrated the need for interventions targeting both patients and their providers.

Black or African American↗
PubMed1995

Risk of child abuse or neglect in a cohort of low-income children.

The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mother's separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.

Adolescent↗
PubMed1995

Literacy skills and communication methods of low-income older persons.

The objectives of this study were to (a) characterize the literacy skills of low-income, community-dwelling, older adults, (b) determine how they obtain information, and (c) determine whether they have difficulty understanding written information provided by clinicians. We studied 177 subjects (mean age 72.2, range 60-94). None had cognitive or visual impairments that precluded assessing literacy. Reading skills were tested, sociodemographic data were recorded, and information was collected on whether subjects have trouble understanding information given to them by health providers. Data analysis determined if literacy was associated with how subjects obtain and understand medical information. The subjects' mean reading skills were at grade level 5, below those of the general US population. One-fourth of subjects reported difficulty understanding written information from clinicians; this was more frequent among poor readers (P = 0.0002). Ninety-seven percent of subjects, regardless of literacy, reported that television was their primary source of information. Health information for low-income seniors should be transmitted through literacy-appropriate communication methods.

Age Factors↗
PubMed1994

Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight.

PURPOSE: The objective of this study was to determine the effect of total sugar intake by pregnant adolescents from low-income families on infant birth weight and small-for-gestational-age (SGA) infants. METHODS: The study sample consisted of 337 adolescents, enrolled in a county-wide demonstration project in Camden, New Jersey, who delivered live, singleton newborns. The adolescents were divided into two groups at the 90th percentile for the study sample total sugar intake (206 g): high-sugar intake (> or = 206 g, n = 34) and low-sugar intake group (< 206 g, n = 303). RESULTS: The sample was 46% black, 30% white, and 24% Hispanic. The sample gestational age and birth weight (mean +/- SD) were 39 +/- 3 weeks and 3189 +/- 666 g, respectively. After adjusting for energy intake, the high- compared with the low-sugar intake group was more likely to consume higher total sugar and carbohydrate but lower protein and fat. Likewise, the high-compared to the low-sugar intake group consumed significantly more calcium and magnesium. After adjusting for possible confounding variables such as maternal age, ethnicity, marital status, parity, smoking, net weight gain, body mass index, energy intake, and gestational age at birth, adolescents on high- compared to low-sugar diets gave birth to infants weighing 215 +/- 104 g less (p = 0.04). The adjusted odds ratios were 3.41 (95% confidence interval, 1.14 to 10.23) for delivering a SGA infant among adolescents with high- compared with low-sugar intakes. CONCLUSIONS: Low-income adolescents consuming high-sugar diets are at increased risk for delivering lower birth weight and SGA infants.

Adolescent↗
PubMed2004

Impact of a motivational intervention on mechanisms of change in low-income pregnant smokers.

Numerous smoking cessation interventions targeting pregnant women have been developed and tested. An overall increase in smoking cessation is indicated, yet quit rates are modest and variable. Although efficacious with other substance abuse populations, motivational interviewing (MI) interventions with pregnant smokers have resulted in marginal outcomes. Examining treatment mechanisms affected by MI interventions may assist in understanding negative results and in developing more innovative and effective interventions. This study assessed the impact of an MI intervention on transtheoretical (TTM)-based mechanisms of change in low-income pregnant smokers (N = 54). Repeated measures analyses indicated that relative to usual care (UC), pregnant smokers who received MI reported a greater increase in confidence to abstain from smoking, a decrease in temptation to smoke, and a decrease in level of depression. However, the MI intervention was not associated with forward progression in the stages of change. More intensive motivational and cognitive-behavioral interventions demonstrated effective in nonpregnant, smoking populations, with more frequent sessions separate from prenatal visits, are recommended to further increase smoking cessation rates among low-income pregnant smokers.

Adolescent↗
PubMed2005

Who, when, and how much? Epidemiology of walking in a middle-income country.

BACKGROUND: Physical inactivity is one of the leading causes of morbidity and mortality worldwide. Walking, an inexpensive and accessible activity, is protective against unhealthy outcomes. Little data on walking practices are available outside developed countries. This study estimated the prevalence and correlates of compliance with physical activity recommendations through leisure-time and all-domain (combined leisure time, commuting, and work-related) walking in individuals aged > or =20 years in a southern Brazilian city. METHODS: Data from two population-based surveys carried out in 2002 and 2003 in Pelotas, Rio Grande do Sul, were compared and analyzed in 2004. Multistage sampling procedures were undertaken in both surveys. Compliance with physical activity recommendations was defined as > or =150 minutes/week of walking during the previous week, although other cut-off points were estimated. The International Physical Activity Questionnaire was used in both studies. RESULTS: Samples comprised 3182 (2002 study) and 3100 (2003 study) individuals. Nonresponse rates were 5.6% and 3.5%, respectively. Both prevalence and correlates of leisure-time and all-domains walking were markedly different. Compliance with physical activity guidelines (> or =150 minutes/week) through walking was 40.6% (all domains) and 15.0% (leisure time). Poor and uneducated participants had a lower likelihood of walking than higher-income and more educated people, particularly in leisure time. Walkers were also more likely to practice other vigorous and moderate-intensity activities. CONCLUSIONS: Although the results derive from a single Brazilian city, they are likely to be relevant to similar environments/locales in middle-income countries, where the obesity epidemic is rapidly increasing. Due to the low levels of walking detected, particularly during leisure time, healthcare professionals are encouraged to recommend walking to their patients.

Adult↗
PubMed2005

Cigarette smoking among low-income African Americans: a serious public health problem.

BACKGROUND: This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women. METHODS: Participants were selected using a two-stage, area probability sample design. Data were collected in 2002-2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design. RESULTS: Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals. CONCLUSIONS: The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention.

Adolescent↗
PubMed2004

The net transfer of transplant organs across race, sex, age, and income.

PURPOSE: To determine how sociodemographic characteristics influence both access to transplantation and organ donation. METHODS: For all transplants in the United States from 1996 to 2001, donor-recipient pairs were categorized as white-white, white-black, black-white, or black-black. The difference in the percentage of white-black versus black-white pairs was calculated as a measure of the net transfer of organs from one racial group to another. A similar approach was used to examine the net transfer of organs across other sociodemographic categories. RESULTS: Among cadaveric renal transplants, 66% of donor-recipient pairs were white-white, 23% were white-black, 5% were black-white, and 6% were black-black. Thus, there was an 18% net transfer of organs from white donors to black recipients (23% minus 5%). Among living donor transplants involving spouses, there was a 36% net transfer from wives to husbands. Among all cadaveric transplants, there was a 36% to 68% net transfer from younger donors to older recipients. Among cadaveric nonrenal transplants, there was a 7% to 18% net transfer from lower-income donors to higher-income recipients. CONCLUSION: The sociodemographic characteristics of persons who donate organs and those who benefit from organ transplantation differ markedly. Efforts to improve access and increase donation should address these differences.

Adult↗
PubMed2006

Comparison of three interventions to increase mammography screening in low income African American women.

BACKGROUND: Low-income African American women are more likely to die of breast cancer than their Caucasian counterparts, and at least part of the difference in mortality results from differential screening adherence. The purpose of this study was to identify more efficacious methods of promoting routine mammography screening in underserved populations. METHODS: A prospective randomized intervention study of 344 low income African American women compared the impact of three interventions on mammography adherence and stage of readiness: (1) pamphlet only; (2) culturally appropriate video; and (3) interactive computer-assisted instruction program. RESULTS: The interactive computer intervention program produced the greatest level of adherence to mammography (40.0%) compared to the video group (24.6%) and the pamphlet group (32.1%). When subjects in the pamphlet and video groups were combined to form a non-interactive group, this group had a significantly lower adherence than the group who received the interactive computer intervention (27.0% versus 40.0%). There was also significantly more forward movement in mammography stage of readiness among participants in the computer group (52.0%) compared to those in the pamphlet group (46.4%) or the video group (31.3%). When combining the non-interactive technology (pamphlet and video) there was also more forward movement in mammography stage of readiness for those in the interactive intervention group (52.0% moved 1 or 2 stages) compared to those in the non-interactive group (36.2%). CONCLUSIONS: These data indicate that tailored approaches are more effective than targeted messages either in print or video format. Another finding of this study is that interactive interventions are more effective than non-interactive interventions in increasing adherence and moving African American women forward in their mammogram stage of readiness.

Adult↗
PubMed2004

The youth/adolescent questionnaire has low validity and modest reliability among low-income African-American and Hispanic seventh- and eighth-grade youth.

The Youth/Adolescent Questionnaire is a food frequency questionnaire developed for youth aged 9 to 19 years that attempts to assess diet during the past 12 months. It was developed and previously validated with white youth; however, a validation study with fourth- to seventh-grade African-American youth revealed lower validation coefficients. This study validated the Youth/Adolescent Questionnaire with 89 low-income seventh- and eighth-grade Hispanic and African-American youth. The youth completed the Youth/Adolescent Questionnaire on two occasions 3 weeks apart, and completed up to six food records in between. Most of the reliability coefficients were adequate, except for percent of energy from fat and high-fat vegetables for Hispanic students. Validity coefficients were low, even after correcting for error. The ability of seventh- and eighth-grade low-income African-American and Hispanic youth to report usual intake over a period of time appears to be limited and may not provide a valid measure of consumption.

Adolescent↗
PubMed2005

Food choices of low-income women during pregnancy and postpartum.

OBJECTIVES: The purpose of this study was to examine dietary behavior during pregnancy and postpartum in a multiethnic sample of low-income women. SUBJECTS: Participants were 149 Medicaid-qualified women (30% white, 24% African American, and 46% Hispanic; median age, 22 years). DESIGN: Subjects were recruited into a longitudinal cohort design 0 to 1 days following delivery. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6 weeks and 6 months postpartum, respectively. STATISTICAL ANALYSES PERFORMED: Frequencies and means were used for descriptive purposes. Paired and independent sample t tests were used for continuous variables; chi 2 and McNemar tests were used for categorical variables. RESULTS: In all subjects, mean daily servings of grains (7.4 vs 6.2, P <.004), vegetables (2.5 vs 2.0, P <.002), and fruit (3.4 vs 1.7, P <.001) declined following childbirth, while the percentage of energy from fat (37.3% vs 38.4%, P <.023) and added sugar (14.4% vs 16.4%, P <.019) increased. Women who breastfed their infants at 6 months postpartum reported lower intakes of total fat (34.2% vs 37.9%, P <.005) during pregnancy and higher fruit (2.2 vs 1.6, P <.05) and vegetable (2.6 vs 1.8, P <.02) intakes in postpartum than those who bottle-fed. Also, a greater proportion of lactating than nonlactating women (66.7% vs 36.9%, P <.05) met recommendations for fruit intake during pregnancy. CONCLUSIONS: The findings suggest that the transition from pregnancy to postpartum may be associated with a negative impact on dietary behavior that could compromise nutritional status in low-income women.

Adult↗
PubMed2005

Dietary patterns of young, low-income US children.

OBJECTIVE: The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality. DESIGN: Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns. SUBJECTS/SETTING: Two subsamples of low-income children, aged 2 to 3 years (n = 1,242) and 4 to 8 years (n = 1,506), were selected from the Continuing Survey of Food Intakes by Individuals data. STATISTICAL ANALYSIS: Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster. RESULTS: Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI. CONCLUSIONS: Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.

Child↗
PubMed2005

A "contract for change" increases produce consumption in low-income women: a pilot study.

This study determined whether a "Contract for Change" goal-setting exercise enhanced the effectiveness of the Expanded Food and Nutrition Education/Food Stamp Nutrition Education programs to increase produce consumption in low-income (<130% of poverty) women after 4 weeks. Thirty-eight participants were randomized in this three-group parallel arm study: (a) control group participants received life-skills lessons, (b) the education group received the Expanded Food and Nutrition Education/Food Stamp Nutrition Education "Food Guide Pyramid" lessons, and (c) the contract group also received the "Food Guide Pyramid" series and completed a "Contract for Change." It was hypothesized that the contract group would have the greatest increases in advancement toward dietary change and produce consumption. Compared with controls, the contract group significantly moved toward acceptance of vegetable consumption (P < or = .05). Compared with the education group, the contract group significantly increased fruit consumption. Results suggest that nutrition professionals can effectively use goal-setting to assist low-income populations with dietary change.

Adult↗
PubMed2006

Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase.

Vouchers for fresh fruit and vegetable purchase were provided to low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles, CA. As the program is currently constituted, the supplemental foods provided contain no fresh produce except for carrots for exclusively breastfeeding women. This study investigated whether providing supplemental financial support specifically for purchase of fresh fruits and vegetables would result in high uptake of the supplement, and what the individuals would choose to purchase. A total of 602 women enrolling for postpartum services at three selected WIC program sites in Los Angeles were recruited. Sites were assigned to intervention with vouchers redeemable at a local supermarket, a nearby year-round farmers' market, and a control site with a minimal nonfood incentive. Vouchers were issued bimonthly, at the level of US $10/wk, and carried out for 6 months. Of 454 participants who completed the study (75.4%), 86% were Hispanic, 7% non-Hispanic black, and 7% of other ethnic backgrounds. Assessment of uptake was by voucher redemption rates and was approximately 90% for both groups. Participants reported purchasing a wide variety of items at both sites. The 10 most frequently mentioned items were oranges, apples, bananas, peaches, grapes, tomatoes, carrots, lettuce, broccoli, and potatoes. In conclusion, low-income women used the supplement provided almost fully, and purchased a wide variety of fresh fruits and vegetables for their families. No particular barriers arose to redemption of the vouchers by either the participants or the retail vendors.

Adolescent↗
PubMed2006

Associations of decisional balance, processes of change, and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African-American mothers.

OBJECTIVE: To determine the relationship between stage of change and decisional balance, processes of change, and self-efficacy variables of the Transtheoretical Model to increase fruit and vegetable consumption by low-income, African-American mothers, and to assess the usefulness of the model for intervention efforts. DESIGN: We used a cross-sectional questionnaire design with a food frequency questionnaire and a staging algorithm to classify women by stage of change before enrollment. We used scaled questionnaire items based on think-aloud data to measure self-efficacy, processes of change, and pros and cons to increasing fruit and vegetable intake and variety. SUBJECTS/SETTING: We recruited a convenience sample of low-income, African-American mothers (n=420) aged 18 to 45 years with children <12 years of age to complete questionnaires at community-based sites. STATISTICAL ANALYSES PERFORMED: Analysis of variance, principal component analysis, chi(2) tests, correlation, and regression analyses were conducted. RESULTS: Perceptions of benefits for health and planning meals were stronger for women in later stages compared with earlier stages. The same relationship was observed for the use of processes of change related to becoming aware of health benefits and engaging in enabling behaviors, and variety of fruits and vegetables consumed. Self-efficacy based on eating fruits and vegetables for various eating occasions and in difficult situations was greater for women in later stages compared to earlier stages. CONCLUSIONS: Interventions for women in earlier stages should include making women aware of health benefits, increasing self-efficacy, and improving ability to make plans and engage in behaviors to increase intake.

Adolescent↗
PubMed2006

Influence of nutrition attitudes and motivators for eating on postpartum weight status in low-income new mothers.

OBJECTIVE: The purpose of this study was to identify attitudes about nutrition and their influence on weight status in low-income mothers in the first year postpartum. DESIGN: Nutrition attitudes were assessed at 1.5, 6, and 12 months postpartum. Body weight was measured at each time point and height at 1.5 months to calculate body mass index. Nutrition attitudes at each time were compared with demographic variables and weight status. SUBJECTS: Subjects were 340 non-Hispanic white (31.3%), non-Hispanic black (25.1%), and Hispanic (43.7%) new mothers (mean age=22.4 years) located in central Texas. Criteria for participation included good health at delivery and low income (</=185% federal poverty guideline). STATISTICAL ANALYSES: chi(2) tests were used to compare demographic groups to categorical variables. Multivariate analysis of variance was done to investigate the effect of demographic variables on instrument subscale scores. A repeated-measures analysis of variance was used to identify significant changes over time. RESULTS: Obese women had higher barriers to healthful eating subscale means at 1 year compared with normal and overweight subjects at 1.5 and 6 months, and had more barriers than overweight participants at 12 months. Obese individuals also had higher emotional eating subscale scores than did overweight women at 1.5 months and both normal and overweight subjects at 12 months. CONCLUSIONS: Women who were obese at 1 year postpartum were more likely to perceive more barriers to healthful eating and respond more to emotional cues to eat. Health professionals could emphasize potential changes and difficulties often faced in postpartum and identify techniques to overcome these obstacles to healthful eating.

Adult↗