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PubMed2004

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments.

PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

Adolescent↗
PubMedDate not supplied

Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.

This article describes the risks and protective factors for symptoms of depression in pregnancy among low-income African American and Caucasian women. Data were collected from 130 women who were between 16 and 28 weeks' gestation and enrolled in an urban prenatal clinic. The questionnaires used in the face-to-face interviews consisted of sociodemographic items, the Beck Depression Inventory (BDI-II), the Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-Being Scale, the Spiritual Perspective Scale, and 4 items on health risk behaviors. Twenty-seven percent of the women reported depressive symptoms at levels indicating risk for clinical depression. However, there were no significant differences between African American and Caucasian women. Sociodemographic factors accounted for 13% of the variance (P < .01) in BDI-II scores. Psychosocial and behavioral risk factors accounted for an additional 19% of the BDI-II variance (P < .001), and psychosocial and spiritual resources accounted for 7% of the variance (P < .001), resulting in these variables accounting for 54% of the total variance in BDI-II scores. Higher levels of stress, lower levels of self-esteem and social support, and higher religiosity had a significant relationship with more symptoms of depression. This supports the need to routinely screen for and to assess factors associated with depressive symptoms in pregnant low-income women.

Adolescent↗
PubMed2005

Impact of sexual networks on risk for gonorrhea and chlamydia among low-income urban African American adolescents.

OBJECTIVE: To determine whether African American adolescents, whose recent sex partners reported having another sex partner, are at increased risk for exposure to genital chlamydial infection or gonorrhea. STUDY DESIGN: A household sample of low-income urban African American adolescents 14 to 19 years of age, up to two of their close friends, and their sex partners were interviewed and tested for gonorrhea and chlamydial infection. RESULTS: Thirty-four of 145 adolescents had at least one recent sex partner infected with Neisseria gonorrhoeae and/or Chlamydia trachomatis. The adjusted model showed that adolescents, whose recent sex partners reported having another sex partner, were more likely to have a recent sex partner with gonorrhea and/or chlamydial infection. CONCLUSION: In addition to individual factors, network factors may explain why African American adolescents are at increased risk for exposure to sexually transmitted infections (STIs). Multi-level community-based interventions may need to address network factors along with personal behaviors in order to prevent STIs among low-income urban African American adolescents.

Adolescent↗
PubMed2005

The development of an instrument measuring unintentional injuries in young children in low-income settings to serve as an evaluation tool for a childhood home injury prevention program.

PROBLEM: Responding to the lack of standardized instrumentation, especially as applied in low-income contexts, the researchers decided that an instrument should be developed to serve as an evaluation tool for a childhood (unintentional) injury prevention program as well as a tool from which injury risks (poisonings, burns and falls) could be identified within households. METHODS: Cross-sectional samples of 521 households in four low-income sites in Cape Town and Johannesburg, South Africa, participated in the three phases of the study. The generation of an item pool based on a table of specifications, subsequent scientific item reduction procedures, reviews from experts and pilot tests were used to develop the scales for measuring the injury risks. RESULTS: The developed instrument complies with all the requirements for a valid and reliable measurement instrument. CONCLUSION: The instrument allows valid comparison of risks between communities, as well as before and after comparisons for an intervention program. IMPACT: The provision of this instrument may bring enormous benefits to research studies. It can also provide proactive, rather than reactive, information about injury risks before they develop into injuries and thus allows focusing of safety efforts for improvement of problematic areas in the households.

Accident Prevention↗
PubMedDate not supplied

Strategies for successful conduct of research with low-income African American populations.

Health disparities among racial and ethnic minorities are associated with poor health outcomes. African Americans bear a disproportionate amount of the burden of health disparities. The elimination of health disparities among the nation's racial and ethnic groups requires immediate action that the health care community cannot accomplish in isolation. Eliminating health disparities calls for new and non-traditional partnerships across diverse sectors of the community that include research initiatives using culturally competent and participatory action methodologies. While there is much evidence documenting health disparities in racial and ethnic groups, there is little evidence of successful interventions that address health disparities in African Americans. Furthermore, there is little direction for successful strategies for recruiting African Americans for participation in health disparities research. This article addresses important factors to consider when conducting research with low income African Americans based on the authors' research experience in health promotion and cancer detection and prevention. Strategies for successful conduct of research with low income African American populations are offered.

Black or African American↗
PubMed2004

Socioeconomic, cultural, and personal influences on health outcomes in low income Mexican-origin individuals in Texas.

Several studies have suggested that the health of Mexican-Americans is better than expected given their low socioeconomic status. The healthy migrant hypothesis and the acculturation hypothesis, stating that the foreign-born and the less acculturated enjoy better health, have been proposed as possible complementary explanations. However, it is not clear which are the socioeconomic, cultural, and personal characteristics that favor good health and that differentiate foreign-born from US-born and unacculturated from acculturated Mexicans. In this paper, we compare, by nativity and acculturation level, the socioeconomic, cultural, and personal characteristics in a sample of low income mostly female Mexican-origin individuals living in Texas and investigate their contribution to differences in self-reported physical health, mental health, and self-rated health (SRH) status. Using a multistage probability sample, we completed 1745 interviews with Mexican-origin individuals. The survey instrument included the SF-12, demographic and socioeconomic information, and questions on social support, religiosity, fear of victimization, trust, perceived racism, and perceived opportunity. Nativity and use of the Spanish language were combined into a nativity/acculturation variable. We estimated multivariate regressions and ordered logit regressions to investigate the association of health outcomes to nativity/acculturation and socioeconomic, cultural, and personal characteristics. Overall, the distribution of strengths (more social support, trust, perceived personal opportunities and less perceived victimization) reflected a nativity-based income gradient and an education gradient reflecting language use. Health outcomes varied by nativity/acculturation after controlling for socioeconomic, cultural, and personal characteristics. Physical health differed by nativity, supporting the healthy migrant hypothesis, while nativity-based differences in mental health were explained by socioeconomic and personal characteristics. SRH varied by language use, suggesting a culturally conditioned response. The socioeconomic, cultural, and personal factors affected health outcomes differently. These findings suggest a complicated interaction between nativity, acculturation, and economic factors in determining social and personal strengths and their influences on health.

Cultural Characteristics↗
PubMed2004

Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults' outcomes.

This study reports results from a quasi-experimental residential mobility study in Yonkers, NY, in which low-income minority families residing in public and private housing in high-poverty neighborhoods were randomly assigned via lottery to relocate to publicly funded attached rowhouses in seven middle-class neighborhoods. One hundred seventy-three Black and Latino families who moved and 142 demographically similar families who remained in the original high-poverty neighborhoods were interviewed approximately 2 years after movers relocated; no baseline data were available. Multiple regression analyses controlling for individual- and family-level background characteristics revealed that adults who moved to low-poverty neighborhoods were less likely to be exposed to violence and disorder, experience health problems, abuse alcohol, receive cash assistance, and were more likely to report satisfaction with neighborhood resources, experience higher housing quality, and be employed, when compared with adults who remained in high-poverty neighborhoods. Adults who moved to low-poverty neighborhoods were less likely than those who stayed in high-poverty neighborhoods to socialize informally with neighbors. No program effects were found on adults' symptoms of depression and anxiety. These early program effects inform housing policy initiatives for low-income families.

Adult↗
PubMed2005

Mothers, daughters and sexual agency in one low-income South African community.

Statistics indicate that sexual health problems like HIV/AIDS and teenage pregnancies are prevalent among young South African low-income women. To improve the effectiveness of preventative programmes for adolescents it is important to focus on adolescents' own understanding and experience of their sexual behaviour within the contexts in which it occurs. Female adolescents' experiences of their own sexuality are shaped by a range of contexts: from the very specific context of their intimate relationships to the broader contexts of gender, ethnicity and social class. It is therefore imperative to adopt a research approach that stratifies groups and develops interventions that are based on the needs, interests, sexual beliefs and behaviours of specific communities rather than developing general educational messages. The current paper is part of a larger study exploring female adolescent sexuality in a South African low-income rural coloured community. Twenty-five adolescent coloured women aged 14-18 years were interviewed about how they viewed their sexuality. The grounded theory analysis indicated that the participants demonstrated a limited sense of sexual agency in these constructions of their sexuality. The mothers of these young women were powerful agents in the young womens' constructions of their own sexuality and they unintentionally contributed to their daughters' limited sense of sexual agency. Mothers presented sex as a dangerous activity to their daughters. This discourse of sex as danger contributed towards a mutual understanding that sex should not be talked about. Daughters' deception of their mothers about their sexual activity maintained mother-daughter connections, but left them without an interactional space where they could talk freely to their mothers about sexuality.

Adolescent↗
PubMed2005

What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?

This paper presents the findings of a critical review of studies carried out in low- and middle-income countries (LMICs) focusing on the economic consequences for households of illness and health care use. These include household level impacts of direct costs (medical treatment and related financial costs), indirect costs (productive time losses resulting from illness) and subsequent household responses. It highlights that health care financing strategies that place considerable emphasis on out-of-pocket payments can impoverish households. There is growing evidence of households being pushed into poverty or forced into deeper poverty when faced with substantial medical expenses, particularly when combined with a loss of household income due to ill-health. Health sector reforms in LMICs since the late 1980s have particularly focused on promoting user fees for public sector health services and increasing the role of the private for-profit sector in health care provision. This has increasingly placed the burden of paying for health care on individuals experiencing poor health. This trend seems to continue even though some countries and international organisations are considering a shift away from their previous pro-user fee agenda. Research into alternative health care financing strategies and related mechanisms for coping with the direct and indirect costs of illness is urgently required to inform the development of appropriate social policies to improve access to essential health services and break the vicious cycle between illness and poverty.

Cost of Illness↗
PubMed2006

The association of subjective social status and health in low-income Mexican-origin individuals in Texas.

There is only limited research on subjective social status (SSS) and its effect on health in general and in minority US populations in particular. This study first investigates the determinants of SSS and the relationship between SSS and objective social status. It then explores the relationships of SSS to self-reported physical health, self-reported mental health, and self-rated health (SRH). The study population consists of Mexican-origin individuals living in low-income neighborhoods in Texas and grouped into acculturation categories based on nativity and use of the Spanish language. We also investigate the role of reference groups. Results indicate that there is no disjuncture between subjective and objective status in this population but that the less acculturated groups rank their social status based on different criteria than the more acculturated. People compare themselves mainly with those similar to them and average subjective status in the different acculturation groups accurately reflects the objective status of the group. Sociocultural factors, in particular perceived differences in opportunities, explain differences between subjective and objective status. Subjective status was associated with all health outcomes. When controlling for objective status, subjective status was associated with mental health and SRH but not with physical health. Objective status indicators were consistently associated with all health outcomes, indicating the prominence of objective socioeconomic status in affecting health in this low-income minority population. Sociocultural characteristics appear to mediate the effect of SSS on health. In particular, perceived victimization might mediate the effect of SSS on mental health.

Acculturation↗
PubMed2006

The association of smoking with perception of income inequality, relative material well-being, and social capital.

The aim of this study is to examine the association of smoking status with income inequality, relative deprivation, perception of relative material well-being and community-level social capital, controlling for individual-level indicators of social capital, and common socio-economic variables. Data were from telephone interviews of approximately 126 residents selected at random (using the Electronic White Pages) from each of 22 local government areas (LGAs) in the Melbourne metropolitan region, Victoria, Australia (total n = 2762). We used logistic regression to assess the association of covariates with smoking status. Being a smoker was associated with a higher level of perceived income inequality, lower perception of relative material well-being and living in a community with a lower degree of trust and safety. While the cross-sectional design of the study does not allow causal inferences, the results imply that smoking is less prevalent in communities that are more egalitarian and have a higher stock of social capital.

Adolescent↗
PubMed2005

Changes in quality of life among low-income men treated for prostate cancer.

OBJECTIVES: To investigate as the primary objective changes over time in general and disease-specific health-related quality of life (HRQOL) among low-income men treated for prostate cancer in a longitudinal prospective study. METHODS: Study participants were recruited from a state-funded program providing free prostate cancer treatment to impoverished men. We included men who completed telephone interviews and self-administered questionnaires at study enrollment and 6 months of follow-up. Covariates univariately associated with HRQOL change scores were included in multivariate linear regression models. All HRQOL models were controlled for age at enrollment, race, baseline HRQOL, and treatment effects at baseline and follow-up. RESULTS: Subjects with greater baseline Gleason scores experienced more negative changes in their physical health than did men with lower Gleason scores. Men with less than a high school education experienced greater improvement in their mental well-being than did men with more than a high school education. Those experiencing treatment effects at baseline displayed greater positive changes in their urinary function than did those without treatment effects at baseline. Finally, men experiencing treatment effects at follow-up were characterized by profound reductions in sexual function compared with those free of treatment effects at follow-up. CONCLUSIONS: This work provides new insights into HRQOL over time in a low-income, multiethnic group of patients with prostate cancer.

Humans↗
PubMedDate not supplied

Prostate cancer screening between low-income African-American and Caucasian men.

OBJECTIVE: African-Americans (AA) are more likely than Caucasians (CA) to be diagnosed with advanced prostate cancer, perhaps due to delayed detection. We investigated racial differences in prostate cancer screening according to age and socioeconomic and demographic indices in a large and predominantly low-income population. METHODS: In-person interviews were conducted with 12,552 men, 84% AA, recruited during 2002 through 2004 from 25 community health centers in the southern United States. Prostate specific antigen test (PSA) and digital rectal examination (DRE) histories, and socioeconomic and demographic indices (i.e., education, household income, health insurance, and marital status) were determined. Odds ratios (OR) from logistic regression summarized the screening and race association as a function of age, while controlling for socioeconomic status (SES). RESULTS: Racial differences in screening prevalence varied with age. Of men older than 65 years, CA were significantly more likely to report a PSA test (OR = 1.4) or DRE (OR = 1.5) within the past 12 months. However, these disparities were reduced with control for SES (PSA: OR =1.2; DRE: OR = 1.3, P > 0.05). In contrast, at ages younger than 65, CA were equally or less likely to have received a recent PSA test or DRE, particularly at ages 45-49 years (PSA: OR = 0.7; DRE: OR = 0.9), with little change after SES adjustment. CONCLUSIONS: Consistent with several screening recommendations, younger AA men, especially those younger than age 50, are more likely than CA to have had a recent PSA test or DRE, independent of SES. Of men older than age 65, less frequent use of screening among AA than CA seems partly attributable to SES and factors other than race.

Adult↗
PubMedDate not supplied

Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control.

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.

Adult↗
PubMed2004

Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children.

BACKGROUND: We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight. METHODS: This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods. RESULTS: Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level. CONCLUSIONS: Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.

Child, Preschool↗
PubMed2004

Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: a comparison of sheltered and low-income housed women in Los Angeles County.

BACKGROUND: Violence against women, substance use and disorder, and HIV represent three significant threats to the health of women, yet little is known about the extent of these epidemics among indigent women. This study investigates and documents differences in the prevalence and co-occurrence of physical and sexual violence, substance use and disorder, and HIV risk behavior in sizable probability samples of sheltered homeless and low-income housed women. METHODS: Retrospective self-reports were obtained through structured interviews with stratified random samples of women residing in shelters (N = 460) and low-income housing (N = 438) in Los Angeles County, California. RESULTS: Sheltered women were more likely than housed women to report experiencing physical and sexual violence, substance use and disorder, HIV risk behavior, and co-occurrence of these problems in the past year. Differences remained when propensity weights were used to equate the groups on demographic and background characteristics. CONCLUSIONS: Findings suggest remarkable need for services among communities of indigent women. Higher rates of problems among women in shelters highlight the importance of differentiating among subgroups of indigent women in community-based prevention and intervention activities and tentatively suggest a protective influence of housing.

Adolescent↗
PubMed2000

Validity and reliability of a modified qualitative dietary fat index in low-income, overweight, African American adolescent girls.

This study evaluated the validity and reliability of a modified qualitative dietary fat index questionnaire (QFQ) in an adolescent minority population. The QFQ was administered to study participants twice over a 2-week period, and data were compared with mean values from three 24-hour recalls. Fifty-seven low-income, overweight, African American adolescent girls, aged 11 to 17 years, were recruited from 7 public housing developments in Atlanta, Georgia. To determine validity, the total QFQ score was compared with the mean values of total fat, percentage of energy from fat, and total energy from three 24-hour recalls within 2 weeks of first administration of the QFQ. Reliability was tested in a subsample (n = 22) by comparing total QFQ scores administered 2 weeks apart. Total fat was significantly correlated (r = 0.31, P < .05) with the QFQ score. Total energy (r = 20.23) and percentage of energy from fat (r = -0.23) were not significantly correlated with the QFQ score. The test-retest QFQ scores were significantly correlated (r = 0.54, P < .01). The data suggest that additional modifications are needed to make the QFQ more appropriate for low-income, over-weight, African American adolescent girls.

Adolescent↗
PubMed2001

5 a day fruit and vegetable intervention improves consumption in a low income population.

OBJECTIVE: This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. SUBJECTS/SETTING: Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. INTERVENTION: Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. DESIGN: Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. MAIN OUTCOME MEASURES: A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. STATISTICAL ANALYSES: Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. RESULTS: Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. APPLICATIONS: This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability.

Analysis of Variance↗