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PubMedDate not supplied

Using computer-based assessments to evaluate interactive multimedia nutrition education among low-income predominantly Hispanic participants.

OBJECTIVE: This research was conducted to measure the effectiveness of interactive multimedia (IMM) with low-income Hispanic persons. DESIGN: The effectiveness of the program was examined using a quasi-experimental pretest/post-test control group design. SETTING: Subjects were recruited from nutrition, health, and English as a Second Language (ESL) programs in Colorado. PARTICIPANTS: Thirty-six intervention and 34 control participants formed a convenience sample of low-income and predominantly Hispanic persons. INTERVENTION: Intervention participants received a 15-minute module about breakfast. Control participants received a non- nutrition-related IMM module. MAIN OUTCOME MEASURES: Primary variables included knowledge, attitude, and stage of change scores. ANALYSIS: Paired and independent sample t tests, chi-square analysis, and repeated-measures analysis of covariance (ANCOVA) were used. RESULTS: Intervention participants significantly increased knowledge, attitude, and total scores (P <.001) between pretest and post-test and had significantly greater increases than the control group (P <.001). CONCLUSIONS: The results support using IMM to disseminate nutrition education to the target population and the feasibility of using computer-based questionnaires to evaluate the effectiveness of IMM nutrition education programs. IMPLICATIONS: This research provides the basis for the continued development of computer-based assessment tools.

Adult↗
PubMedDate not supplied

Using interpretative phenomenology to understand the food-related experiences and beliefs of a select group of low-income UK women.

OBJECTIVE: The purpose of this study was to provide an in-depth account of the beliefs and experiences pertaining to food and health from a specific group of low-income women in the United Kingdom. DESIGN: Data for this in-depth, qualitative study were collected using audiotaped semistructured interviews. PARTICIPANTS: Fourteen white, European women (aged 40 to 60 years) from a defined low-income group were recruited using systematic, nonprobabilistic sampling. Participants lived in a small city in a largely rural region of the United Kingdom. ANALYSIS: Interview transcripts were analyzed using an interpretative phenomenological approach. They were evaluated independently by several investigators, and, following discussions, a series of "shared themes" were agreed upon. RESULTS: All of the shared themes identified could be grouped into three superthemes or "drivers," which seemed to govern the women's attitudes and behaviors toward food choice and health. "Egocentric systems" related to the uniqueness of the participants and the social worlds they inhabit. "Information characteristics" described what information the participants were exposed to and how it was processed. Finally, "control issues" described how perceptions of control influenced attitudes toward food and health. CONCLUSIONS AND IMPLICATIONS: The study highlights the need for health professionals to consider the different value systems of target groups in health promotion policies. The impact of "New Age" beliefs and the Human Genome Project on public health nutrition are two areas that particularly merit further research.

Adult↗
PubMedDate not supplied

Sisters in health: experiential program emphasizing social interaction increases fruit and vegetable intake among low-income adults.

Sisters in Health, a nutrition education program aimed at increasing fruit and vegetable consumption among low-income women, includes active food experiences, positive social settings, a flexible meeting series, and small-group facilitation by paraprofessionals. The program's impact was evaluated in a nonrandom sample of 269 low-income adults in 32 intervention and 10 control groups in New York State using a quasi-experimental, pre-/postprogram evaluation design. Intervention groups reported increased fruit and vegetable consumption, measured by a brief screener, of 1.6 times a day (versus 0.8 times in the control groups) and were 0.44 times more likely to be eating fruits and vegetables 5 or more times a day (P < .05) than control groups. Group support, taste, and food skill experiences can be effective for increasing fruit and vegetable consumption.

Adult↗
PubMedDate not supplied

Against the odds: breastfeeding experiences of low income mothers.

This qualitative study asked low income mothers about their experiences of breastfeeding care in the health system and about integrating breastfeeding into their daily lives. Focus group interviews were conducted with urban and rural nursing mothers who participated in the WIC Program and were supported by breastfeeding peer counselors. Mothers said that helpful breastfeeding care providers knew correct information, established supportive personal relationships, referred women to breastfeeding specialists for problems, showed enthusiasm for nursing, and facilitated breastfeeding through concrete actions during the prenatal, intrapartum, and postpartum periods. Unhelpful providers missed opportunities to discuss breastfeeding, gave misinformation, encouraged formula supplementation, provided perfunctory or routine breastfeeding care, and were hard to contact when problems arose. Women valued their breastfeeding peer counselors for responding promptly to distress calls, making home visits, being knowledgeable about breastfeeding, providing hands-on assistance, and acting personal and caring. Incorporating breastfeeding into daily activities was a challenge for many mothers. Ambivalence about the physical bond of nursing, personal modesty, and getting on with life at home, work, or school were identified as important issues. Listening to the thoughts and experiences of low income nursing mothers can help health workers to provide more culturally sensitive, effective breastfeeding care to this population.

Adolescent↗
PubMed1999

Quality of life in low-income patients with metastatic prostate cancer: divergent and convergent validity of three instruments.

Few studies have evaluated Quality Of Life (QOL) among low-income patients with cancer. Information is needed about the feasibility and psychometric characteristics of QOL instruments in these populations. The purpose of this study was to examine the convergent and discriminant relationships between scales of three QOL instruments: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC), Functional Assessment of Cancer Therapy--General (FACT), and Quality of Life Index (QLI). Participants included 110 men with metastatic prostate cancer of whom 94% were low income and 62% were African-American. Interviewers administered the questionnaires. Cronbach alpha internal consistency reliabilities were 0.57 to 0.90 for the EORTC, 0.65 to 0.86 for the FACT, and 0.63 for the QLI. Convergent validity was supported for the EORTC and FACT scales measuring emotional, physical, and role/functional dimensions (r = 0.54 to 0.72), but not on scales measuring social function (r = 0.12). Divergent validity was supported between dissimilar scales (r = 0.14 to 0.38). Analysis with receiver operating characteristics curves provided empirical support for the EORTC and FACT as multidimensional measures. These findings suggest that, even in busy clinical settings with low literacy patients, interviewer-administered EORTC and FACT QOL instruments can provide valid and reliable information.

Aged↗
PubMed2001

Determinants of social support among low-income mothers: a longitudinal analysis.

This study examined the reciprocal relationships between perceived mastery, stress, and three functional areas of social support: tangible support, informational support, and belongingness support. Data were collected during two face-to-face interviews with a sample of low-income, primarily African-American mothers, conducted approximately 1 year apart. Consistent with predictions, initial levels of mastery predicted higher subsequent levels of instrumental social supports (tangible and advice support), but were unrelated to belonging support. Conversely, initial levels of tangible support were predictive of later mastery. Perceived stress did not account for any additional variance in subsequent support, although initial levels of belonging support only did predict reduced stress at Time 2. Results suggest that successful attempts to garner instrumental supports is an important contributor to individuals' sense of self-efficacy, at the same time, self-efficacy leads to more successful use of existing social support systems. These findings point to the importance of having both available tangible support networks as well as close emotional supports for low-income parents. The importance of using longitudinal, multidimensional analyses to better understand the social support process is discussed.

Black or African American↗
PubMed1998

Multiple perspectives on nutrition education needs of low-income Hispanics.

As part of a multi-level nutrition intervention for low-income Hispanics (LIH) and the professionals and paraprofessionals who serve them, focus groups were used to 1) identify nutrition education needs and preferred means of receiving nutrition information, 2) identify the LIH's barriers/motivators to dietary behavior change, and 3) assess the feasibility of using abuelas (Hispanic grandmothers) as educators. Nine focus groups were conducted using trained, local bilingual and bicultural moderators. Low-income Hispanics' primary concerns were their children's nutritional habits and ways to prepare quick, nutritious meals and snacks. Their major barriers to dietary change were financial limitations, lack of time, and family customs/habits. Professionals were concerned with the lack of interagency cooperation. Paraprofessionals were most interested in training on how to teach. All audiences preferred to receive nutrition education through classes with hands-on, interactive formats. Professionals and paraprofessionals noted advantages and disadvantages to using abuelas as educators. Including three populations in the needs assessment allowed comparisons of perspectives across groups and allowed the design of nutrition education programs appropriately targeted to these populations.

Child↗
PubMed1998

Supplemental Security Income (SSI), Disability Insurance (DI), and substance abusers.

Federal legislation repealed Supplemental Security Income (SSI) and Disability Insurance (DI) for alcohol and drug abusers as of January 1997. This article outlines the context in which the legislation was passed and summarizes concerns resulting from the legislation. We discuss the effects of the legislation on treatment participation, financing, and availability, and the legislation's impact on individuals with dual mental health and substance abuse problems. We also consider the individual and societal implications of substance abusers' loss of monthly income and health insurance.

Adult↗
PubMed2002

Investigating correlates of health related quality of life in a low-income sample of patients with diabetes.

OBJECTIVE: We sought to describe and find correlates of health-related quality of life among under-served low-income patients in North Carolina with diabetes mellitus. METHODS: A telephone survey of 310 patients recording quality of life, patient satisfaction, self-reported health, and patient complaints was conducted as part of a diabetes care improvement project. Demographic and clinical records were available for 249 of these patients: 69% were female, 45% were minority, and 84% had type 2 diabetes. Ages ranged from 18 to 88 years with a mean of 56. Quality of life indices consisted of SF-36 physical functioning, mental health and diabetes-39 sub-scores. RESULTS: Comparison to SF-36 norms showed the sample had lower sub-scores than expected. The multivariate analysis suggested that being within an acceptable metabolic control predicted better quality of life physically, mentally, and sexually. Strong associations were detected between most sub-scores and complaints involving legs and feet, self-rated vision, and hassles in self-management. CONCLUSIONS: The consistent associations between the sub-scores and complaints, symptoms, and hassles underscore the strong relationship quality of life may share with the severity of diabetes complications as well as with psychosocial factors. Significantly lower quality of life in this sample highlights the need to improve the care of minority low-income diabetes patients.

Adolescent↗
PubMed2002

Adapted cognitive behavioral group therapy for depressed low-income African American women.

In this study we examine the degree to which a manualized cognitive-behavioral therapy intervention can be adapted to be culturally sensitive in treating depressed low-income African American women with multiple stressors. We describe the adaptations we made to an existing intervention, a group treatment developed for depressed low-income medical patients. We also describe our evaluation of the adapted treatment in which outcomes of African American women treated in the culturally adapted group were compared to African American women treated in the non-adapted group. Following treatment, women in the adapted group exhibited a larger drop in average BDI scores. Implications are discussed in terms of challenges related to the development and evaluation of culturally adapted treatment.

Adult↗
PubMed2002

Community animal health services for improving household wealth and health status of low-income farmers.

Community animal health services (CAHS) have been promoted since the 1970s by aid organizations in low-income countries to improve the health of animals. They are also thought to improve directly the wealth and health or livelihood of their owners. We have systematically searched for observational studies of basic preventive and curative animal health services provided by a community animal health worker in communities in low-income countries. The objective was to summarize the available research on the effects of CAHS on indicators for household wealth and health. Studies for inclusion were assessed independently according to predefined eligibility criteria, the methodological quality of the studies examined, and data extracted. Fourteen studies of varying methodological quality met the inclusion criteria. The results were unclear in four studies, and in the remaining studies it was difficult to summarize the results because they reported different outcomes. However, the studies report that CAHS has a considerable potential for improving human health and wealth as well as animal health and productivity. Given the amount of money and time invested in this area, these observations need to be confirmed in the context of a well-designed study using standard pragmatic outcomes.

Animal Husbandry↗
PubMed1999

Using Medicaid data to estimate state- and county-level prevalence of asthma among low-income children.

OBJECTIVES: Asthma is one of the most common illnesses among children, yet there is little reliable information on the number of children at the state and county level who are living with asthma. This study examines the prevalence of asthma among low-income children in North Carolina using Medicaid paid claims and enrollment data. METHODS: Claims paid by Medicaid during state fiscal year 1997-1998 with a diagnosis of asthma or for a prescription drug used to treat asthma are examined to estimate prevalence among children ages 0-14 years. Percentages of enrolled children with asthma are presented by age, race, and rural/urban residence, and the costs of asthma treatment are calculated. RESULTS: More than 12% of North Carolina children ages 0-14 years on Medicaid had an indication of asthma. Prevalence rates were found to be highest among younger children, some minority groups, and residents of rural areas. More than $23 million was paid by Medicaid during the fiscal year for asthma-related services for children ages 0-14 years. CONCLUSIONS: State Medicaid databases are a useful means of studying the prevalence of asthma and other health conditions in low-income populations. Strengths and weaknesses of the proposed methodology are discussed. Existing administrative data systems can provide quick updates of prevalence rates at the state and county level, enhancing the ability to study trends in illness over time.

Adolescent↗
PubMed1997

The "Yes, I Quit" smoking cessation course: does it help women in a low income community quit?

The objectives were to evaluate the impact of "Yes, I Quit" (a smoking cessation course tailored for women in a low income, low education community), and to identify baseline predictors of short and longer-term self-reported cessation. The impact was evaluated in a before-after study design with no comparison group. Baseline data were collected in self-administered questionnaires at the beginning of the first session of the course. Follow-up data were collected in telephone interviews at one, three and six months after the designated Quit Day. Self-reported quit rates among 122 participants were 31.1%, 24.7% and 22.3% at one, three and six months. Non-quitters reduced their consumption by 10.3, 8.3, and 7.1 cigarettes per day at one, three and six months. Multivariate logistic regression analyses showed that being in excellent/good health was significantly associated with cessation at one month (odds ratio (OR) = 2.4). Being married (OR = 13.0) and no other smokers in the household (OR = 3.6) were associated with three-month cessation. Only being married was associated with six-month cessation (OR = 6.8). "Yes, I Quit" produced quit rates among low income, low education participants comparable to those reported for cessation programs directed at the general population of smokers. Good health is associated with early cessation, while support from a spouse is important to maintaining a non-smoking status among quitters.

Adolescent↗
PubMed2000

Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women.

OBJECTIVES: We explored perceptions of the safety and side effects of oral and injectable hormonal contraceptives among low-income women at high risk of unintended pregnancy. METHODS: Overall safety perceptions, specific health concerns, and the relationship between these safety perceptions and contraceptive choices were determined by focus groups and questionnaires obtained from white non-Latina (n = 19), English-speaking (n = 21), and Spanish-speaking Latina women (n = 19). RESULTS: Uncertainty or ambivalence about the safety of oral and injectable contraceptives was reported by 41% and 70% of respondents respectively, while 20% considered these methods to be mostly harmful. Personal experiences and stories from social networks proved to be more salient than medical opinions in shaping safety perceptions. Side effects and concerns about long-term health effects were common themes. While white non-Latina women focused predominantly on physical side effects, emotional side effects also contributed to Latinas' decisions about contraceptive switching. Spanish-speaking Latinas differed from English-speaking Latinas in other attitudinal dimensions, contraceptive use prevalence, and access to contraceptive services. CONCLUSION: Low-income mothers lacked confidence in method safety and had many concerns about the side effects of oral and injectable contraceptives. Because such concerns can be a barrier to contraceptive use, these perceptions need to be corrected to encourage more effective use of hormonal methods and to prevent unintended pregnancies. Culturally appropriate interventions should focus on client-provider interactions, social networks, and access to care.

Adult↗
PubMed2004

Construct validity of the EQ-5D in low-income Chinese American primary care patients.

OBJECTIVES: Although the EQ-5D has been used with increasing frequency to measure health-related quality of life, to date, the measure's validity has not been examined in Chinese American immigrants. We evaluated the construct validity of the EQ-5D by testing its performance with respect to sociodemographic and clinical characteristics of the population and comparing responses on the EQ dimensions with the SF-36 subscales. METHODS: The study surveyed low-income Chinese patients attending a community health center in New York City's Chinatown. Participants received self-administered versions of the EQ-5D and SF-36 and additional questions regarding demographic and clinical information. RESULTS: 856 patients were approached and data were collected from 523 patients (61%). Analysis of the EQ-5D responses by sociodemographic and clinical variables found significant differences among categories of age, gender, marital status, number of medical problems, self-rated health, and specific medical problems. Correlations between similar dimensions and subscale scores were stronger between the two measures than dissimilar ones. Patients without impairments on a given EQ dimension tended to have higher SF-36 subscale scores than patients reporting 'any' impairment (i.e. some/moderate or severe). CONCLUSIONS: The results provide initial support for the construct validity of the EQ-5D in our sample. Further studies should compare the performance of the EQ-5D with other preference-based measures in Chinese persons and examine the valuations that both low-income and Chinese persons place on core aspects of health.

Activities of Daily Living↗
PubMed2006

Does home internet use influence the academic performance of low-income children?

HomeNetToo is a longitudinal field study designed to examine the antecedents and consequences of home Internet use in low-income families (http://www.HomeNetToo.org). The study was done between December 2000 and June 2002. Among the consequences considered was children's academic performance. Participants were 140 children, mostly African American (83%), mostly boys (58%), and most living in single-parent households (75%) in which the median annual income was 15,000 (U.S. dollars) or less. Average age was 13.8 years. Ages ranged between 10 and 18 years, Internet use was continuously recorded, and multiple measures of academic performance were obtained during the 16-month trial. Findings indicated that children who used the Internet more had higher scores on standardized tests of reading achievement and higher grade point averages 6 months, 1 year, and 16 months later than did children who used it less. Older children used the Internet more than did younger children, but age had no effect on the nature or the academic performance benefits of Internet use. Implications for the digital "use" divide are discussed.

Black People↗
PubMed2006

Gender differences in early risk factors for adolescent depression among low-income urban children.

One component of a model by Nolen-Hoeksema and Girgus, who propose that risk factors for adolescent depression are more common in girls than in boys during childhood, was tested with 85 low-income, urban, African American and Latino kindergarten through fourth grade children who completed inventories of depression, stress, attributional style, gender role, and body image. Endorsing two of three predicted risk factors, girls reported slightly poorer body image and identified more strongly with a feminine gender role. Boys, however, reported a more negative attributional style. Feminine gender role was not associated with body image or negative attributional style. The applicability of the proposed model to a low-income, ethnic minority, urban population is discussed.

Adolescent↗
PubMed1992

Shared parenting in dual-income families.

Dual-income couples who share child care were compared with traditional couples in which the wife takes primary responsibility for the children. Couples who reported that they shared child care were found more likely to have a male first-born, compatible work arrangements, and similar levels of income than were traditional couples. They were also more likely to feel that their relationship was egalitarian and that the division of labor in the household was satisfactory.

Adult↗