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PubMed1995

Preventing school failure, drug use, and delinquency among low-income children: long-term intervention in elementary schools.

A six-year, school-based prevention program, which modified classroom teacher practices, offered parent training, and provided child social skills training, was evaluated for its effects on school failure, drug abuse, and delinquency among low-income urban children. Compared to a low-income control group, children in the intervention group showed enhanced school commitment and class participation. The girls in the group also evidenced lower rates of substance use initiation, while the boys exhibited increased social and school work skills.

Adolescent↗
PubMed1996

Work and welfare: job histories, barriers to employment, and predictors of work among low-income single mothers.

The work histories of 436 sheltered homeless and low-income women were analyzed to develop a predictive model of factors that facilitate employment possibilities for some low-income women and deter others from obtaining work. Findings suggest the need for programs of education, early intervention, and job training. However, the availability of adequate jobs and affordable child care are prerequisites for poor, single mothers to become self-supporting.

Adolescent↗
PubMed2005

Treatment of morbid obesity in low-income adolescents: effects of parental self-monitoring.

OBJECTIVE: This study examined the extent to which consistency of self-monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low-income minority adolescents. RESEARCH METHODS AND PROCEDURES: Eighty-three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m2; mean BMI z-score, 6.0) and at least one parent participated in a long-term treatment program that included a very-low-fat dietary focus, weekly group cognitive-behavior therapy, monthly nutrition education classes, a 12-week physical therapy class, and medical monitoring. RESULTS: Participants who self-monitored on the majority of days compared with those who did not self-monitor at all or who self-monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self-monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self-monitored were much more likely to self-monitor consistently and lose weight during the first 3 months. DISCUSSION: These results indicate that self-monitoring is a cornerstone of successful weight control even for morbidly obese low-income minority adolescents; targeting consistency of self-monitoring among these high-risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.

Adolescent↗
PubMed2006

A primary care weight management intervention for low-income African-American women.

OBJECTIVE: To determine whether a tailored weight management program, addressing the needs of obese, low-income African-American women, would produce greater weight loss than standard medical care. RESEARCH METHODS AND PROCEDURES: A randomized, controlled trial was conducted between 1999 and 2003 with 144 overweight or obese women (predominantly African-American) enrolled at two primary care clinics. Four physicians at each clinic were randomly assigned to provide either tailored weight management interventions or standard care. The tailored condition consisted of six monthly outpatient visits lasting approximately 15 minutes each, which included personalized materials and messages. The main outcome was body weight change. RESULTS: The intervention group lost more weight than the standard care group (p = 0.03). The tailored group lost a mean (standard deviation) of 2.0 (3.2) kg by Month 6. The standard care group gained 0.2 (2.9) kg. More participants in the tailored group lost weight (79% vs. 47%; p = 0.04). DISCUSSION: Obese, low-income, African-American women provided with 90 minutes of physician-delivered, tailored weight management instruction over 6 months achieved greater weight loss than those receiving standard medical care. The primary care physician can be effective in delivering weight loss interventions, and the primary care clinic may be a useful setting to implement weight management interventions.

Adolescent↗
PubMed2003

Food insecurity is associated with dietary intake and body size of Korean children from low-income families in urban areas.

OBJECTIVE: This study examined household food insecurity of urban low-income families in Korea and the associations of the food insecurity with children's dietary intake and body size. DESIGN: Cross-sectional study. SETTING: Low-income neighborhoods in large cities. SUBJECTS: Included 370 children aged 4-12 y, who had all records on dietary intake and anthropometry as well as household food insecurity measures. RESULTS: Using the 10-item Radimer/Cornell Scale, 62.7% of the households showed some degree of food insecurity (8.6% for food insecure for family, 28.4% for food insecure for adults and 25.7% for child hunger households). Food insecurity was linearly and negatively associated with household economic conditions as well as the caretaker's use of nutrition knowledge. There were also significant associations of food insecurity with the children's dietary intakes, indicating the largest amount of nutrients for the children from the household food insecure, followed by those from the food secure, adult food insecure and child hunger groups. The household food insecure children were fatter than the food secure children. The fatter condition of the former children appeared to be related to more frequent intakes of low-quality foods. CONCLUSION: This study reports curvilinear associations between the status of household food insecurity and children's food intakes and fatness. SPONSORSHIP: This work was funded by a grant of the 2001 Korea Health Promotion Research Program, the Ministry of Health & Welfare, Republic of Korea.

Adult↗
PubMed2004

Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle.

The effectiveness of community health workers (CHWs) assisting families in reducing exposure to indoor asthma triggers has not been studied. In all, 274 low-income asthmatic children were randomly assigned to high- or low-intensity groups. CHWs visited all homes to assess exposures, develop action plans and provide bedding encasements. The higher-intensity group also received cleaning equipment and five to nine visits over a year focusing on asthma trigger reduction. The asthma trigger composite score decreased from 1.56 to 1.19 (Delta=-0.37, 95% CI 0.13, 0.61) in the higher-intensity group and from 1.63 to 1.43 in the low-intensity group (Delta=-0.20, 95% CI 0.004, 0.4). The difference in this measure due to the intervention was significant at the P=0.096 level. The higher-intensity group also showed improvement during the intervention year in measurements of condensation, roaches, moisture, cleaning behavior, dust weight, dust mite antigen, and total antigens above a cut point, effects not demonstrated in the low-intensity group. CHWs are effective in reducing asthma trigger exposure in low-income children. Further research is needed to determine the effectiveness of specific interventions and structural improvements on asthma trigger exposure and health.

Air Pollution, Indoor↗
PubMedDate not supplied

The association of life events to gestational age at delivery among low-income, urban, African American women.

OBJECTIVE: To investigate the relationship of life events stress to gestational age at delivery for a cohort of low income, African-American women. STUDY DESIGN: Four hundred seventy-two African-American women from three public prenatal clinics were interviewed about life events, emotional support, and health habits. Pregnancy and birth data were collected from a clinical data base. The contribution of life events stress and other study variables to length of pregnancy was determined using linear regression models for primiparous and multiparous women. RESULTS: Frequency of life events was not related to gestational age at delivery, directly or indirectly. An unexpected finding was that women who experienced a death of a mother or sister delivered on average 4.6 weeks earlier than other women in the study. Complications of pregnancy also explained lower gestational age for both primiparas and multiparas. CONCLUSION: Among low-income women, the acute stressor of losing a mother or sister during pregnancy was significantly related to shorter pregnancy, although total number of events was not.

Black or African American↗
PubMedDate not supplied

Health beliefs and parenting attitudes influence breastfeeding patterns among low-income African-American women.

OBJECTIVE: To describe breastfeeding initiation among 210 urban African-American mothers with inadequate prenatal care. METHODS: This study is a case-control study of postpartum mothers recruited from four large urban hospitals. RESULTS: Mothers who chose to breastfeed were more educated, employed before birth, married, and using contraception postnatally. Regression model analysis controlling for demographic differences revealed that breastfeeding was significantly associated with a higher perception of severity of illness and higher confidence in the ability of health care to prevent illness. Breastfeeding mothers were less likely to reverse parent-child roles and had a lower perception of hassle from their infant's behavior. When comparing mothers who breastfed longer than 8 weeks to those who did not breastfeed, breastfeeding mothers had high scores related to empathy toward infants on the Adult-Adolescent Parenting Inventory as well as a low perception of hassle on the Parenting Daily Hassle. The perception of existing formal or informal social support did not influence breastfeeding behavior. CONCLUSION: Personal attributes of low-income urban mothers such as health beliefs and parental attitudes may play a role in the initiation and duration of breastfeeding. Low-income African-American mothers may be influenced in their choice to breastfeed by supportive messages from physicians and nurses delivering care to mothers and their newborns. Emphasis should be placed on the role breastfeeding can play in preventing childhood illnesses.

Adolescent↗
PubMed2006

Language performance of low-income African American and European American preschool children on the PPVT-III.

PURPOSE: The performance of low-income African American preschoolers (36 to 52 months old) on the Peabody Picture Vocabulary Test--Third Edition (PPVT-III; L. M. Dunn & L. M. Dunn, 1997) was examined to provide a norm for assessing the performance of this population and to explore the link between socioeconomic status (SES) and language scores on the PPVT-III. METHOD: Four hundred and eighty-two African American and 52 European American children in a comparison group were individually administered the PPVT-III. RESULTS: On average, African American children performed approximately 1.5 SD below the expected mean based on national norms. Using standard cutoff scores, the PPVT-III identified more children as having language delays than did other measures of language abilities. Socioeconomic factors were related to PPVT-III scores, indicating that the degree of disadvantage within children with low SES was related to language abilities. Maternal education level, marital status, and the number of children in the household were uniquely associated with children's performance on the PPVT-III. CLINICAL IMPLICATIONS: The importance of supporting language development in preschool children from low-income families is discussed.

Black or African American↗
PubMed2004

Problem behaviors of low-income children with language delays: an observation study.

Children from low-income families are at increased risk for significant behavioral and language problems. Early identification of these problems is essential for effective intervention. The purpose of the present study was to use multiple behavioral assessments to examine the behavioral profiles of sixty 3- and 4-year-old children from low-income families enrolled in Head Start programs and to compare the behavior characteristics of 32 children with language delays with those of 28 children with typical language development. Teachers completed the Child Behavior Checklist/Caregiver-Teacher Report Form/2-5 (CTRF; T. M. Achenbach, 1997) and the Social Skills Rating System (SSRS; F. M. Gresham and S. N. Elliott, 1990), and children were observed in the classrooms during structured and unstructured activities. Children with language delays exhibited more problem behaviors and poorer social skills on some of the observational measures than did children with typical language development, as predicted, but not on all.

Analysis of Variance↗
PubMedDate not supplied

Does work pay psychologically as well as economically? The role of employment in predicting depressive symptoms and parenting among low-income families.

This longitudinal study examined quantity and quality of maternal employment as predictors of depressive symptoms and parenting style in a sample of 94 low-income mothers whose 4-year-old children were enrolled in Head Start at baseline. Results suggest that answers to the question of whether work "pays" are complex: Findings suggest some benefits of greater employment participation while also indicating that women holding lower prestige jobs experienced increases in their use of negative parenting style, net of baseline demographic and psychological characteristics. Sparse evidence for selection processes was found, with cohabitation and maternal depressive symptoms modestly predictive of subsequent maternal employment. Implications of these findings for welfare reform and educationally related policies for low-income families are discussed.

Adult↗
PubMed1998

Intention to breastfeed in low-income pregnant women: the role of social support and previous experience.

BACKGROUND: The purpose of this study was to describe the relationship between breastfeeding intention among socioeconomically disadvantaged pregnant women and maternal demographics, previous breastfeeding experience, and social support. METHODS: A cross-sectional, convenience sampling strategy was employed for data collection. Low-income women (n = 1001) in a public hospital completed a six-page questionnaire about their infant feeding plans, demographics, and social support. Simple regression analyses were conducted to compare maternal breastfeeding intention with the hypothesized correlates. RESULTS: Breastfeeding intention was positively correlated with older maternal age, higher education, more breastfeeding experience, Hispanic ethnicity, and hearing about breastfeeding benefits from family members, the baby's father, and lactation consultants, but not from other health professionals. Health professionals' attitudes were less influential on women's infant feeding decisions than the attitudes and beliefs of members of women's social support networks. When controlling for breastfeeding experience (none vs any), some findings, varied, indicating a need for breastfeeding interventions tailored to women's level of experience. CONCLUSION: Use of peer counselors and lactation consultants, inclusion of a woman's family members in breastfeeding educational contacts, and creation of breastfeeding classes tailored to influential members of women's social support networks may improve breastfeeding rates among low-income women, especially those with no breastfeeding experience, more effectively than breastfeeding education to pregnant women that is solely conducted by health professionals.

Adolescent↗
PubMedDate not supplied

Nothing is going to stop me now: obstacles perceived by low-income women as they become self-sufficient.

As low-income women struggle to become self-sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low-income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self-esteem, especially relating to school; "bad" relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.

Anecdotes as Topic↗
PubMed2002

Beyond the examination room: primary care performance and the patient-physician relationship for low-income women.

OBJECTIVE: To assess whether primary care performance of low-income women's primary care delivery sites is associated with the strength of their relationships with their physicians. DESIGN: Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING: Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold. PARTICIPANTS: Women over age 40 (N=1,205), 82% of whom were African American. MEASUREMENTS AND MAIN RESULTS: The response rate was 85%. Primary care performance was assessed using women's ratings of their systems' accessibility (organizational, geographic, and financial), continuity, comprehensiveness, and coordination. Respondents' ratings of trust in their physicians, communication with their physicians, and compassion shown by their physicians were used to operationalize the patient-physician relationship. Controlling for population and insurance characteristics, 4 primary care features were positively associated with women's trust in and communication with their physicians: continuity with a single clinician, organizational accessibility of the practice, comprehensive care, and coordination of specialty care services. Better organizational access, but not geographic or financial access, was associated with greater levels of trust, compassion, and communication (odds ratios [ORs], 3.2, 7.4, and 6.9, respectively; P < or =.01). Women who rated highest their doctor's ability to take care of all of their health care needs (highest level of comprehensiveness) had 11 times the odds of trusting their physician (P < or =.01) and 6 times the odds of finding their physicians compassionate and communicative (P < or =.01), compared to those with the lowest level of comprehensiveness. CONCLUSIONS: Primary care delivery sites organized to be more accessible, to link patients with the same clinician for their visits, to provide for all of a woman's health care needs, and to coordinate specialty care services are associated with stronger relationships between low-income women and their physicians. Primary care systems that fail to emphasize these features of primary care may jeopardize the clinician-patient relationship and indirectly the quality of care and health outcomes.

Adult↗
PubMed2002

Adherence of low-income women to cancer screening recommendations.

BACKGROUND: African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE: To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN: Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING: Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold. PARTICIPANTS: Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES: Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS: The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS: Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations.

Adult↗
PubMed2003

Comparing nutrient intake from food to the estimated average requirements shows middle- to upper-income pregnant women lack iron and possibly magnesium.

OBJECTIVE: To determine whether nutrient intake from food alone was adequate across trimesters for middle- to upper-income pregnant women when compared with estimated average requirements (EAR), and to determine whether food intake exceeded the tolerable upper intake level (UL) for any nutrient. DESIGN: Observational study in which pregnant women completed 3-day diet records each month during their pregnancy. Records were analyzed for nutrient content, and usual intake distributions were determined. SUBJECTS/SETTING: Subjects were low-risk women in their first trimester of pregnancy (living in middle- to upper-income households). Ninety-four women were recruited, and sixty-three participated. STATISTICAL ANALYSIS PERFORMED: Nutrient intake data were adjusted to achieve normality by using a power transformation. A mixed model method was used to assess trends in intake over time, and to estimate mean intake and within-subjects and between-subjects variance. The usual intake distribution for each nutrient was determined and compared with the EAR and UL. RESULTS: The probabilities of usual nutrient intake from food being less than the EAR were highest for iron (.91), magnesium (.53), zinc (.31), vitamin B6 (.21), selenium (.20), and vitamin C (.12). Women were not at risk of exceeding the UL from food intake for any nutrient studied. APPLICATIONS/CONCLUSIONS: Study participants did not consume adequate amounts of iron from food to meet the needs of pregnancy, and therefore iron supplementation is warranted in this population. Intake of magnesium was suboptimal using the EAR as a cut-point for adequacy.

Adult↗
PubMed2002

Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital.

OBJECTIVE: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. STUDY DESIGN: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. RESULTS: The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. CONCLUSION: Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.

Adult↗
PubMed2005

Correlates of perceived difficulty in potentially disclosing HIV-positive test results: a study of low-income women attending an urban clinic.

BACKGROUND: The study identified correlates of women's perception that testing positive for HIV would be very difficult to communicate to friends, family members and sex partners. We also determined whether perceived disclosure difficulty was associated with HIV-testing intent. METHODS: Face-to-face interviews were conducted with 143 women attending an urgent care centre in Atlanta, Georgia. The centre served primarily low-income or indigent African-American women. A three-item scale (alpha = 0.81) assessed disclosure difficulty. Assessed correlates included selected social/contextual factors and intrapersonal factors. RESULTS: In controlled multivariate analyses, only the social/contextual factors were associated with HIV disclosure difficulty. Women perceiving an inability to cope with positive results were more likely to report high disclosure difficulty (P = 0.01). Women perceiving an inadequate support system and those believing that HIV would substantially complicate their lives were more likely to anticipate high disclosure difficulty (P = 0.006 and P = 0.03, respectively). Disclosure difficulty was not associated with intent for HIV-testing 'today' (P = 0.50) or within the next 12 months (P = 0.27). CONCLUSION: Findings provide initial evidence suggesting that selected social/contextual factors rather than intrapersonal factors are associated with anticipated disclosure difficulty of HIV-positive test results among low-income minority women, residing in the urban south. High levels of anticipated disclosure difficulty may not preclude HIV test acceptance.

AIDS Serodiagnosis↗