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PubMed2003

Globalization and the distribution of income: the economic arguments.

One of the issues currently being debated in the ongoing discussion of the pros and cons of today's globalization concerns the effects of greater world trade as well as of the changes in technology on a country's internal distribution of income, especially on skilled versus unskilled wage rates. In this article, I attempt to spell out some of the arguments concerning internal income distribution that have been put forth both by labor economists and international trade theorists. The impact of globalization on the wage premium between the skilled and unskilled may not be as obvious as is first imagined.

Journal Article↗
PubMedDate not supplied

Traffic-related injury prevention interventions for low-income countries.

Traffic-related injuries have become a major public health concern worldwide. However, unlike developed or high-income countries (HICs), many developing or low-income countries (LICs) have made very little progress towards addressing this problem. Lack of the progress in LICs is attributable, in part, to their economic situation in terms of their governments' lack of resources to invest in traffic safety, cultural beliefs regarding the fatalism of injuries, competing health problems particularly with the emergence of HIV/AIDS, distinctive traffic mixes comprising a substantial number of vulnerable road users for whom less research has been done, low literacy rates precluding motorists to read and understand road signs, and peculiar political situations occasionally predominated by dictatorship and non-democratic governments. How then can LICs tackle the challenge of traffic safety from the experiences of HICs without reinventing the wheel? This paper reviews selected interventions and strategies that have been developed to counter traffic-related injuries in HICs in terms of their effectiveness and their applicability to LICs. Proven and promising interventions or strategies such as seat belt and helmet use, legislation and enforcement of seat belt use, sidewalks, roadway barriers, selected traffic-calming designs (e.g., speed ramps/bumps), pedestrian crossing signs combined with clearly marked crosswalks, and public education and behavior modification targeted at motorists are all feasible and useable in LICs as evidenced by data from many LICs. While numerous traffic-related injury policy interventions and strategies developed largely in HICs are potentially transferable to LICs, it is important to consider country-specific factors such as costs, feasibility, sustainability, and barriers, all of which must be factored into the assessment of effectiveness in specific LIC settings. Almost all interventions and strategies that have been proven effective in HICs will need to be evaluated in LICs and particular attention paid to the effectiveness of enforcement measures. It behooves LIC governments, however, to ensure that only standard, approved safety devices like helmets are imported into their countries. Additionally, LICs may need to improvise and innovate in the traffic safety technology transfer.

Accidents, Traffic↗
PubMed1998

The nutrition transition and its health implications in lower-income countries.

OBJECTIVE: This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition. DESIGN AND SETTING: Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992-96 and the nationwide China Health and Nutrition Survey from 1989-93 are examined in detail. RESULTS: Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted. CONCLUSIONS: The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

Adult↗
PubMed2002

Longitudinal study of energy and nutrient intakes for infants from low-income, urban families.

OBJECTIVE: To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations. DESIGN: We interviewed mother-infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs). SUBJECTS/SETTING: Infants were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits. STATISTICAL ANALYSES PERFORMED: Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes. RESULTS: Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages. CONCLUSIONS: This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.

Adult↗
PubMed2000

Estimating the economic effects of cystic echinococcosis: Uruguay, a developing country with upper-middle income.

Cost-benefit analyses, run before the commencement of a programme to control a parasitic disease, should include estimates of the economic losses attributable to the disease. Uruguay, a middle-income, developing country, has a recent history of persistent problems with cystic echinococcosis, in both its human population and livestock. The economic effects in Uruguay of this disease, caused by the larval stage of the canine tapeworm Echinococcus granulosus, have now been evaluated. Data on the incidence of the disease, in humans and livestock, were used to construct cost estimates. The estimated minimum cost (U.S.$2.9 million/year) was based on the condemnation costs of infected offal together with the actual costs of the hospital treatment of the human cases. The estimate of the maximum cost (U.S.$22.1 million/year) also included the production losses resulting from lower livestock efficiency and the reduced income of individuals with morbidity attributable to the disease.

Animals↗
PubMedDate not supplied

Medicalization, reproductive agency, and the desire for surgical sterilization among low-income women in urban Brazil.

This article draws on data from ethnographic fieldwork in an urban housing project to examine the social context and meanings of surgical sterilization for low-income women in Brazil. Low-income women resort to sterilization because they distrust or are unsatisfied with alternative methods and because it helps them to fulfill the requirements of modern, responsible motherhood. Although sterilization is an option among few alternatives, and one that has subjected women to greater medical management and intervention, I argue that sterilization also represents poor women's active struggle to improve their lives and to resist the burdens placed on them by unequal gender relations. This article contributes to a growing anthropological literature that demonstrates how reproduction has become a central site where social values are constituted and contested, and it details women's diverse responses to the process of medicalization.

Adult↗
PubMedDate not supplied

The breastfeeding support team for low-income, predominantly-minority women: a pilot intervention study.

This quasiexperimental pilot study explored whether a focused breastfeeding intervention had potential to improve outcomes in low-income breastfeeding women. Twenty breastfeeding women (10 in intervention and 10 in usual care) were matched on type of delivery, previous breastfeeding experience, and race. Women were low-income, young, 65% high school graduates, and 40% minority. For this intervention, the BST, a breastfeeding support team (community health nurse and peer counselor) provided hospital and home visits and telephone support. Outcomes were measured weekly for the first month, and monthly through month five. At all time periods, more women who received the intervention were breastfeeding. Further, they had less nipple discomfort in the first month; significantly less fatigue in month four and at three and five months reported less fatigue, depression, and anxiety.

Adult↗
PubMed2005

Identifying healthy eating strategies in low-income pregnant women: applying a positive deviance model.

Using positive deviance methodology, we identified strategies that enabled some low-income pregnant women to eat healthy meals while others did not. We used a descriptive design consisting of small group interviews of low-income pregnant women and identified 6 of 18 women as eating healthy diets. Women with healthy diets knew to eat balanced meals, had family support, were willing to prepare foods that were different than other family members, and ate at home more frequently than women with unhealthy diets. Health care providers can use the positive deviance approach to guide the development of interventions to improve women's diets using community-specific solutions to enhance the health of mothers and infants.

Adult↗
PubMed2006

Ethnophysiology and contraceptive use among low-income women in urban Brazil.

Distrust and dissatisfaction with contraceptive methods among low-income Brazilian women contributes to incorrect contraceptive use, harmful health risks, and an extensive reliance on surgical sterilization. Data from ethnographic fieldwork in a low-income neighborhood in urban Brazil illustrate that women's concerns regarding contraception make sense in the context of their general health and illness beliefs and their understanding of reproductive physiology. Women interpret and experience biomedical concepts and contraceptive methods (such as "hormones" and oral contraceptives, respectively) according to an ethnophysiology of fecundity, menstruation, and conception. These popular representations of reproduction embody social relations and local experience and therefore persist despite the influence of biomedical models. Recognition of this ethnophysiology and greater emphasis on culturally appropriate counseling and education among health care professionals will improve women's experience and effective use of reversible contraception.

Adult↗
PubMed2001

Two community outreach strategies to increase breast cancer screening among low-income women.

BACKGROUND: Two approaches were designed for low-income women to promote their use of mammography screening. METHODS: During 1995-96, as part of a community outreach project in a Florida city, 1,157 women aged 45 years or older attended group education sessions on breast cancer screening, while another 1,450 participated in one-on-one talks about screening at display tables in various public places. County mammography registry data were used to assess changes in the use of mammography screening. RESULTS: Among women 55 years old or older, especially whites, the one-on-one approach was more often associated with subsequent mammography screening than was the group approach. African American women and Latina women appeared to benefit more from the group approach than from the one-on-one approach. CONCLUSIONS: Group or one-on-one breast cancer screening education can improve screening behaviors among low-income women, depending on the age and ethnicity of the women targeted.

Breast Neoplasms↗
PubMed1996

Use of a photoessay to teach low-income African American women about mammography.

BACKGROUND: Although incidence rates of breast cancer are lower among African American women than white women, mortality rates among African American women are higher, especially for women of lower socioeconomic levels. Reasons for this situation include the lesser use of breast cancer screening examinations by low-income, primarily African American women, late stage of diagnosis, and delays in treatment. METHODS: As part of community outreach and public health clinic inreach programs for the Forsyth County Cancer Screening Project, approximately 908 African American women who reside in low-income housing communities were targeted for educational efforts related to breast cancer screening. Early in the project, it was discovered that many of the women were unfamiliar with mammography and had very little awareness of how the entire examination was conducted. This low level of knowledge was particularly important because it was a barrier for obtaining regular mammography. A photoessay depicting the process of getting a mammogram was developed and used in community outreach efforts in three formats: in educational classes, as a display in the housing communities, and in physicians' offices. The acceptability of this photoessay to communicate knowledge of and reduce fears about mammography was assessed through evaluation surveys in interviews with a sample of 47 women from the target population. RESULTS: Overall, these women liked the photoessay and felt that it provided knowledge about mammography and reduced fears associated with anticipating mammography. CONCLUSIONS: Strategies such as this may be ideal to communicate important information about cancer prevention and control in low-literacy populations.

Adult↗
PubMed2002

Psychological distress among minority and low-income women living with HIV.

The growing incidence of HIV infection among low-income and minority women makes it important to investigate how these women adjust to living with HIV and AIDS. Psychological distress associated with HIV infection may compound the adjustment difficulties and increase the barriers to care associated with living in poverty. The authors surveyed 100 women who were receiving HIV care at a public hospital in the southeastern United States on measures of depression, anxiety, life stress, social support, and coping; they also assessed demographic and medical characteristics of the sample. Participants' annual incomes were low (87% < $10,000), and most participants were minorities (84% African American). Their levels of depression, stress, and anxiety symptoms were elevated relative to community norms. Greater anxiety and depression symptoms were associated with women who reported higher stress, using fewer active coping strategies, and perceiving less social support (ps < .001).

Adaptation, Psychological↗
PubMed2005

Access to vision care in an urban low-income multiethnic population.

OBJECTIVE: This study applied a well-known, recently revised theoretical model of healthcare access and utilization, the Behavioral Model for Vulnerable Populations, to examine the relationship between access to care and utilization of eye care services among a multiethnic, predominately minority sample of residents from low-income public housing. DESIGN: Population-based, cross-sectional survey of community sample. SETTING: Urban Public Housing Communities in Los Angeles County, California. PARTICIPANTS: A geographically defined stratified random sample of 152 residents (86% Latino or African American) 40 years of age and older from three urban public housing communities. RESULTS: Only 62% of our sample of persons 40 years and older had received an eye examination within the past 2 years. Sixty-one percent of participants reported having vision care coverage. Yet, one out of four respondents claimed that no health care provider had ever told them that they needed an eye-examination. Applying multiple logistic regression and controlling for a number of predisposing, enabling, and need-for-care characteristics, the variables 1) receiving advice from health care providers for eye examination (OR = 3.9, p < 0.01), 2) possessing coverage for eye-care (OR = 3.2, p < 0.01), and 3) having regular and continuity of medical care (OR = 2.4, p < 0.01) remained significant predictors of eye-examination within the past 2 years. CONCLUSION: This study documents significantly diminished utilization of eye care services relative to recommended guidelines for a low-income, predominately minority sample of residents from public housing communities. We documented no association between presence of diabetes or hypertension and recency of eye examination. Affordability, continuity, and regular sources of care, as well as receiving physician advice, remain the core factors significantly associated with receiving vision care. These results underscore the need for continued efforts to ensure that the medically underserved minority have access to vision care services. These findings also point toward the urgent need for educational and motivational interventions that encourage health care providers serving underserved communities to promote eye examination, particularly among diabetic patients, hypertensive patients, and other individuals at risk for eye-related disease and complications.

Adult↗
PubMed1999

Assessing the contribution of soybean utilisation on the nutritional status of children from low-income families: Lagos State, Nigeria as a case study.

Questionnaires were administered to mothers from 120 randomly selected households. Anthropometric measurement of 258 children from these households were taken, to assess the contribution of soybean in the diet of the infants from low-income families in Lagos State (Imota, Idimu and Badagry), Nigeria. The result showed that majority of the mothers either have no formal education or were primary-school leavers. Most mothers were categorised into low-income earners because they earn about N500 (US$6) per month. The frequency of soybean consumption in Idimu and Imota is significantly higher (P < 0.05) than that of Badagry. Although the frequency of animal protein consumption in Badagry households is significantly higher (P < 0.05), it is found to be inadequate to meet their daily requirements. The protein intakes were between 92-110, 97-100 and 75-103% of FAO requirements for the children in Idimu, Imota and Badagry respectively. The weight and height of children from Idimu and Imota are higher than the children from Badagry. About 26, 32 and 71% of the children studied in Idimu, Imota and Badagry respectively fell below the WHO 5th centile bracket of weight for age. These differences are attributed to the introduction and contribution of soybean (a cheaper source of protein) to Imota and Idimu.

Anthropometry↗
PubMedDate not supplied

Welfare reform, employment, and drug and alcohol use among low-income women.

In 1996 welfare reform legislation transformed income assistance for needy families by imposing work requirements, time-limited benefits, and explicit provisions allowing states to sanction recipients who fail to meet program requirements. Though they represent a minority of the welfare population, women with substance use disorders (SUDs) experience multiple, and more severe, employment barriers than other Temporary Assistance to Needy Families (TANF) recipients. This review of welfare reform, substance abuse, and employment documents the evidence to date regarding the employment patterns of women with SUDs before and after welfare reform, and proposes several topics for further research. Based on higher rates of unemployment, less work experience, and lower earnings when working, women with SUDs have worse employment records than other TANF recipients. Despite elevated employment barriers, women with SUDs left TANF after 1996 as fast as, or faster than, other women. Since the 1996 welfare reform, women with SUDs have increased their employment and earnings, but by less than similar women without SUDs. Future research should describe how specific state welfare policies relate to employment of low-income women with SUDs, how the well-being of these women and their children changes with employment, and how welfare and employment interact to affect access to health insurance among this population.

Alcoholism↗
PubMed2003

Cancer screening practices and attitudes: comparison of low-income women in three ethnic groups.

OBJECTIVE: Based on the Health Belief Model, this study investigates differences among ethnically diverse, low-income women in the USA to inform better outreach strategies to encourage participation in the Centers for Disease Control & Prevention (CDC)- sponsored breast and cervical cancer early detection program. DESIGN: Program-eligible, low-income, Hispanic, Vietnamese and Cambodian American women who were over the age of 40 volunteered to be interviewed in their first language for the study. A total of 78 women completed the interviews. RESULTS: All three samples of women were more likely to perceive barriers to having a mammogram performed compared to the non-minority normative group. Hispanic and Vietnamese women were more similar in their health beliefs and behaviors than Vietnamese and Cambodian women. CONCLUSION: This study supports other research on the barriers and health belief differences found among ethnic minority women in the USA. Further, these findings suggest that it is not advisable to collapse ethnic groups into general categories such as 'Asian' when planning cancer control strategies, as differences were found by country of origin.

Adult↗
PubMedDate not supplied

Longitudinal effects of an HIV testing and counseling programme for low-income Latina women.

OBJECTIVES: The purpose of this study was to assess the effects of an HIV antibody testing, counseling and education programme on the knowledge and practices of low-income Los Angeles Latina women. METHODS: The study design was prospective and longitudinal involving pre-test, post-test and retest measures over a 2-year period. The study employed an experimental group and a comparison group which did not receive the intervention. The study group was comprised of a convenience sample of 508 low-income Latina women who were recruited from the Public Health Service nutrition programme for women, infants and children (WIC). The comparison group (n = 51) was recruited from the same setting. A battery of instruments was selected to measure HIV knowledge and practices, the social support received, self-esteem, the level of acculturation and sociodemographic characteristics. The instruments were administered at pre-test, 2 weeks post-test and 1 year retest. The HIV antibody serostatus was assessed at pre-test and retest. An intervention protocol based on cultural competence, women as traditional health care givers and the major transmission categories was provided after the pre-test and was reinforced post-test. Finally, qualitative data were collected from the focus group participants (n = 55) to evaluate the intervention protocol. RESULTS: The participants in the study made significant improvements in HIV knowledge and reported condom use practices from pre-test to post-test that were retained on retest. The comparison group subjects did not make significant pre-test-post-test improvements on these measures. CONCLUSIONS: It should be noted that the changes in practices made by the study group did not necessarily reduce their risk of HIV infection or transmission and were not related to the demonstrated knowledge and skills improvement. Of special significance to programme planners, educators and researchers, both the quantitative and qualitative data revealed problem areas with the intervention protocol related to cultural norms and the possible fragmentation of information based on the behavioral transmission categories.

AIDS Serodiagnosis↗