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PubMedDate not supplied

The structure of thriving/distress among low-income women at 3 months after giving birth.

This article explores the dimensionality of thriving among low-income Anglo, African American, and Hispanic women using factor analysis of psychosocial, behavioral, and weight measures at 3 months postpartum. Three factors were extracted for each ethnic group. The first and most robust factor was psychosocial distress, which encompassed stress, depressive symptoms, (low) social support, (unhealthy) lifestyle, and (less favorable) body image. For Anglo and Hispanic women, self-regulation also loaded on the distress factor. The findings suggest that interventions to ameliorate psychosocial distress among low-income women, regardless of ethnicity, may need to consider a comprehensive range of intervention content.

Adaptation, Psychological↗

PubMedDate not supplied

Diabetes management among low-income African Americans: a description of a pilot strategy for empowerment.

Incidence of type II diabetes is increasing in the United States and is most prevalent among low-income African Americans. Community health initiatives supported by partnerships of community leaders and health professionals can contribute to the elimination of inequalities in health status. The focus of Racial and Ethnic Approaches to Community Health (REACH) 2010, an initiative sponsored by the Centers for Disease Control and Prevention, is to facilitate the initiation of community-wide changes as well as increase individual empowerment to reduce disparities in diabetes, cardiovascular disease, and cancer. A pilot program developed by REACH health educators and community health partners to improve disease self-management among low-income African American diabetic patients was implemented at a community health center in Nashville, Tenn. The program's major components included health education, individual counseling, screenings, and outreach. The program shows promise of improving patient care and outcomes.

Black or African American↗

PubMed1998

Relationship between hunger and psychosocial functioning in low-income American children.

OBJECTIVE: Using large-scale surveys from nine states, the Community Childhood Hunger Identification Project (CCHIP) estimates that 8% of American children under the age of 12 years experience hunger each year. CCHIP operationalizes child hunger as multiple experiences of parent-reported food insufficiency due to constrained resources. The current study examined the relationship between food insufficiency and school-age, low-income children's psychosocial functioning. The study also assessed the interinformant (parent versus child) reliability and time-to-time reliability of the CCHIP measure. METHOD: Two hundred four school-age children and their parents from four inner-city public schools were interviewed using parent, teacher, and clinician report measures of psychosocial functioning. Ninety-six children and their parents were reinterviewed 4 months later. RESULTS: Hungry and at-risk for hunger children were twice as likely as not-hungry children to be classified as having impaired functioning by parent and child report. Teachers reported higher levels of hyperactivity, absenteeism, and tardiness among hungry/at-risk children than not-hungry children. Parent and child reports of hunger were significantly related to each other, and time-to-time reliability of the CCHIP measure was acceptable. CONCLUSIONS: Results of this study suggest that intermittent experiences of food insufficiency and hunger as measured by CCHIP are associated with poor behavioral and academic functioning in low-income children. The current study also supports the validity and reliability of the CCHIP measure for assessing hunger in children.

Adolescent↗

PubMed1994

Caregiving women and the US welfare state: the case of elder kin care by low-income women.

Long-term care in the unique US welfare state is largely a private responsibility, and current long-term care policy rests on the assumption that care--of the elderly, in our example--will be provided by women. Because alternatives to personal care of dependent kin are available based on ability to pay, lower-income women bear a disproportionate burden. A study was undertaken to examine the experience of caregiving in a convenience sample of 10 low-income women providing informal care to a frail elder. Half the study sample were women of color. Responses to the core question, "What is taking care of ... like for you?" were analyzed using phenomenologic analysis techniques. A pattern of four interrelated key themes, which describe a transitional process beginning with inevitability of the caregiving role and ending with acquiescence to it, were identified. These data are placed in the political context that surrounds caregiving; such analyses are important both to generate theory and to identify possible points of intervention.

Adult↗

PubMed1995

Risky business: managing the health care of urban low-income families.

The article examines the managed care movement and its threat of neglecting the public health needs of particular populations. Case studies and service parameters of an urban perinatal home visiting program exemplify the health and illness needs of low-income families and the urgent need for nursing representation at managed care planning forums. Client, provider, planner, and environmental characteristics that will contribute to the financial risks or health successes of managed care organizations are discussed. One potential risky design for low-income urban populations is described. Nursing input into the design and implementation of managed care programs is advocated.

Adolescent↗

PubMedDate not supplied

Opportunity cost: the impact of contextual risk factors on the cardiovascular health of low-income rural southern African American women.

Low-income rural southern African American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African American women continue to die at a disproportionately higher rate, and at earlier ages than do Caucasian women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.

Adaptation, Psychological↗

PubMed2000

Firearm availability and homicide rates across 26 high-income countries.

BACKGROUND: Among developed nations, the United States has the highest rate of civilian gun ownership, and the highest homicide rate. We examine whether the United States is merely an exception, or if a relationship between gun availability and homicide exists across all developed nations. METHODS: Homicide rates for the early 1990s come from 26 of 27 of the highly industrialized or high-income countries with greater than 1 million population as classified by the World Bank. Two common proxies for gun availability are used, the percentage of suicides with a firearm, and the"Cook index," the average of the percentage of suicides with a firearm and the percentage of homicides with a firearm. RESULTS: In simple regressions (no control variables) across 26 high-income nations, there is a strong and statistically significant association between gun availability and homicide rates. CONCLUSION: Across developed countries, where guns are more available, there are more homicides.

Developed Countries↗

PubMed2002

The role of public insurance and the public delivery system in improving birth outcomes for low-income pregnant women.

BACKGROUND: Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. OBJECTIVES: The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women and the role of different delivery systems in these outcomes. MATERIALS AND METHODS: The experience in Florida during the years 1989-1994 is studied. Data are from linked birth certificates, hospital discharge data, Medicaid eligibility and claims files, and county health department records. Use of prenatal care and birthweight for low-income women is compared under different financing for prenatal care and for those using different delivery systems. Several approaches to control for self-selection are adopted, and similar results are obtained with each. RESULTS: Women enrolled in Medicaid have more prenatal care visits than the uninsured. Outcomes for those on Medicaid and the uninsured are significantly better if they receive care in the public health system than if they receive care in the private system-including private offices, clinics, and HMOs. Over time, the gap in outcomes between those in the public system and those receiving prenatal care from private physicians has diminished. CONCLUSIONS: Public insurance improves access to services, but the delivery system is a key factor in improving outcomes.

Birth Weight↗

PubMedDate not supplied

Relationships between psychosocial factors and abusive parenting attitudes in low-income single mothers.

BACKGROUND: Linkages among family violence, maternal mental health, and parenting attitudes are not clearly understood. OBJECTIVE: To investigate the relationships of abuse (childhood and/or partner), everyday stressors, self-esteem, depressive symptoms, and anger with abusive parenting attitudes. METHOD: Cross-sectional analysis of data collected in interviews with 53 low-income, single mothers from wave two of a 3-wave study. A conceptual framework and bivariate correlations guided a series of multiple regressions to identify the best predictors for each variable. RESULTS: A high prevalence of abuse, depressive symptoms, and abusive parenting attitudes was found. Few women had ever received mental health treatment. Abuse (partner and childhood physical) predicted higher everyday stressors which in turn predicted lower self-esteem. Childhood abuse and lower self-esteem predicted more depressive symptoms. More depressive symptoms were related to higher levels of state anger. More everyday stressors and more depressive symptoms predicted higher levels of trait anger. Higher levels of anger expression were associated with higher everyday stressors and lower self-esteem. The presence of partner abuse best predicted higher levels of overall abusive parenting attitudes and more parent-child role reversal. Less parental empathy was associated with higher levels of state anger. CONCLUSIONS: This study partially explains the relationships of maternal abuse history and mental health status with parenting attitudes. Other predictors of parenting attitudes remain to be identified. The findings underscore the need for healthcare providers to consider the mental health status and abuse histories of low-income, single mothers. The potential disturbance in the parenting process of single mothers in abusive relationships warrants further investigation.

Adolescent↗

PubMedDate not supplied

Incoming nursing students' perceptions of their caring behaviors.

What are the caring attitudes and abilities of incoming nursing students? This phenomenologic study used the Colaizzi method to analyze descriptions of caring interactions written by 15 incoming nursing students on orientation day. It indicates that students have definite attitudes and values about caring and established patterns of caring behaviors. Educators need to start where the learners are-namely, recognizing and valuing their inherent caring behaviors. Using these threads, nurse educators can begin to weave the fabric of professional caring.

Adult↗

PubMed2000

Hepatitis B prevalence in young women living in low-income areas: the population-based San Francisco Bay area's Young Women's Survey.

BACKGROUND: The risk of sexually transmitted hepatitis B virus infection is proportionally higher for young adults and women. Low socioeconomic groups have high rates of hepatitis B infection with no identified source of transmission. The prevalence and correlates of transmission of hepatitis B virus among young women of low socioeconomic status have not been well documented. GOAL: To determine the population-based prevalence and correlates of sexually acquired hepatitis B virus infection in young low-income women in the San Francisco Bay Area. STUDY DESIGN: A three-county, door-to-door serosurvey of hepatitis B virus core antibody among young women living in low-income areas was conducted from April 1996 to January 1998. Multivariate analysis of sexually acquired hepatitis B virus infection excluded participants of Asian or Pacific Islander ethnicity or with a history of intravenous drug use or transfusion. RESULTS: The prevalence of sexually acquired hepatitis B virus infection was 6.4% (95% CI, 4.7%-8.1%). Correlates of infection were black race (odds ratio, 3.9; 95% CI, 1.2-11.9 compared with white race) and herpes simplex virus type 2 infection (odds ratio, 2.0; 95% CI, 1.0-3.9). CONCLUSIONS: Young black women have a higher risk of sexually acquired hepatitis B virus infection. Herpes simplex virus type 2 infection may predispose to hepatitis B virus infection and/or be a marker for lifetime sexual risk behavior.

Adolescent↗

PubMed2004

Correlates of weight loss behaviors among low-income African-American, Caucasian, and Latina women.

OBJECTIVE: To examine the prevalence and correlates of weight reduction behaviors among low-income women. METHODS: A total of 1,709 Caucasian, African-American, and Latina women aged 12-58 years attending a federally funded family planning clinic reported their weight loss behaviors during the past 30 days, including using diet pills, exercising, purging (vomiting, laxatives, diuretics), and dieting. Approximately 60% (n = 999) had a body mass index of 25 or greater. RESULTS: Overall, 35.3% (n = 603) of women dieted, 43.7% (n = 746) exercised, 15.1% (n = 258) used diet pills, and 4.3% (n = 69) purged. Only 14.8% (n = 253) of the sample reported both dieting and exercising. The odds of exercising for weight loss decreased as parity increased. Those who smoked currently or in the past were more likely than nonsmokers to report purging (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.2, 5.4). African Americans were least likely to diet or exercise compared with Caucasians and Latinas. Exposure to family members using diet pills (OR 4.6; 95% CI 3.2, 6.5), dieting (OR 2.1; 95% CI 1.6, 2.8), or purging (OR 5.6; 95% CI 2.7, 11.9) was associated with increased odds of performing these behaviors oneself. CONCLUSION: This research demonstrates that low-income women frequently use maladaptive strategies, such as diet pills and purging, to lose weight. Obesity and family exposure to these behaviors places women at increased risk of unhealthy behaviors. Interventions designed to reduce obesity must include precautions regarding the dangers of these practices. LEVEL OF EVIDENCE: III

Adolescent↗

PubMed2005

Mental health of low income uninsured men with prostate cancer.

PURPOSE: We evaluated mental health outcomes in a cohort of low income, uninsured men with prostate cancer and identified factors that influence mental health. MATERIALS AND METHODS: We performed a retrospective cohort study of 277 subjects enrolled in a program that provides free care to men with prostate cancer who have an annual income of no more than 200% of the federal poverty level. We compared scores on the 5-item RAND Mental Health Inventory (MHI-5) to those in individuals with other chronic diseases. We also examined the relationship between MHI-5 scores and validated measures of general and disease specific health related quality of life. Disease specific quality of life included measures of distress related to urinary, sexual and bowel habits. Multivariate analyses were performed to evaluate factors associated with mental health score. RESULTS: Most men studied were Hispanic (51.6%) and had at most a high school education (85.9%). Mean MHI-5 score +/- SD was 68 +/- 23 on a 100-point scale, significantly worse than cohorts of men with diabetes, congestive heart failure and chronic pulmonary disease. Hispanic ethnicity, urinary bother and bowel bother were negatively associated with mental health. Spirituality and physical functioning were positively associated with mental health. CONCLUSIONS: Economically disadvantaged men with prostate cancer report worse mental health than people with other chronic diseases. Patients especially at risk are those with significant urinary or bowel distress, poor physical health, low spirituality and Hispanic ethnicity.

Adenocarcinoma↗

PubMedDate not supplied

Depressive symptoms are associated with blunted cortisol stress responses in very low-income women.

OBJECTIVE: The purpose of this study was to examine the association between depressive symptoms and salivary cortisol responses to stress in a high-risk population of very poor Mexican women. METHODS: Adult women (N = 1109) between the ages of 18 and 44 years (mean age, 29) were identified in a house-to-house survey in low-income areas (income <20th percentile nationally) of urban Mexico. An interview containing the Spanish version of the Center for Epidemiologic Studies--Depression Scale (CES-D) was administered to all women. The naturalistic stressor was defined as the unexpected arrival of a team of researchers at the participants' homes followed by an in-depth interview and physical assessment, with saliva samples taken at time of arrival (baseline), 25 minutes, and 50 minutes after arrival. RESULTS: The mean CES-D score was 19.42 (range, 0-53). Results of hierarchical linear modeling analyses revealed no effect of depressive symptoms on baseline salivary cortisol levels. However, a significant depressive symptom by time interaction revealed that women with elevations in depressive symptoms (CES-D scores = 35) failed to exhibit a cortisol response to the stressor. In contrast, in women with lower CES-D scores, cortisol levels significantly increased in response to the stressor. CONCLUSION: Consistent with research on individuals with major depressive disorder, results of this study demonstrate that women with very high levels of depressive symptoms exhibit blunted cortisol responses to a naturalistic psychological stressor. Results also contribute to previous research by generalizing findings to a high risk, underserved population of women.

Adolescent↗

PubMed2005

The Chilean AIDS cohort: a model for evaluating the impact of an expanded access program to antiretroviral therapy in a middle-income country--organization and preliminary results.

Chile, middle-income country with 15 million people, began an expanded access program (EAP) to antiretroviral therapy (ART) in 2001. EAP provides ART, monitoring, and funding for management of associated complications in 32 points of care. A national cohort (Chilean AIDS Cohort [ChiAC]), enrolling 98% of these patients, was created for standardized treatment and impact evaluation. Information exchange is mainly through the Internet. By December 2004, the ChiAC had 4365 participants (83.3% male). At baseline, 47.5% had clinical AIDS, 26.2% were asymptomatic, 80.2% had a CD4 count <200 cells/mm and 58.2% were ART naive; in these patients, the most frequent regimen is zidovudine, lamivudine, and efavirenz. A 6-month follow-up in 1057 patients showed a global mortality of 5% (0.5% if patients were asymptomatic at baseline and 8.3% if patients had baseline AIDS). There was a similar risk of death if the baseline CD4 count was 100 to 200 cells/mm or >200 cells/mm ( approximately 1%), but this increased to 4.8% (relative risk [RR] = 5.2) and 10.7% (RR = 11.5) if the CD4 count was 51 to 100 cells/mm or <or=50 cells/mm, respectively. Discontinuation occurred in 7.7% of patients because of drug toxicity, and progression occurred in 2.9%. A successful EAP to ART with the resources of a middle-income country is possible. Early results are similar to those of industrialized countries. A national cohort allows better implementation and evaluation of the program and may be a useful model for other countries.

AIDS-Related Opportunistic Infections↗

PubMed2003

Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia.

BACKGROUND: A five-year prospective study was conducted in North Iraq and Cambodia to test a model for rural prehospital trauma systems in low-income countries. RESULTS: From 1997 to 2001, 135 local paramedics and 5,200 lay First Responders were trained to provide in-field trauma care. The study population comprised 1,061 trauma victims with mean evacuation time 5.7 hours. The trauma mortality rate was reduced from pre-intervention level at 40% to 14.9% over the study period (95% CI for difference 17.2-33.0%). There was a reduction in trauma deaths from 23.9% in 1997 to 8.8% in 2001 (95% CI for difference 7.8-22.4%), and a corresponding significant improvement of treatment effect by year. The rate of infectious complications remained at 21.5 percent throughout the study period. CONCLUSION: Low-cost rural trauma systems have a significant impact on trauma mortality in low-income countries.

Adolescent↗

PubMed2026

A systematic review of qualitative research on HIV and food insecurity in high-income countries.

OBJECTIVES: Food insecurity leads to adverse health outcomes in people living with HIV, including obesity, poor mental health and viral non-suppression. Qualitative studies in low- and middle-income countries have described the impact of food insecurity on medication adherence. However, limited qualitative research exists on the lived experiences of food insecurity among people living with HIV in high-income countries (HICs). We aimed to synthesize qualitative literature on food insecurity among people living with HIV in HICs. DESIGN: Systematic review and textual narrative synthesis. METHODS: We searched MEDLINE, CINAHL, Scopus, Embase, and PsycINFO, extracting data from included articles on a standardized form in Covidence. We synthesized literature using a textual narrative approach. We conducted quality appraisal (Critical Appraisal Skills Programme Qualitative Studies Checklist) and graded certainty of findings (GRADE-CERQual). RESULTS: We reviewed 2772 articles, reduced to 940 after deduplication, with 12 articles included after full text screening. Included articles reported on studies conducted in the United States ( n  = 7), and Canada ( n  = 5). We identified three key themes, each with their own sub-themes: the role of structural inequalities in shaping and navigating food insecurity; the impacts of food insecurity on health and wellbeing; and the labour of acquiring of food. CONCLUSIONS: Our review highlights the syndemic nature of food insecurity and HIV; intersecting experiences of multiple structural hardships constellate and interact synergistically to amplify poor health outcomes. Interventions should address the multiple and reinforcing social and structural conditions that shape food insecurity among people living with HIV.

Humans↗

PubMedDate not supplied

Healthy behaviors and sources of health information among low-income pregnant women.

This article addresses responses from two open-ended questions, describing the healthy behaviors and sources of health information in 150 low-income pregnant women. Data for this exploratory study were collected as part of a larger descriptive correlational study. Qualitative content analysis was used in the analysis. One hundred fifty English-speaking pregnant women aged 18 and over were interviewed at a public prenatal clinic in the Southeastern United States at their first prenatal visit. Health behaviors were placed into seven mutually exclusive categories: food-related behaviors, substance-related behavior, exercise/rest/activity, self-awareness/appearance, learning, focus on baby, and no specific behaviors. Sources of information questions were placed into seven mutually exclusive categories: family, health personnel, reading, hearing, other people, self-intuitive, and no response. Low-income pregnant women are aware of healthy behaviors and report practicing them during their pregnancies. Because family members are a common source of information for health practices, they should be included in health education efforts.

Adult↗