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PubMedDate not supplied

Maternal correlates of growth in toddler vocabulary production in low-income families.

This study investigated predictors of growth in toddlers' vocabulary production between the ages of 1 and 3 years by analyzing mother-child communication in 108 low-income families. Individual growth modeling was used to describe patterns of growth in children's observed vocabulary production and predictors of initial status and between-person change. Results indicate large variation in growth across children. Observed variation was positively related to diversity of maternal lexical input and maternal language and literacy skills, and negatively related to maternal depression. Maternal talkativeness was not related to growth in children's vocabulary production in this sample. Implications of the examination of longitudinal data from this relatively large sample of low-income families are discussed.

Child, Preschool↗

PubMed2005

Factors affecting plan choice and unmet need among supplemental security income eligible children with disabilities.

OBJECTIVE: To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee-for-service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability. DATA SOURCES: We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia. RESEARCH DESIGN: We employed a two-step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care. PRINCIPAL FINDINGS: More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant. CONCLUSIONS: We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees.

Adolescent↗

PubMed1994

Smoking among low-income, pregnant women: prevalence rates, cessation interventions, and clinical implications.

Smoking has a significant effect on the major causes of death and disability among women, including coronary heart disease, stroke, cancer, and osteoporosis. When pregnant women smoke, it adversely affects not only them but also the health, development, and functioning of their unborn and young children. Of the general population of pregnant women, between 20 and 45 percent smoke. Furthermore, among low-income and less educated pregnant women, the increase in prevalence of postpartum smoking relapse rates, continued smoking, and initiation of smoking underlies the need for developing effective interventions for prevention and cessation. Although self-help, stop-smoking materials demonstrated success in several trials, interventions used in conjunction with these materials were brief with little follow-up, and did not address the need for continued intervention to help maintain abstinence or cessation after birth. This article reviews the smoking cessation trials that have assessed the effects of various interventions on cessation rates among low-income pregnant women, and describes future research needs for clinic-based smoking interventions for those women and the clinical implications for health professionals.

Adolescent↗

PubMedDate not supplied

Are tri-ethnic low-income women with breast cancer effective teachers of the importance of breast cancer screening to their first-degree relatives? Results from a randomized clinical trial.

The purpose of this study was to determine the efficacy of women with breast cancer as teachers of the importance of breast cancer screening to their first-degree female relatives. The sample was restricted to low-income working age women recruited from four hospitals. The study design was a randomized clinical trial. At each hospital, breast cancer patients (probands) were randomized into one of two study groups: (i) intensive, individual educational training on breast cancer screening or (ii) standard clinic education on breast cancer screening. The probands were instructed to teach at least one of their first-degree female relatives (21+ years of age) about breast cancer screening techniques. Three to six months after the enrollment of the probands, their relatives were contacted by telephone to determine breast cancer screening practices. A total of 79 probands and 96 relatives participated in the study. Relatives in the education group when compared with the control group were: 1.25 times more likely to have clinical breast examination (p = 0.005), 2.83 times more likely to have scheduled a clinical breast examination (p = 0.046), and, 1.36 times more likely to have been told about performing breast self-examination (p = 0.05). Additionally, relatives in the education group were more likely to have received a pamphlet on breast cancer screening (RR = 1.58, p = 0.009) and have discussed the importance of breast cancer screening (RR = 1.33, p = 0.020) from the proband. Special education training did not impact mammography utilization of the relatives. From these findings, a tri-ethnic group of low-income women with breast cancer can be effective teachers of breast cancer screening practices, at least for promoting clinical breast examination and transmitting messaging for performance of breast self-examination if given the adequate training.

Adult↗

PubMed2005

Utilization of services by abused, low-income African-American women.

BACKGROUND: Little is known about health care and service utilization patterns among low-income African-American women, particularly those who report intimate partner violence (IPV). OBJECTIVES: (1) Identify utilization patterns among low-income African-American women. (2) Demonstrate utilization differences by IPV status. PARTICIPANTS: One hundred and fifty-three African-American women from medical care clinics at a large inner-city public hospital. DESIGN: Case-control study. Predictor variable IPV assessed by the Index of Spouse Abuse. Outcome variables, health care, and service utilization, determined using the Adult Service Utilization Form. RESULTS: Of the 153 participants, 68 reported high IPV levels. The mean age was 32 years, majority were poor and unemployed, and 15.7% were homeless. The overall utilization rates were low. When controlled for homelessness and relationship status, high IPV levels were associated with greater psychiatric outpatient utilization. We found differences in the use of other medical or community services by IPV group. CONCLUSIONS: Women reporting high IPV levels are more likely to receive mental health services than women reporting low IPV levels, but may not have access to other needed services. Primary care providers should assess the mental health, legal, and social service needs of abused women, which will facilitate receipt of services.

Adult↗

PubMed2005

Testing an intervention to reduce negative thinking, depressive symptoms, and chronic stressors in low-income single mothers.

PURPOSE: To test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income, single mothers at risk for depression. DESIGN AND METHODS: A randomized, controlled prevention trial was conducted with 136 low-income, single mothers with children between the ages of 2 and 6 years. Each participant was screened before enrollment and was determined to be at risk for depression. Participants were randomly assigned to either the control or experimental group. The experimental group was invited to participate in a 4- to 6-week cognitive-behavioral group intervention. Data on depressive symptoms, negative thinking, and chronic stressors were collected via self-report questionnaires from control and experimental groups at baseline, 1 month, and 6 months after the intervention to assess the effects of the intervention. FINDINGS: Compared with those in the control group, women who received the intervention had a greater decrease in depressive symptoms, negative thinking, and chronic stressors; these beneficial effects were maintained over a 6-month period. CONCLUSIONS: The findings indicate the effectiveness of this cognitive-behavioral group intervention and show the beneficial effects of reducing negative thinking via the use of affirmations and thought-stopping techniques.

Adult↗

PubMedDate not supplied

Early discharge with home follow-up: impacts on low-income mothers and infants.

Low-income mothers and infants discharged at 24 to 47 hours after birth were compared to two control groups: early discharge with infant separation and conventional discharge. No differences among the three groups in maternal or infant morbidity at seven to 15 days postdelivery were recorded. Simultaneous early discharge was associated with higher maternal attachment scores, fewer maternal concerns, and greater maternal satisfaction with discharge type than early discharge with infant separation. All three groups had substantial morbidity in the first two weeks of life. A shorter hospital stay and more health monitoring postdischarge may be a better use of health resources than a conventional hospital stay for low-income mothers and their infants.

Aftercare↗

PubMedDate not supplied

Health practices and anxiety in low-income, high and low-risk pregnant women.

OBJECTIVE: To evaluate anxiety and health-protective and health-promoting behaviors in low- and high-risk, low-income pregnant women. DESIGN: Nonrandomized descriptive study. SETTING: Low- and high-risk prenatal clinics at a tertiary-care center. PARTICIPANTS: Sixty-five black and white low-income women between 20 and 41 weeks of pregnancy. MAIN OUTCOME MEASURES: Anxiety and health-promoting behavior. RESULTS: No significant differences were found in anxiety levels. A significant difference was found between the two groups in overall Health-Promoting Lifestyle Profile (HPLP) scores. Women in the low-risk group scored higher on all HPLP subscales, with significant differences on self-actualization and health responsibility. CONCLUSION: Findings support the need for nurses to assess high-risk pregnant women for their health practices during pregnancy. Although a major focus on nursing care during pregnancy is teaching the promotion of health, only limited research exists on the effectiveness of such interventions.

Adult↗

PubMedDate not supplied

Psychosocial and spiritual factors associated with smoking and substance use during pregnancy in African American and White low-income women.

OBJECTIVE: To determine the associations between sociodemographic, psychosocial, and spiritual factors to health risk behaviors during pregnancy in African American and White low-income women. DESIGN: Descriptive, using prenatal interviews and medical record review as data sources. SETTING: An urban prenatal clinic in the Midwestern United States. PARTICIPANTS: One hundred thirty ethnically diverse low-income women. MAIN OUTCOME MEASURES: Smoking and substance use in pregnancy. RESULTS: For the total sample, 39% reported smoking and 28% reported substance use in pregnancy. Significant predictors of smoking were White race, less than high school education, abuse, and religiosity. Abuse and depressive symptoms predicted substance use. African American women were significantly less likely to report smoking in pregnancy (28%) than were White women (55%) (p < .05). African American women who smoked during pregnancy were significantly more likely to report lower levels of education (p < .01), less social support from others (p < .01) and total social support (p < .01), higher levels of stress (p < .05), and more frequent substance use (56.5%) than African American women who did not smoke (12%) (p < .001). White women who used substances were significantly more likely to report smoking (p < .01), abuse (p < .05), and a history of delivering a preterm or low-birthweight infant (p < .01) than the White women who did not. CONCLUSION: Integrating social support and stress-relieving activities in smoking cessation interventions, particularly for African American women, may reduce health risk behaviors, eliminate health disparities, and improve maternal and infant quality of life.

Adolescent↗

PubMed2005

Diabetes beliefs among low-income, white residents of a rural North Carolina community.

CONTEXT: Every social group shares beliefs about health and illness. Knowledge and understanding of these health beliefs are essential for education programs to address health promotion and illness prevention. PURPOSE: This analysis describes the diabetes Explanatory Models of Illness (EMs) of low-income, rural, white Southerners who have not been diagnosed with diabetes. METHOD: In-depth interviews were conducted with low-income white women (n = 19) and men (n = 20) aged 18 to 54 years who resided in a rural Southern town. The tape-recorded interviews were completed by trained interviewers and were transcribed verbatim. Computer-assisted text analysis was used, and all transcripts were coded by 2 investigators. FINDINGS: Although all the participants had heard of diabetes, their EMs were vague and undeveloped. Women were more knowledgeable than men were. Family and heredity were widely believed to be causes, with heredity including genetic and learned behavior components. Participants disagreed about the role of diet and weight in causing diabetes; exercise was not perceived as related to causation. Participants had knowledge of those symptoms, complications, and treatments that could be observed. CONCLUSIONS: These rural, white Southerners did not share well-developed EMs for diabetes, with most having a vague and incomplete understanding of this disease. The diabetes beliefs of these rural Southerners differ significantly from current medical knowledge. To be effective, culturally appropriate primary prevention programs must recognize these lay beliefs.

Adult↗

PubMed1998

Dental utilization by low-income mothers.

OBJECTIVE: This study examines the influence of predisposing, enabling, and need variables on whether low-income mothers sought dental care during the past year. This report is a substudy of mothers and children on their self-reported health status, utilization, access, and satisfaction with health care in general. METHODS: A convenience sample of 502 mothers and youngest child younger than 6 years old was administered a face-to-face questionnaire in four Ohio counties. Information was collected at county human services offices and WIC clinics between November 1995 and July 1996. Using whether or not the mother sought dental care as the dependent variable, logistic regression models were created for the variables within the predisposing, enabling, and need characteristics separately and together. RESULTS: Fewer than one-half of the mothers sought dental care during the past year. Variables associated with the predisposing characteristic explained little about who sought care. Those mothers who have Medicaid coverage are 2.7 times more likely to have a dental visit than those without insurance. Moreover, those mothers who perceive any dental need are several times less likely to have received dental care than those who have no perceived need. CONCLUSIONS: Even among a somewhat homogeneous population of low-income women, source of payment for dental services and perceived need for dental care are discriminating variables in determining who seeks dental care.

Adolescent↗

PubMed2006

Assessment of the relationship between neighborhood characteristics and dental caries severity among low-income African-Americans: a multilevel approach.

OBJECTIVES: To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans. METHODS: A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002-03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information. RESULTS: There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition. CONCLUSION: Neighborhoods contribute something unique to caregivers' oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.

Adolescent↗

PubMed1994

Access to health care for children in low-income families.

This paper draws on data from the Health Care for Children Project to consider issues of access to health care for children in low-income families in three geographic areas. Group and individual interviews were held with mothers in an innercity area and two outlying suburbs. Financial, geographic, sociocultural and other barriers to use of health services are discussed. Major obstacles to access to health care for their children identified by the mothers included cost of medication, hours of opening, transport and language. The paper highlights the impact of even quite small charges for health services on low-income families.

Australia↗

PubMed1995

Food consumption of parents on low incomes.

In the Redfern area in metropolitan Sydney, there are many people on low incomes living in public housing. To investigate their nutritional status, a sample of 60 parents in this area was interviewed; 51 participants completed a food frequency questionnaire. Participants also completed weighed food records. The weighed food records showed energy intakes lower than expenditure calculated as necessary to maintain body weight (as estimated by the Schofield equation and activity factor). Therefore, the data are unlikely to be accurate and are not reported here. The food-frequency questionnaire indicated energy intakes close to those required to maintain body weight. Recorded nutrient intakes were similar to those recorded in other Australian studies. Fat supplied 35.6 per cent of the energy in the diets of the sample, compared to 37.3 per cent in the National Dietary Survey. Although the results were obtained by convenience sampling and may not be representative, the results do suggest that some parents on low incomes are able to maintain nutrient intake similar to that of the wider community.

Adult↗

PubMed2026

Effects of Cognitive Behavioral Couple Therapy With Integrated Mindfulness on Mindful Attention, Depressive Symptoms, and Dyadic Adjustment in Low-Income Couples: A Pilot Randomized Clinical Trial.

Psychosocial distress can exacerbate marital conflict, maladjustment, and mental health vulnerability. This pilot randomized clinical trial examined cognitive-behavioral couple therapy (CBCT) integrated with mindfulness in low-income Brazilian couples (per-capita household income up to one minimum wage). Thirty-four participants (17 heterosexual couples) were randomized (independent computer-generated sequence) to an experimental (n = 16) or waitlist control group (n = 18). We assessed dyadic adjustment, mindful attention, marital social skills, and depressive symptoms (R-DAS, MAAS, IHSC, BDI-II) at baseline, post-treatment, and 3-month follow-up. The intervention was eight 80-min conjoint sessions plus daily home exercises. Time × group effects favored the experimental group for dyadic adjustment, mindful attention, and depressive symptoms (all p < 0.001, = 0.20-0.37), but not marital social skills (p = 0.14). Because two outcomes differed at baseline, effects were confirmed with baseline- and dependence-adjusted sensitivity analyses. These findings provide preliminary evidence that CBCT with mindfulness may benefit disadvantaged couples.

Adult↗

PubMed1991

Transport of incoming influenza virus nucleocapsids into the nucleus.

Upon penetration of the influenza virus nucleocapsid into the host cell cytoplasm, the viral RNA and associated proteins are transported to the nucleus, where viral transcription and replication occur. By using quantitative confocal microscopy, we have found that over half of cell-associated nucleoprotein (NP) entered the nucleus with a half time of 10 min after penetration into CHO cells. Microinjection and immunoelectron microscopy experiments indicated that the NP entered the nucleus through the nuclear pore as part of an intact ribonucleoprotein (RNP) structure and that its transport was an active process. Transport of the incoming RNPs into the nucleus was not dependent on an intact microfilament, microtubule, or intermediate filament network. Subsequent to penetration, the matrix (M1) protein appeared to dissociate from the RNP structure and to enter the nucleus independently of the RNP. We found that 50% of penetrated M1 entered the nucleus with a half time of 25 min after penetration into CHO cells. Nuclear transport of M1 appeared to occur by passive diffusion. Entry of incoming M1 into the nucleus was not a prerequisite for infection.

Animals↗

PubMed2006

Low pH-dependent endosomal processing of the incoming parvovirus minute virus of mice virion leads to externalization of the VP1 N-terminal sequence (N-VP1), N-VP2 cleavage, and uncoating of the full-length genome.

Minute virus of mice (MVM) enters the host cell via receptor-mediated endocytosis. Although endosomal processing is required, its role remains uncertain. In particular, the effect of low endosomal pH on capsid configuration and nuclear delivery of the viral genome is unclear. We have followed the progression and structural transitions of DNA full-virus capsids (FC) and empty capsids (EC) containing the VP1 and VP2 structural proteins and of VP2-only virus-like particles (VLP) during the endosomal trafficking. Three capsid rearrangements were detected in FC: externalization of the VP1 N-terminal sequence (N-VP1), cleavage of the exposed VP2 N-terminal sequence (N-VP2), and uncoating of the full-length genome. All three capsid modifications occurred simultaneously, starting as early as 30 min after internalization, and all of them were blocked by raising the endosomal pH. In particles lacking viral single-stranded DNA (EC and VLP), the N-VP2 was not exposed and thus it was not cleaved. However, the EC did externalize N-VP1 with kinetics similar to those of FC. The bulk of all the incoming particles (FC, EC, and VLP) accumulated in lysosomes without signs of lysosomal membrane destabilization. Inside lysosomes, capsid degradation was not detected, although the uncoated DNA of FC was slowly degraded. Interestingly, at any time postinfection, the amount of structural proteins of the incoming virions accumulating in the nuclear fraction was negligible. These results indicate that during the early endosomal trafficking, the MVM particles are structurally modified by low-pH-dependent mechanisms. Regardless of the structural transitions and protein composition, the majority of the entering viral particles and genomes end in lysosomes, limiting the efficiency of MVM nuclear translocation.

Animals↗

PubMed1994

Cigarette smoking by socioeconomic group, sex, and age: effects of price, income, and health publicity.

OBJECTIVE: To assess effects of price, income, and health publicity on cigarette smoking by age, sex, and socioeconomic group. DESIGN: Econometric multiple regression analysis of data on cigarette smoking from the British general household survey. SUBJECTS: Random sample of adult population in Britain interviewed for biennial general household surveys 1972-90. MAIN OUTCOME MEASURES: Changes in cigarette consumption and prevalence of smoking. RESULTS: Price elasticities of demand for cigarettes (percentage change in cigarette consumption for a 1% change in price) were significant at -0.5 (95% confidence interval -0.8 to -0.1) for men and -0.6 (-0.9 to -0.3) for women, were highest in socioeconomic group V (-1.0 for men and -0.9 for women), and lowest (not significantly different from zero) in socioeconomic groups I and II. The gradient in price elasticities by socioeconomic group was significant for men (F = 5.6, P = 0.02) and for women (F = 6.1, P = 0.02). Price was a significant factor in cigarette consumption by age for women in every age group and for men aged 25-34. Cigarette consumption by young men aged 16-34 increased with income. There was a significant decrease in smoking over time by women in socioeconomic groups I and II and by men in all age and social groups except socioeconomic group V attributable to health publicity. Price significantly affected smoking prevalence in socioeconomic group V (-0.6 for men and -0.5 for women) and for all women (-0.2). CONCLUSIONS: Men and women in lower socioeconomic groups are more responsive than are those in higher socioeconomic groups to changes in the price of cigarettes and less to health publicity. Women of all ages, including teenagers, appear to have been less responsive to health publicity than have men but more responsive to price. Response to health publicity decreased linearly with age. Real price increases in cigarettes could narrow differences between socioeconomic groups in smoking and the related inequalities in health, but specific measures would be necessary to ameliorate effects on the most deprived families that may include members who continue to smoke. The use of a policy to steadily increase cigarette tax is likely to help achieve the government's targets for smoking and smoking related diseases.

Adolescent↗