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PubMed2002

An innovative video succeeds in addressing barriers to breastfeeding among low-income women.

This study evaluates the effectiveness of an innovative breastfeeding promotion video intervention in addressing barriers to breastfeeding among low-income women in the state of Mississippi. The 15-minute video features a diverse group of women and their families. Survey data were collected from Special Supplemental Nutrition Program for Women, Infants and Children clients in the intervention group (n = 310) before and after watching the video, and from a comparison group (n = 204) that did not watch the video. The 2 groups were comparable at baseline. The intervention significantly improved women's perceptions with regard to the "embarrassment" and "time and social constraints" barriers to breastfeeding. In terms of the "lack of social support" barrier, the video positively affected participants' feelings that the baby's father encouraged breastfeeding but did not change their perceptions of support from female relatives and friends. The authors conclude that the video is an effective method of breastfeeding promotion among low-income women.

Adult↗
PubMed2005

Factors influencing the initiation and duration of breastfeeding among low-income women followed by the Canada prenatal nutrition program in 4 regions of quebec.

The factors that influence the actual initiation and duration of breastfeeding were studied among low-income women followed by the Canada Prenatal Nutrition Program (CPNP). A group of 196 pregnant women were selected at random from a sample of 6223 pregnant women who registered with the CPNP. Two 24-hour recalls and information regarding lifestyle habits, peer support, and infant-feeding practices were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth. Women who received a university education (completed or not completed) versus women with < or = high school education (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.02-69.50), women born outside Canada (OR,8.81; 95% CI, 3.34-23.19), and women of low birth weight infants (OR, 0.39; 95% CI, 0.16-0.96) were more likely to initiate breastfeeding. Late introduction of solid foods (P = .004), nonsmoking (P = .005), multiparity (P = .012), and a higher level of education (P = .049) were positively associated with the duration of breastfeeding among initiators. Understanding factors associated with initiation and duration of breastfeeding among low-income women is critical to better target breastfeeding promotion.

Adult↗
PubMed1994

Effect of peer counselors on breastfeeding initiation, exclusivity, and duration among low-income urban women.

This study examined the effect of support from trained peer counselors on breastfeeding initiation, duration, and exclusivity among low-income urban women. Training of counselors, under the supervision of a registered nurse certified in lactation, adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues. The study compared infant feeding practices of women who planned to breastfeed and received support from counselors (counselor group, N = 59) to women who requested counselors but, owing to inadequate numbers of trained counselors, did not have a counselor (No-counselor group, N = 43). Women in the counselor group had significantly greater (p < .05) breastfeeding initiation (93 percent vs. 70 percent), exclusivity (77 percent vs. 40 percent), and duration (mean of 15 weeks vs. mean of 8 weeks) than women in the no-counselor group. The findings suggest that peer counselors, well-trained, and with on-going supervision, can have a positive effect on breastfeeding practices among low-income urban women who intend to breastfeed.

Adult↗
PubMed1999

The effect of a peer counseling program on breastfeeding initiation and longevity in a low-income rural population.

Breastfeeding rates among low-income women in the east-south-central United States are among the lowest in the country. This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee. A postpartum survey and chart review were conducted with WIC clients at nine health departments. Response rate was 99% (291/293). Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group (n = 156) compared with women in the no-peer counselor group (n = 135) (53% vs. 33%, p < 0.001, and 26% vs. 13%, p = 0.006, respectively). Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding (OR = 2.43, 95% CI = 1.23-4.67) and to be breastfeeding at 6 weeks (OR = 2.78, 95% CI = 2.08-9.51), than those in the no-peer counselor group.

Adolescent↗
PubMed1998

The relationship among income, other socioeconomic indicators, and functional level in older persons.

Socioeconomic status (SES) is well established as a cause of morbidity and mortality, but relatively few studies have investigated the relationship between SES and functional level. Functional level is closely related to the use of long-term care services and is a more salient indicator of quality of life than specific diseases. We used data from 1,570 respondents in the Growing Older in New York City Study, a probability sample of people age 65 and older, to examine this relationship. The association between income and function was seen throughout the full gradient of income and remained significant when controlling for age, gender, race/ethnicity, household size, education, occupation, age of immigration, and locus of control. Education and residential environment, but not occupation, were independently associated with functional level. These findings support both the association between SES and functional limitation and the hypothesis that the SES and health association continues into old age.

Activities of Daily Living↗
PubMed2006

Why lower income mothers do not engage with the formal mental health care system: perceived barriers to care.

Lower income mothers who bring their children for mental health services also have high rates of depression and anxiety, yet few seek help. Maternal and child mental health are intimately intertwined; thus, the distress of both is likely to continue if the mother's needs are unaddressed. Because mothers overcome numerous instrumental challenges to help their children, the authors identify potential perceptual barriers to mothers' help seeking. An ethnographic analysis of in-depth qualitative interviews with 127 distressed mothers suggests several critical perceptual factors. For example, mothers attributed their distress to external causes (e.g., poverty, negative life stressors), which they believed individually focused mental health services could not affect. Interviewees also anticipated negative ramifications for seeking care, including being labeled unfit mothers, and thus potentially losing custody of their children. The authors discuss the implications of these and other key themes for engaging lower income mothers and their children.

Adult↗
PubMed2004

Stepped-care, community clinic interventions to promote mammography use among low-income rural African American women.

Few studies have investigated community clinic-based interventions to promote mammography screening among rural African American women. This study randomized older low-income rural African American women who had not participated in screening in the previous 2 years to a theory-based, personalized letter or usual care; no group differences in mammography rate were evident at 6-month follow-up. Women who had not obtained a mammogram were then randomized to a tailored call delivered by community health care workers or a tailored letter. There were no group differences in mammography rates after the second 6-month follow-up. However, among women who had never had a mammogram, the tailored call was more effective in promoting mammography use. Tailored counseling may be an effective screening promotion strategy for hard-to-reach rural African American women with no history of screening. Further research into this strategy may facilitate efforts to reduce health disparities in underserved low-income rural African American populations.

Black or African American↗
PubMed2006

Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites.

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness. However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with "nested" data.

Aged↗
PubMed2006

Pathways to health: a cluster randomized trial of nicotine gum and motivational interviewing for smoking cessation in low-income housing.

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Adult↗
PubMed1989

A hospital-based infant safety seat program for low-income families: assessment of population needs and provider practices.

Evaluation of a hospital-based car safety seat education and loan program for low-income families included hospital interviews with new mothers (N = 94), a survey of pediatricians (N = 28), and a task analysis of the program coordinator's time. Mothers who entered the hospital with safety seats were more likely than those without safety seats to (1) be White or Mexican-American than Black; (2) not be dependent on public transportation; (3) have an older child who always rides in a car seat; and (4) wear seat belts themselves. Mothers with seats did not differ from mothers without seats in knowledge or beliefs about the importance of, or intent to use, car seats. Of mothers without seats, 86.3% were aware of the hospital's car seat rental program, but only 12 of 51 rented a seat from the program. 61% of pediatricians surveyed believed that mothers' lack knowledge and skills to acquire and use car seats regularly, but only 31% always included education about the importance of using car seats and only 21% always referred mothers without seats to the rental program. Car seat loan programs addressing low-income populations should place greater emphasis on education of medical providers to provide education and referrals, encourage organizational policy that requires a safe first ride home and address issues of social support and perceived norms and ease of acquisition.

Black or African American↗
PubMed1995

Mobilizing a low-income African-American community around tobacco control: a force field analysis.

A statewide tobacco control campaign in California has been highly successful in reducing public exposure to the health hazards of secondhand smoke. Over 250 cities and counties in California have enacted local ordinances to regulate smoking in public places and workplaces. Although low-income people of color are disproportionately affected by the use of tobacco, the issue of regulating secondhand smoke tends to be a lower priority in communities that are confronted by other, more immediately pressing social justice issues, such as high rates of violence and lack of economic opportunity. This article describes the process undertaken by a county health department to mobilize a low-income African American community in a San Francisco Bay Area city to support a local ordinance mandating 100% smoke-free workplaces and restaurants. These efforts are more likely to succeed if health advocates (1) reframe issues in a context that acknowledges the political, economic, and social justice realities and strengths of the community; (2) organize within existing local networks and foster the integration of tobacco issues into the group's existing work; and (3) can defer their own agendas during times of community grieving and healing.

Advertising↗
PubMed2006

Conceptualization and development of a theory-based healthful eating and physical activity intervention for postpartum women who are low income.

Eating and physical activity behaviors that confer risk for chronic disease are prominent among women from varying ethnic and racial groups who are low income. Conceptualization and development of a theory-based behavioral intervention to address their unique needs during the first year following childbirth comprised four steps: (a) translating public health guidelines and emerging epidemiologic data into specific intervention messages; (b) developing practical strategies to operationalize theoretical constructs, in the context of a social ecological framework; (c) stating achievement-based objectives and writing scripts for five home visits; and (d) conducting formative research. Focus group participants expressed a desire for a "health mentor," not somebody who "nags" or "stresses you out." Paraprofessionals from the Expanded Food and Nutrition Education Program (EFNEP) were directly involved in pretesting the intervention and remain involved as health mentors. This intervention can serve as a basis for future organizational partnerships to benefit the health of populations who are low income.

Adult↗
PubMed2005

Low-income housing policy and socioeconomic inequalities in women's health: the importance of nursing inquiry and intervention.

Decent, affordable housing is the building block of healthy neighborhoods. Housing characteristics not only shape the quality of life in communities but also affect individual and family health. The structural and social aspects of housing have a significant impact on the health of individuals and populations. Early public health nursing pioneers such as Lillian Wald and Jane E. Hitchcock understood the adverse impact of substandard housing on population health and incorporated advocacy for housing and other social policy reforms as an integral aspect of their nursing interventions. Contemporary nursing literature, however, is lacking in its critical examination of relationships between housing and health. This article presents historical and current issues in low-income housing policy, discusses how low-income housing policy has contributed to social inequalities in health, and advocates for the importance and inherent value of nursing inquiry and intervention in this area.

Community Health Planning↗
PubMed2006

Use of traditional medicine and globalized complementary and alternative medicine among low-income cancer service users in Brazil.

BACKGROUND: Complementary and alternative medicine (CAM) has become increasingly high profile in prosperous countries over the past 2 decades. Alongside this has been a renewed interest in the use of traditional medicine (TM) in poorer countries. Academic attention has tended to focus on either CAM in rich countries or indigenous TM in poorer ones. However, such a differentiation leads to a potential to gloss over global complexities, such as the study of countries where both CAM and TM are a potentially significant part of health options. Brazil is just such a country. Brazil is marked by massive socioeconomic inequalities; cancer is its second highest cause of death. To date, there has been little research on CAM/TM in cancer care in Brazil. PURPOSE: The purpose of this study is to provide the first exploratory data on the proportion of the use of CAM and/or TM among low-income cancer service users in Brazil. METHOD: A survey of cancer patients was conducted in November 2004 in a public-sector hospital in a major city in Brazil. A random sample (n = 92) was generated from a list of all appointments scheduled during that month (n = 570). Eighty-nine of the 92 patients contacted (97%) completed the questionnaire. RESULTS: Of the sample, 62.9% had used at least 1 form of CAM or TM. However, this headline figure is potentially misleading. The data reveal an almost total absence of use of non-indigenous international CAM; it also shows prayer to be a major contributor to the relatively high use rate. DISCUSSION: On the basis of this small-scale exploratory study, there is no evidence that those international CAMs ubiquitous in the West are spreading to low-income cancer service users in Brazil (despite anecdotal evidence of its increasing presence in the country generally). Moreover, when excluding prayer, use of indigenous traditional medicine was found to be relatively low. Further research is needed to examine these findings on a larger scale and to explore the relative importance of social, cultural, and economic factors behind them.

Brazil↗
PubMed2006

Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy.

BACKGROUND: We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy". METHODS: Survey of risk factors using an age- and sex-stratified random sample of the population of Seychelles aged 25-64 in 2004. Assessment of CVD risk and treatment modalities were in line with international guidelines. Costs are expressed as USD per capita per year. RESULTS: 1255 persons took part in the survey (participation rate of 80.2%). Prevalence of main risk factors was: 39.6% for high blood pressure (> or =140/90 mmHg or treatment) of which 59% were under treatment; 24.2% for high cholesterol (> or =6.2 mmol/l); 20.8% for low HDL-cholesterol (<1.0 mmol/l); 9.3% for diabetes (fasting glucose > or =7.0 mmol/l); 17.5% for smoking; 25.1% for obesity (body mass index > or =30 kg/m2) and 22.1% for the metabolic syndrome. Overall, 43% had HBP, high cholesterol or diabetes and substantially increased CVD risk. The cost for medications needed to treat all high-risk individuals amounted to USD 45.6, i.e. 11.2 dollars for high blood pressure, 3.8 dollars for diabetes, and 30.6 dollars for dyslipidemia (using generic drugs except for hypercholesterolemia). Cost for minimal follow-up medical care and laboratory tests amounted to 22.6 dollars. CONCLUSION: High prevalence of major risk factors was found in a rapidly developing country and costs for treatment needed to reduce risk factors in all high-risk individuals exceeded resources generally available in low or middle income countries. Our findings emphasize the need for affordable cost-effective treatment strategies and the critical importance of population strategies aimed at reducing risk factors in the entire population.

Adult↗
PubMed2004

Self-help: What future role in health care for low and middle-income countries?

In the debate on 'Third options' for health care delivery in low- and middle-income countries it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform.Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a de-personalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure.In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as self-help groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems - they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.

Editorial↗
PubMed2003

Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies.

Journal Article↗
PubMed2007

Contribution of low- and middle-income countries to research published in leading general psychiatry journals, 2002-2004.

We aimed to describe the contribution of low- and middle-income (LAMI) countries to leading general psychiatric journals. We reviewed original research published over a 3-year period (2002-2004) in the six highest-impact general psychiatry journals and contacted editorial offices to gather data on country of origin of submitted and accepted articles. Only 3.7% of published research emerges from these less affluent countries, which account for over 80% of the global population. Compared with the findings of a similar review of the period 1996-1998, there has been little change. The three European journals had a higher representation than the three American journals. The proportion of psychiatrists in a country was associated with that country's research output. As much as 50% of the research from LAMI countries is led by authors from high-income countries. The proportion of submissions from LAMI countries was very low, and articles from them were more frequently rejected. Strengthening the research capacity of these countries and reviewing the editorial policies of leading journals can help increase the international representation of LAMI countries in psychiatric research.

Bibliometrics↗