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PubMed2006

The schizophrenia drug-treatment paradox: pharmacological treatment based on best possible evidence may be hardest to practise in high-income countries.

Most people with schizophrenia live in low- and middle-income countries in which clinicians/policy makers are not the first targets of marketing. Because it is years after a drug is first launched that the full effects become known with confidence, the evidence upon which to base practice in low- and middle-income countries may be less biased than that in richer nations.

Developed Countries↗
PubMed2005

Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer.

PURPOSE: To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer, receipt of antidepressant medications or counseling services, and correlates of depression. PATIENTS AND METHODS: Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (stage 0 to III) or gynecologic cancer (International Federation of Gynecology and Obstetrics stage 0 to IIIB). A diagnostic depression screen and baseline questionnaire were administered before or during active treatment or during active follow-up. Self-report data were collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care. RESULTS: Twenty-four percent of women reported moderate to severe levels of depressive disorder (30% of breast cancer patients and 17% of gynecologic cancer patients). Only 12% of women meeting criteria for major depression reported currently receiving medications for depression, and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage nor treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social and family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression. CONCLUSION: Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecologic cancer is prevalent and is correlated with pain, anxiety, and health-related quality of life. Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation, and treatment in this population.

Adult↗
PubMed2001

A prospective study of the impact of stress on quality of life: an investigation of low-income individuals with hypertension.

The role that major and minor life events play in the quality of life in low-income hypertensives was examined. Participants were randomly recruited from 2 primary care clinics at a public medical center. The study utilized a prospective design. Participants were determined to have hypertension and were being treated with antihypertensive medication prior to and throughout the duration of the study. Participants were administered the Life Experiences Survey and the Weekly Stress Inventory repeatedly during Year 1 to assess major and minor stress, respectively. Participants were repeatedly administered the RAND 36-Item Health Survey during Year 2 to assess quality of life. Usable data were obtained from 183 patients. Analyses revealed that major and minor stress were significant predictors of all measured domains of quality of life, even after age and number of chronic illnesses were statistically controlled. Minor stress contributed uniquely to the prediction of each dimension of quality of life even when age, number of chronic illnesses, and major life events were accounted for. Findings suggest that stress has a significant, persistent impact on the quality of life of low-income patients with established hypertension. These findings extend prior research that has examined the impact of medications on quality of life and suggest that stress needs to be accounted for as well.

Female↗
PubMed2006

Information-Motivation-Behavioral Skills (IMB) Model: testing direct and mediated treatment effects on condom use among women in low-income housing.

BACKGROUND: The Information-Motivation-Behavioral Skills (IMB) model of HIV preventive behavior (1-4) specifies that treatment effects on behavior occur largely as the result of treatment effects on behavioral skills, which follow from effects on information and motivation. PURPOSE: The objective was to determine whether the variables specified by the IMB model of HIV preventive behavior (1-4) accounted for the relation between an IMB-based treatment and resulting HIV preventive behavior (condom use). METHOD: Women (n = 557) living in 18 low-income housing developments in 5 geographically dispersed cities were recruited to participate in an HIV-prevention study. Women (within housing developments) were randomly assigned to receive an IMB-based, HIV risk-avoidance intervention or a comparison intervention. Baseline and posttreatment (16 months after baseline) data were collected on condom use information, motivation (social norms, attitudes, intentions, and perceived risk), enactment of behavioral skills (condom negotiation and procurement), and rates of condom use in the past 2 months. RESULTS: The IMB intervention led to a 12% to 16% increase in condom use rates over the course, whereas the comparison intervention led to 2% decrease. In addition, the IMB treatment led to greater increases in condom use information, in the intentions and social norms components of motivation and the condom procurement and condom conversations components of behavioral skills. The IMB model provided an acceptable fit to the data (root mean square error of approximation < .05) and accounted for 50% of the variance in posttreatment condom use among the sample. Treatment effects on condom use were almost entirely mediated by the IMB variables; specifically, motivation and enactment of behavioral skills mediated the intervention's impact on condom use. CONCLUSIONS: These results provide supporting evidence as to how theoretical variables operate to effect change within a theory-based intervention and provide evidence as to the applicability of a prevailing theory of HIV risk behavior among low-income minority women.

Adolescent↗
PubMed1995

Opportunities for older children and adolescents with disabilities through the Supplemental Security Income Program.

The revitalization of the Supplemental Security Income Program for low-income children with disabilities has important implications for state Title V programs for children with special health care needs. Historically, this program has focused primarily on recipients under the age of 7. The files of children between the ages of 7 and 16 referred to Children's Special Health Services, North Carolina's Title V children with special health care needs program from July to August 1991 were analyzed to determine whether there was documentation that children in this age group were receiving recommended services. Reports in the files indicated that most (n = 214, 77%) of the children's needs for specific services were being met. The utility of information that currently exists on older children and adolescents eligible for SSI for assisting Title V children with special health care needs programs in coordinating care is discussed.

Adolescent↗
PubMed1999

Mammography adherence and beliefs in a sample of low-income African American women.

The purpose of this article is to describe the relation of perceptions of perceived breast cancer risks and perceived benefits and barriers to mammography and stage of mammography adherence in a convenience sample of low-income African American women. The theoretical framework of the Health Belief Model and the Transtheoretical Model were used to identify concepts and stage of mammography adherence. Data were obtained in waiting rooms of multipurpose centers. Scores for susceptibility and benefits were lowest for those who were in (a) precontemplation (had not thought about having a mammogram); as compared to (b) contemplation (had thought about having a mammogram, but not yet acted); (c) action (had a mammogram as recommended by the American Cancer Society); and (d) relapse (had a mammogram in the past, but overdue). Barriers scores were highest for those who had not had a mammogram (precontemplators and contemplators). In addition, individual barriers were significantly lower for women in action. Results have implications for interventions to increase screening in low-income African American women.

Journal Article↗
PubMed1991

Stressors and coping behaviors of homeless, poor, and low-income mothers.

Homeless mothers and their children have become a highly politicized issue. This article presented a study comparing the stressors and coping behaviors of homeless women with their domiciled counterparts, low-income and poor mothers. The results of the study indicated that although homeless, poor, and low-income mothers cope in a similar manner, homeless mothers were considerably more disadvantaged in terms of education, family size, and work history, and were besieged by many more stressors. These results suggest that CHNs must design interventions that are not only interdisciplinary in nature and use the expertise of many professional groups but also influence the communities' political and decision-making bodies.

Adaptation, Psychological↗
PubMed1998

Breastfeeding among low-income women with and without peer support.

This research examined the effect of peer support on breastfeeding duration and exclusivity (breastfeeding without supplements) in a population of low-income women during the first 3 months postpartum. Participants in the peer counselor group (n = 18) exhibited higher rates of exclusive breastfeeding across time than those without a counselor (n = 18), and more exclusive breastfeeding was associated with long duration overall. Mother's career plans had the greatest effect on duration of breastfeeding. Women who intended to return to work, attend school, or both breastfed 6 to 9 weeks less than participants who intended to stay home. Attendance at a breastfeeding class and knowing someone who had breastfed was significantly correlated with a longer duration of breastfeeding. Nutritionists from the Women, Infants and Children (WIC) Program were the primary source of breastfeeding information. Two main factors discouraged women from breastfeeding: returning to work, school, or both and the perception of a diminished milk supply. Greater emphasis should be placed on prenatal breastfeeding education for low-income women, and their mothers and grandmothers should be included. Peer support is one important component of social support in the area of breastfeeding that community health nurses (CHNs) can utilize. CHNs are in a unique position to assist working mothers, provide support, and develop educational programs to enhance breastfeeding success in this population.

Adolescent↗
PubMed2002

Early problem behavior among children from low-income, mother-headed families: a multiple risk perspective.

Examined proximal and contextual factors most strongly related to externalizing behavior among young children growing up in low-income, mother-headed families. Participants were 50 low-income single mothers and their preschool-age children who were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high levels of punitive disciplinary practices, low levels of maternal emotional well-being) and contextual (low maternal support, high levels of family stress) risk were assessed in relation to maternal reports of child externalizing behavior and an index of negative child behavior during a clean-up task. Child defiance during the clean-up task was highly associated with punitive maternal control in the same situation but had no other direct correlates. However, multiple risk factors representing both proximal and contextual variables were associated with variations in children's behavior problem scores. Mothers of children with high behavior problem scores reported lower feelings of self-efficacy in handling child care and emotional stressors, more frequent use of punitive child disciplinary practices, and lower feelings of satisfaction with the quality of their supportive resources than others. Maternal self-evaluations of coping efficacy mediated the relation between perceived support and child behavior problems, suggesting that constructs of personal control are important to represent in future studies of highly stressed parents.

Adaptation, Psychological↗
PubMed2000

Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population.

This report examines the wintertime vitamin D and PTH status of 308 participants in the Boston Low Income Elderly Osteoporosis Study of noninstitutionalized low income elderly men and women (age, 64-100 yr) living in subsidized housing in Boston, MA. Twenty-one percent of the 136 black subjects and 11% of the 110 whites had very low plasma 25-hydroxyvitamin D (25OHD) concentrations (<25 nmol/L), and 73% of the blacks and 35% of the whites had 25OHD concentrations less than 50 nmol/L. The mean 25OHD levels of the smaller Hispanic and Asian subsets were generally similar to those of the white subjects. In addition to race, significant predictors of 25OHD included vitamin D intake (positive association) and smoking (inverse association), but not sex or age. Low 25OHD concentrations were associated with increased PTH and reduced serum calcium. The PTH level in the black subjects was substantially higher than that in the white subjects, and this difference was only partially explained by the racial difference in 25OHD. Elderly individuals who live in northern areas, particularly African-Americans, should be strongly encouraged to increase their vitamin D intake, especially in winter.

Activities of Daily Living↗
PubMed2000

Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program.

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.

Breast Neoplasms↗
PubMed2001

Effects of physical interventions on house dust mite allergen levels in carpet, bed, and upholstery dust in low-income, urban homes.

House dust mite allergen exposure is a postulated risk factor for allergic sensitization, asthma development, and asthma morbidity; however, practical and effective methods to mitigate these allergens from low-income, urban home environments remain elusive. The purpose of this study was to assess the feasibility and effectiveness of physical interventions to mitigate house dust mite allergens in this setting. Homes with high levels of house dust mite allergen (Der f 1 + Der p 1 > or = 10 microg/g dust by enzyme-linked immunosorbent assay) in the bed, bedroom carpet, and/or upholstered furniture were enrolled in the study. Carpets and upholstered furniture were subjected to a single treatment of either dry steam cleaning plus vacuuming (carpet only) or intensive vacuuming alone. Bed interventions consisted of complete encasement of the mattress, box spring, and pillows plus either weekly professional or in-home laundering of nonencased bedding. Dust samples were collected at baseline and again at 3 days (carpet and upholstery only) and 2, 4, and 8 weeks posttreatment. We compared pretreatment mean allergen concentrations and loads to posttreatment values and performed between-group analyses after adjusting for differences in the pretreatment means. Both dry steam cleaning plus vacuuming and vacuuming alone resulted in a significant reduction in carpet house dust mite allergen concentration and load (p < 0.05). Levels approached pretreatment values by 4 weeks posttreatment in the intensive vacuuming group, whereas steam cleaning plus vacuuming effected a decrease that persisted for up to 8 weeks. Significant decreases in bed house dust mite allergen concentration and load were obtained in response to encasement and either professional or in-home laundering (p < 0.001). Between-group analysis revealed significantly less postintervention house dust mite allergen load in professionally laundered compared to home-laundered beds (p < 0.05). Intensive vacuuming and dry steam cleaning both caused a significant reduction in allergen concentration and load in upholstered furniture samples (p < 0.005). Based on these data, we conclude that physical interventions offer practical, effective means of reducing house dust mite allergen levels in low-income, urban home environments.

Allergens↗
PubMed2002

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

Air Pollution, Indoor↗
PubMed1994

Contraceptive risk-taking in a medically-underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the non-use of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking, and also compared levels of contraceptive knowledge and pregnancy histories of non-contraceptors versus barrier method contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger and for those whose knowledge of the fertility cycle is incorrect, but was found to be only weakly related to the women's marital status. Non-contraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to non-use of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a sub-group of the medically-underserved low-income population.

Adolescent↗
PubMed1994

Health promotion behavior in low income black and Latino women.

Health promotion behaviors were examined in a sample of low-income, Black and Latino women. Latino women were more likely than Black women to eat a daily breakfast; sleep 7-8 hours per night and abstain from alcohol and tobacco use. Black women were more likely to be eating vegetables on a regular basis and exercising at least once per week. The results suggest that low-income Latino women may need to increase their consumption of vegetables and frequency of exercise. Among Black women, a wider range of healthy lifestyle behaviors such as sleeping eight hours per night, eating a daily breakfast and decreasing alcohol and tobacco consumption may need to be emphasized.

Adult↗
PubMed1999

Interpersonal violence in a "normal" low-income control group.

This paper examines the rates of interpersonal violence and trauma reported in a sample of 98 urban, low-income women, predominantly Latina or African-American descent constituting a "normal" control group for a larger study on drug abuse and violence. This sample was recruited from the obstetrics-gynecology outpatient clinic at St. Luke's-Roosevelt Hospital Center in New York City and carefully screened for the absence of any DSM-IV Axis I psychopathology including major mood disorders, anxiety, psychotic, alcohol and substance use disorders. Consistent with the literature, our sample exhibited rates of interpersonal violence and trauma markedly above estimates for women nationwide; compared to such national figures, our sample was at higher risk for experiencing childhood sexual abuse, childhood physical abuse, and partner violence. Almost one-quarter of our sample met diagnostic criteria for lifetime post-traumatic stress disorder. Ten to twenty percent of our sample reported other kinds of trauma, such as witnessing a murder, seeing violence between her parents, or being homeless. Interestingly, women in our sample were more likely than women nationwide to tell someone else of their abuse or trauma; it may be that disclosure of such events to a supportive person has protected these women to a certain extent from some of the longer-term potential effects of such negative experiences. The data collected in this study underscore the need for mental health and medical professionals to be sensitive to the high prevalence of certain kinds of traumatic and violent experiences in the lives of inner-city, low-income, minority women.

Adult↗
PubMed2002

Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women.

The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.

Adult↗
PubMed2004

Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: I. Methods and context.

OBJECTIVE: In this paper, we present the background, hypotheses, methods, and descriptive findings from the Austin New Mothers Study, a longitudinal series measuring weight and contextual variables across the first postpartum year. Among the distinguishing features of this study are its tri-ethnic sample of low-income women and its serial measurement of the behavioral and psychosocial context of postpartum weight changes post-delivery and at 6 weeks, and 3, 6, and 12 months postpartum. METHOD: A prospective longitudinal design was used to assess body mass index (BMI), energy intake, fat intake, physical activity, health-related lifestyle, depressive symptoms, body image, and weight-related distress at each observation. SAMPLE: The analytic sample consisted of 382 White, African American, and Hispanic women. FINDINGS: For BMI, effects for ethnicity (p < .001), time (p < .001), and their interaction (p = .005) were significant. All ethnic groups had significant declines in BMI from delivery to 6 weeks postpartum. Thereafter, BMIs of White women declined during the second 6 months, whereas those of Hispanic and African American women either displayed small gains or plateaus between adjacent observations. Time-related effects were significant for behavioral and psychosocial variables except for body image and weight-related distress, whereas effects for ethnicity were significant on fat intake, depressive symptoms, and body image. Despite declines in depressive symptoms, women remained at risk of depression across the first postpartum year. CONCLUSIONS: Low-income ethnic minority women have a higher vulnerability to postpartum weight gains or plateaus. High depressive symptoms occurred in all ethnic groups examined.

Adult↗