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PubMed1988

Dental caries and periodontal disease among Mexican-American children from five southwestern states, 1982-1983.

Analysis of Southwestern HHANES data showed that the prevalence of dental caries among Mexican-American children is similar to that of children of the same age examined during the NIDR survey (1979-1980), despite a lower level of restorative treatment. Approximately 50% of Mexican-American children 17 years of age, however, had five or more teeth that were either decayed or filled. Occlusal surfaces of molars were the most susceptible teeth to decay; few anterior teeth were affected. This distribution of dental caries strongly supports the use of fissure sealants on molar teeth. Children from low-income families had two times more decayed teeth than children from high-income families. Mild gingivitis and poor oral hygiene were more prevalent in the Mexican-American children than in the child population for the region examined during NHANES I in 1971-1974. Children from high-income families had better periodontal health than those from low-income families.

Adolescent↗
PubMed2001

[Epidemiology of cervix uteri cancer in Latin America].

Uterine cervical cancer in Latin American women is a serious health problem. It is the first cause of death among women in their productive years. The programs of early detection haven't improved the survival rates, and so, there is a high prevalence of women with advanced stages of the disease. Hispanic people living in Southern of USA and Central America have an important increase up to three-fold the incidence and mortality attributable to cervical cancer. Poor coverage of cervical cancer detection in Latin American women, low income, population overgrowth, malnutrition and poor sexual education among high risk groups, are the main reasons that threatens survival.

Adult↗
PubMed1997

The role of access in explaining state abortion rates.

The likelihood of having an abortion in the U.S.A. is strongly dependent upon where a woman lives. Abortion rates vary markedly from state to state, and these variations have been increasing, especially in recent years. Path analysis shows the causal structure of public demand and access variables that determined state abortion rates in 1991 and 1992. Access variables, including the restrictiveness of state laws regulating abortion, state funding of abortions for poor women and the availability of hospital abortions, affect abortion rates directly. Greater accessibility leads to higher abortion rates. Public demand variables affect abortion rates both directly and indirectly through access conditions. The number of women at risk of unintended pregnancies leads to higher abortion rates directly and indirectly through its effects on medical access. Per capita income, percent Catholic, and percent of the population born outside the state affect abortion rates indirectly through the access variables. High per capita income leads directly to greater availability of hospital abortions, higher levels of state funding of abortions for poor women, less restrictive state abortion laws, and indirectly to higher abortion rates. States with large non-native populations have less restrictive abortion laws and higher abortion rates. The presence of a large Catholic population reduces the number of hospitals offering abortion services and leads indirectly to lower abortion rates. The interaction of public demand and access at the state level creates geographically varying environments in which abortion decisions are made.

Abortion, Legal↗
PubMedDate not supplied

An assessment of contraceptive need in the inner city.

A survey of low-income areas of Los Angeles County indicates that 41 percent of nonsterile women in their childbearing years who had not made a family planning visit in three years were using some means of birth control, 21 percent were not, 25 percent were not sexually active and 13 percent were pregnant or trying to become pregnant. Given that approximately 10 percent of the respondents were using unreliable means of contraception, at least one-third of respondents were in need of effective contraception. This proportion corresponds roughly to the percentage of respondents who expressed a desire to receive family planning care from a doctor or clinic (34 percent). The percentage of women who were at risk of unwanted pregnancy but not using any method of contraception was greatest among those with incomes below poverty level and among black and Hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a family planning visit shows that those who utilized formal family planning services were substantially more likely than those who did not to be married (40 percent vs. 32 percent) and to belong to a health maintenance organization (24 percent vs. 14 percent), whereas nonusers of formal family planning services were slightly older, on average (29.6 years vs. 28.0 years), and more likely to have other types of private health insurance (47 percent vs. 25 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

The vanishing weight gap: trends in obesity among adult food stamp participants (US) (1976-2002).

High rates of obesity among low-income populations have led some to question whether USDA's food assistance programs have contributed to this health problem. Using data from National Health and Nutrition Examination Surveys (NHANES), this study shows that the association between food assistance program participation and body weight measures has weakened over the past three decades. Earlier NHANES data show that program participants were more likely to be overweight than individuals who were eligible but not participating in the program. This was particularly true among white women. However, the more recent data show that these differences have vanished, as the BMI of the rest of the population has caught up to BMI levels of food stamps recipients.

Adult↗
PubMed1982

An epidemic of Kawasaki syndrome in Hawaii.

A community-wide outbreaks of Kawasaki syndrome, apparently the first in the United States, occurred in Hawaii in the first half of 1978. Twenty-seven of the 33 cases were subjected to intensive epidemiologic and microbiologic study. Patients with Kawasaki syndrome, compared to the general population, more often had Japanese ancestry, high-income status, and possibly a history of respiratory infection in the preceding month (44%). Staphylococcus aureus was not found in high frequency in the patients (15%), and viral cultures and serologic studies, immune electron microscopy, and guinea pig and primate inoculation did not reveal a causative microorganism. Febrile illnesses in guinea pigs inoculated with a skin biopsy specimen should not be further passaged.

Child↗
PubMedDate not supplied

Measuring attitudes and health beliefs among Mexican Americans with diabetes.

Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare practitioners, particularly when dealing with the high-risk, low-income, Mexican-American population. Assessing the attitudes and beliefs of this group is vital for planning effective and realistic intervention strategies. Therefore, we designed a culturally sensitive instrument to measure health beliefs and attitudes of low-income Mexican Americans with diabetes. The Health Belief Model (HBM) was used as a basis for this study because it is well accepted as a predictor of health-related behaviors. However, we found that the HBM was not an effective tool for assessing the health beliefs or attitudes of this patient population even after rigorous efforts to operationalize the HBM and after conducting extensive statistical analyses. Only two of the five subscales of the traditional HBM, barriers and benefits, were reliable. Scales to measure acculturation and fatalism were added to increase the cultural sensitivity of the tool. These added components were found to be an important variable in interpreting the results for low-income Mexican-American patients.

Adolescent↗
PubMed2005

Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities.

Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

Adaptation, Psychological↗
PubMed1976

Rates and correlates of expenditure increases for personal health services: pre- and post-medicare and medicaid.

This investigation of the increases in expenditures for medical care of the noninstitutionalized population of the United States in two recent periods suggests the following: Price increases contributed substantially more to overall expenditure increases in both periods than did use increases. Hospital price increases contributed most to overall price increases in both periods. Drug use in the first period and hospital use in the second period contributed most to overall use increases. The so-called "free services" made a substantial contribution to increases in use between 1963 and 1970, while apparently making no contribution in the earlier period. In the pre-Medicare/Medicaid period, use increase were greatest among the working-age and male population. However, increases in use also seemed to be relatively high among the low-income group. In the most recent period, use increases shifted not only to the elderly and the very young, but also to the group 55-64. The relatively high rate of use increase for males and the low-income group continued. These findings, then, suggest that institution of the Medicare and Medicaid programs was accompanied by acceleration of some trends that were already taking place, i.e., relatively high rates of increase in the use of health services for the low-income population and the aged. Some groups not considered to be target populations for the programs, such as those 35-54, showed a reduction in their use rates; others those 55-64, increased their use. Finally, the non-white population showed no greater rate of increase in use of health services than the white population, even though the former would presumably be considered a target group.

Adolescent↗
PubMedDate not supplied

Risk status and pregnancy outcome among medicaid recipients.

Although Medicaid has increased access to medical care for low-income pregnant women, the Medicaid population remains at high risk for poor pregnancy outcomes. In 1983 the Michigan Department of Public Health conducted 1 week of in-hospital, postpartum interviews addressing risk factors for poor pregnancy outcome among 1,945 women. These births represented over 90% of the births during the study period and constituted a sample of approximately 1.5% of the yearly births in Michigan. Of these women, 24.6% reported receiving Medicaid during pregnancy. The demographic characteristics of the Medicaid women placed them at greater risk for poor pregnancy outcomes than either insured or uninsured women. In terms of medical services, Medicaid recipients began prenatal care later and had fewer visits. In terms of behavioral risks, more Medicaid recipients reported tobacco and alcohol use than did the other mothers. Finally, the infants of Medicaid recipients were 200 g lighter than the other infants. We suggest that the Medicaid program--the major source of prenatal health care for these women--is not adequate to address their risks for poor pregnancy outcomes.

Adolescent↗
PubMed2003

Who are the high hospital users? A Canadian case study.

OBJECTIVES: Researchers have taken two different approaches to understanding high use of hospital services, one focusing on the large proportion of services used by a small minority and a second focusing on the poor health status and high hospital use of the poor. This work attempts to bridge these two widely researched approaches to understanding health care use. METHODS: Administrative data from Winnipeg, Manitoba covering all hospitalizations in 1995 were combined with public use Census measures of socio-economic status (neighbourhood household income). High users were defined as the 1% of the population who spent the most days in hospital in 1995 (n = 6487 hospital users out of population of 648715 including non-users). RESULTS: One per cent of the Winnipeg population consumed 69% of the hospital days in 1995. Thirty-one per cent of the highest users were among the 20% of residents of neighbourhoods with the lowest household incomes, and 10% of the highest users were among the 20% from neighbourhoods with the highest household incomes. However, on most other dimensions, including gender, age, average days in hospital, average admissions, percentage who died in hospital and diagnostic reasons for being hospitalized, the similarities between high users, regardless of their socio-economic group, were striking. CONCLUSIONS: The lower the socio-economic status, the more likely an individual is to make high demands on hospitals. However, patterns of use as well as the diseases and accidents that produce high use among residents of low income neighbourhoods are not much different from those that produce high use among residents of high income neighbourhoods.

Adolescent↗
PubMed2005

Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study.

BACKGROUND: Diabetes is the sixth leading cause of death and results in significant morbidity. The purpose of this study is to determine what demographic, health status, treatment, access/quality of care, and behavioral factors are associated with poor glycemic control in a Type 2 diabetic, low-income, minority, San Diego population. METHODS: Longitudinal observational data was collected on patients with Type 2 diabetes from Project Dulce, a program in San Diego County designed to care for an underserved diabetic population. The study sample included 573 patients with a racial/ethnic mix of 53% Hispanic, 7% black, 18% Asian, 20% white, and 2% other. We utilized mixed effects models to determine the factors associated with poor glycemic control using hemoglobin A1C (A1C) as the outcome of interest. A multi-step model building process was used resulting in a final parsimonious model with main effects and interaction terms. RESULTS: Patients had a mean age of 55 years, 69% were female, the mean duration of diabetes was 7.1 years, 31% were treated with insulin, and 57% were obese. American Diabetes Association (ADA) recommendations for blood pressure and total cholesterol were met by 71% and 68%, respectively. Results of the mixed effects model showed that patients who were uninsured, had diabetes for a longer period of time, used insulin or multiple oral agents, or had high cholesterol had higher A1C values over time indicating poorer glycemic control. The younger subjects also had poorer control. CONCLUSION: This study provides factors that predict glycemic control in a specific low-income, multiethnic, Type 2 diabetic population. With this information, subgroups with high risk of disease morbidity were identified. Barriers that prevent these patients from meeting their goals must be explored to improve health outcomes.

Age Factors↗
PubMed2003

The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life.

The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Multicenter randomized, controlled trial of a preterm birth prevention program. Collaborative Group on Preterm Birth Prevention.

OBJECTIVE: The results of a randomized, controlled trial of a preterm birth prevention program at five centers with primarily low-income populations are presented. STUDY DESIGN: Pregnant women at high risk for preterm labor were independently randomized into intervention and control groups at each of five centers (2395 women). Specially trained staff instructed women in the intervention group to recognize early signs of preterm labor and to notify the staff should any sign of preterm labor occur, and women came in weekly for pelvic examinations after 20 to 24 weeks' gestation. Because the intervention had very different and contrary effects on preterm birth rates across these sites, the analysis focused on patient risks and on measures of the process of care as possible explanations for the differences in outcomes. RESULTS: The observed spontaneous preterm birth rates, when averaged for all sites, were not lower in the intervention group than in the control groups (16.1% vs 15.4% for < 37 completed weeks' gestation, 11.9% vs 10.9% for < 36 completed weeks). There was substantial heterogeneity of program effects between centers (p < 0.01 for homogeneity test statistic). The differences in intervention effects between centers were explainable only in part by patient risk characteristics (p < 0.10 for homogeneity test statistic). The only intermediate measure of the process of care that tended to differentiate among sites with positive intervention effects was the rate of hospital admission for preterm labor. Sites with elevated admission rates in the intervention group versus the control group tended to have negative intervention effects on outcomes. CONCLUSION: Because the preterm birth prevention program did not show a reliable benefit and because the reasons for varied outcomes are not understood, the use of the program cannot be recommended for predominantly low-income populations.

Female↗
PubMedDate not supplied

Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory.

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Black or African American↗
PubMed1981

The economic implication in pregnancy outcome.

The economic implication in pregnancy outcome is evaluated in a Spanish homogeneous population. The potential risk is assessed for: prematurity, intrauterine growth retardation, perinatal mortality and major malformation. The husband's employment appears worthless as an economic parameter. The best estimators of economic level in our population are the total income per capita and the monthly food allowance per capita. Study results clearly support the relationship between poverty and prematurity, intrauterine growth retardation and major malformation. No correlation is found between perinatal mortality and lower economic conditions, which differs from previous reports. The author suggests that perinatal problems be differentiated from each other in studies of risk factors.

Congenital Abnormalities↗