Preconception Health Behaviors of Low-Income Women.

PubMed

Ayoola, Adejoke B; Sneller, Krista; Ebeye, Tega D; Dykstra, Megan Jongekrijg; Ellens, Victoria L; Lee, HaEun Grace; Zandee, Gail L

2016-01-01

Preconception behaviors have a significant impact on birth outcomes, particularly among low-income minority groups, and women with unplanned pregnancies. This study examined women's perceived health status and behaviors such as drinking, smoking, exercise, and use of multivitamins and folic acid. This was a descriptive study based on a convenience sample of women living in urban underserved neighborhoods. Univariate and bivariate analyses were conducted using STATA 13. The sample consisted of 123 women ages 18 to 51 years (mean = 30.57); 51.22% were Hispanic, 36.59% African American, and 12.2% Caucasian. Over 70% had a household income of less than $20,000, 57.72% had no health insurance in the last year, and 58.54% were not married. These women were below the Healthy People 2020 goals for drinking, smoking, and multivitamin use, especially those who were planning to get pregnant in the next 6 months or not sure of their pregnancy planning status. There were no significant differences on any of the preconception health behavior variables based on pregnancy intention. Nurses and healthcare providers should emphasize importance of practicing healthy behaviors during the preconception period among low-income ethnic minority women specifically those living in urban medically underserved areas who are unsure of their pregnancy planning status or are at risk of unintended pregnancy.

Low Income Women and Physician Breastfeeding Advice: A Regional Assessment

ERIC Educational Resources Information Center

Stolzer, J; Zeece, Pauline

2006-01-01

Objectives: The aims of the pilot study presented here were to determine whether low income women were receiving compendious breastfeeding advice from their attending physicians. Design: This study assessed low income women's reports of physician breastfeeding advice using a newly designed Likert scaled survey based on the American Surgeon…

Prevalence of Food Addiction Among Low-Income Reproductive-Aged Women.

PubMed

Berenson, Abbey B; Laz, Tabassum H; Pohlmeier, Ali M; Rahman, Mahbubur; Cunningham, Kathryn A

2015-09-01

Hyperpalatable foods (i.e., high in salt, sugar, or fat) have been shown to have addictive properties that may contribute to overeating. Prior studies conducted on food addiction behaviors are mostly based on white and middle-aged women. Data are not available, however, on reproductive-aged women from other races/ethnicities or low-income women. The purpose of this study was to examine the prevalence and correlates of food addiction among multiethnic women of low socioeconomic status. We conducted a cross-sectional survey of health behaviors, including food addiction according to the Yale Food Addiction Scale (YFAS) between July 2010 and February 2011 among 18- to 40-year-old low-income women attending reproductive-health clinics (N = 1,067). Overall, 2.8% of women surveyed met the diagnosis of food addiction. The prevalence of food addiction did not differ by age group, race/ethnicity, education, income, or body mass index categories, tobacco and alcohol use, or physical activity. However, it did differ by level of depression (p < 0.01). The YFAS symptom count score significantly differed by race/ethnicity (p < 0.01) with black women having higher scores than Hispanic women. Racial differences were also observed among some of the YFAS symptoms. These findings demonstrated a low prevalence of food addiction among low-income, reproductive-aged women. Racial differences were observed in the YFAS symptom count score, but not in the overall prevalence of food addition. Additionally, women with food addiction had higher levels of depression than women without food addiction.

Breast-feeding intentions among low-income pregnant and lactating women.

PubMed

Hill, Gina Jarman; Arnett, Dennis B; Mauk, Eileen

2008-01-01

Provide a better understanding of the process used by low-income pregnant/postpartum women when deciding whether to breast-feed or not. Pregnant/postpartum women admitted to an obstetrics floor completed a survey to determine breast-feeding intention (n=88). Subjects were primarily Hispanic and African American women. Beliefs and referent other were related positively to attitude and subjective norm, respectively. Subjective norm was related positively to intention to breast-feed. Breast-feeding knowledge was low. Others' opinions clearly influence feeding intentions among this population of low-income women. Inclusion of these significant others, family, and friends within the breast-feeding education process is warranted.

Sugars consumption in a low-income sample of British young people and adults.

PubMed

Ntouva, A; Tsakos, G; Watt, R G

2013-07-01

To report the consumption of non-milk extrinsic sugars (NMES) among a low-income UK sample, compare it with nationally representative estimates and examine the association between socioeconomic position and NMES consumption among low income adults.Design Secondary analysis of the Low Income Diet and Nutrition Survey (LIDNS) data. Two thousand, seven hundred and ninety-six adults and 415 young people from 2,477 households.Main outcome measures Mean NMES intakes (grams) and their percentage contribution to food energy, from dietary data collected via a 24-hour recall 'multiple pass' method. The low income sample consumed more NMES than the general population sample. The percentage of food energy from NMES exceeded the 11% target, especially among adolescents (17.2% in males, 16.3% in females). After adjusting for age, men who finished full-time education aged 16 years consumed significantly more sugar (p = 0.028), whereas those who finished aged 18 consumed significantly less sugar (p = 0.023) than the reference group (finished aged 15). No significant associations were found between NMES and socioeconomic variables in women. Compared to the general population, the nutritional disadvantage of the most deprived segments of society relates primarily to excessive NMES consumption. In men, higher educational level appears to play a protective role against high sugar intakes.

Determinants of coronary heart disease risk for women on a low income: literature review.

PubMed

Hemingway, Ann

2007-11-01

This paper is a report of a literature review of the determinants of health and health behaviour relevant to coronary heart disease risk for women living on a low income. Coronary heart disease is now recognized as the biggest killer of women in both developed and developing countries. As in men, women's mortality rates for coronary heart disease seem to be directly related to income inequality and social deprivation. The Medline, British Nursing Index, CINAHL, Cochrane Library, Psychinfo and Web of Science databases were searched from 1996 to 2006 using the search terms 'women and CHD risk', 'women and health behaviour', 'women low income and health behaviour', 'women low income and smoking', 'women low income and diet' and 'women low income and exercise'. In relation to the wider determinants of health 'women low income and CHD', 'women education and CHD', 'women employment and CHD' and 'women housing and CHD'. Seminal research reports before this period were included if they proved highly influential on later research. A narrative review was conducted. All the wider determinants of health considered had a negative impact on heart disease risk for women living on low incomes. The latter also appears to have a negative impact on health behaviour. Although the impact of the wider determinants of health on coronary heart disease risk are well-understood, their impact on health behaviour (specifically diet, exercise and smoking) is less well-understood. If effective interventions are to be designed to tackle inequalities in health, then this deficiency needs to be addressed urgently.

Food Group Categories of Low-Income African American Women

ERIC Educational Resources Information Center

Lynch, Elizabeth B.; Holmes, Shane

2011-01-01

Objective: Describe lay food group categories of low-income African American women and assess the overlap of lay food groups and MyPyramid food groups. Design: A convenience sample of African American mothers from a low-income Chicago neighborhood performed a card-sorting task in which they grouped familiar food items into food groups. Setting:…

Predictors of mammography screening among ethnically diverse low-income women.

PubMed

Cronan, Terry A; Villalta, Ian; Gottfried, Emily; Vaden, Yavette; Ribas, Mabel; Conway, Terry L

2008-05-01

Breast cancer is the second leading cause of cancer deaths among women in the United States. Minority women are less likely to be screened and more likely to die from breast cancer than are Caucasian women. Although some studies have examined ethnic disparities in mammography screening, no study has examined whether there are ethnic disparities among low-income, ethnically diverse women. The present study was designed to determine whether there are ethnic disparities in mammography screening and predictors of screening among low-income African American, Mexican American, and Caucasian women, and to determine whether the disparities and predictors vary across ethnic groups. The participants were 146 low-income women who were Mexican American (32%), African American (31%), or Caucasian (37%). Statistical analyses were performed to assess the relationships between mammography screening during the past 2 years and potential predictors of screening, both within ethnic groups and for the combined sample. The results varied depending on whether analyses combined ethnic groups or were performed within each of the three ethnic groups. It is, therefore, important to examine within-group differences when examining ethnic disparities in predictors of mammography.

Predicting Child Protective Services (CPS) Involvement among Low-Income U.S. Families with Young Children Receiving Nutritional Assistance.

PubMed

Slack, Kristen S; Font, Sarah; Maguire-Jack, Kathryn; Berger, Lawrence M

2017-10-11

This exploratory study examines combinations of income-tested welfare benefits and earnings, as they relate to the likelihood of child maltreatment investigations among low-income families with young children participating in a nutritional assistance program in one U.S. state (Wisconsin). Using a sample of 1065 parents who received the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) benefits in late 2010 and early 2011, we find that relying on either work in the absence of other means-tested welfare benefits, or a combination of work and welfare benefits, reduces the likelihood of CPS involvement compared to parents who rely on welfare benefits in the absence of work. Additionally, we find that housing instability increases the risk of CPS involvement in this population. The findings from this investigation may be useful to programs serving low-income families with young children, as they attempt to identify safety net resources for their clientele.

Recruiting Low-Income Healthy Women to Research: An Exploratory Study

PubMed Central

Joseph, Galen; Kaplan, Celia P.; Pasick, Rena J.

2015-01-01

Objective The study goals were (1) to assess the feasibility of using an existing telephone health information and referral service for low-income, ethnically diverse women to recruit women for research participation; (2) to assess the feasibility of recruiting low-income, African American and Latino men into health research through the women callers to the telephone service; and (3) to describe the challenges women face and the strategies they use when talking to men about the men’s health and research participation. Design We recruited women for individual semi-structured qualitative interviews via the Every Woman Counts (EWC) telephone information and referral service, a California Department of Health Services Cancer Detection Program. This paper describes our eligibility and recruitment assessment, and our qualitative data from 23 interviews with low-income African American and Latino women who called EWC. Results We found that it was feasible to recruit women, but not to recruit men through women who call this telephone service. Almost 50% (113) of women demographically eligible for recruitment, completed our screening questionnaire, despite calling EWC for a different purpose. Some 48% (54) of those women were eligible for an interview. Of interview-eligible women, 58% (10) of African Americans and 35% (13) of Latinos completed an interview. Only 17% (4) of women referred a man for participation in an interview for our study. Several themes emerged from our analysis of interview data: (1) women’s role in men’s health can be significant but is often uneasy; (2) challenges when talking to men about their health include health access, gender dynamics, and men’s fear of health care; (3) women’s understanding of research may be limited; (4) women use a range of strategies to address and overcome men’s resistance to taking care of their health and participating in research. Conclusions The challenges women face when talking with men about their health

The health benefits of secondary education in adolescents and young adults: An international analysis in 186 low-, middle- and high-income countries from 1990 to 2013.

PubMed

Viner, Russell M; Hargreaves, Dougal S; Ward, Joseph; Bonell, Chris; Mokdad, Ali H; Patton, George

2017-12-01

The health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds. Exposures: average length of secondary and primary education from 1980 to 2013.Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries.Analysis: Longitudinal mixed effects models, entering secondary and primary education together, adjusted for time varying GDP and country income status. Longitudinal structural marginal models using inverse probability weighting (IPW) to take account of time varying confounding by primary education and GDP. Counterfactual scenarios of no change in secondary education since 1980/1990 were estimated from model coefficients for each outcome. Each additional year of secondary education decreased AFR by 8.4% in mixed effects models and 14.6% in IPW models independent of primary education and GDP. Counterfactual analyses showed the proportion of the reduction in adolescent fertility rate over the study period independently attributable to secondary education was 28% in low income countries. Each additional year of secondary education reduced mortality by 16.9% for 15-19 year and 14.8% for 20-24 year old young women and 11.4% for 15-19 year and 8.8% for 20-24 year old young men. Counterfactual scenarios suggested 12% and 23% of the mortality reduction for 15-19 and 20-24 year old young men was attributable to secondary education in low income countries. Each additional year of secondary education was associated with a 24.5% and 43.1% reduction in HIV prevalence amongst young men and women. The health benefits associated with secondary education were greater than those of primary education and were greatest amongst young women and those from low income countries. Secondary education has the potential to be a social vaccine

Employment and Economic Issues of Low-Income Women: Report of a Project.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

A series of consultations between low-income women and representatives of local and State service agencies in the Department of Labor's ten regions was undertaken to examine the needs, issues, and circumstances that affect the employment opportunities of low-income women. Each central consultation was preceded by several smaller meetings, attended…

Concepts of Healthful Food among Low-Income African American Women

ERIC Educational Resources Information Center

Lynch, Elizabeth B.; Holmes, Shane; Keim, Kathryn; Koneman, Sylvia A.

2012-01-01

Objective: Describe beliefs about what makes foods healthful among low-income African American women. Methods: In one-on-one interviews, 28 low-income African American mothers viewed 30 pairs of familiar foods and explained which food in the pair was more healthful and why. Responses were grouped into codes describing concepts of food…

Looking for Solutions: Gender Differences in Relationship and Parenting Challenges Among Low-Income, Young Parents

PubMed Central

Albritton, Tashuna; Angley, Meghan; Grandelski, Valen; Hansen, Nathan; Kershaw, Trace

2015-01-01

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes. PMID:24980026

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women.

PubMed

Arend, Elizabeth D

2005-01-01

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the

Exploring the Self/Group Initiated and On-the-Job Learning Activities of Low Income Women.

ERIC Educational Resources Information Center

Butterwick, Shauna

The self- and group-initiated and on-the-job learning activities of low-income women were explored in a study of a small group of low-income mothers living in the greater Vancouver area of British Columbia, Canada. During the study, the low-income women attended meetings during which a participating researcher documented the women's experiences.…

Smoking among Low-Income Pregnant Women: An Ethnographic Analysis

ERIC Educational Resources Information Center

Nichter, Mimi; Nichter, Mark; Muramoto, Myra; Adrian, Shelly; Goldade, Kate; Tesler, Laura; Thompson, Jennifer

2007-01-01

This article presents findings from a qualitative study of 53 low-income women who were smokers at the onset of pregnancy. Study participants were interviewed during pregnancy to document smoking trajectories and factors contributing to, or undermining, harm reduction and quit attempts. Thirty percent of women quit smoking completely, 43% engaged…

Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women

PubMed Central

Corwin, Elizabeth J.; Guo, Ying; Pajer, Kathleen; Lowe, Nancy; McCarthy, Donna; Schmiege, Sarah; Weber, Mary; Pace, Thaddeus; Stafford, Brian

2014-01-01

Summary Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r = −0.73, p < 0.0001), IL6/IL10 (r = 0.38, p = 0.01), IL1β/IL10 (r = −0.44, p = −0.004) and TNFα/IL10 (r = −0.41; p = 0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r = −0.25, p = 0.43; IL6/IL10:r = 0.12, p = 0.70; IL1 β/IL10: r = 0.05, p = 0.87; TNFα/IL10: r = 0.10; p = 0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p < 0.05). Without cytokine glucocorticoid feedback, a pregnant woman’s ability to regulate inflammation is limited, potentially contributing to adverse maternal

Low-income women with early-stage breast cancer: physician and patient decision-making styles.

PubMed

McVea, K L; Minier, W C; Johnson Palensky, J E

2001-01-01

Poor women have low rates of breast conservation therapy not explained by differences in insurance status or treatment preferences. The purpose of this study was to explore how low-income women make decisions about breast cancer treatment. Twenty-five women diagnosed with early-stage breast cancer through the Nebraska Every Woman Matters program were interviewed about their experiences selecting treatment options. These interviews were transcribed and then analysed using established qualitative techniques. More than half of the women (n=16) described playing a passive role in decision making. Choice was determined by medical factors or not offered by their physicians. Intense emotional distress affected some women's ability to compare options. The women who did engage in a rational decision-making process (n=9) based their choices on concerns about body image and fear of recurrence. When presented with a choice, and when able to objectively weigh treatment options, low-income women base their treatment decisions on the same issues as those of higher income. Whether differences in income strata alter the doctor-patient power dynamic in favor of physician control over decision making, or whether low-income women are less prepared to engage in a rational deliberative process warrants further study. Copyright 2001 John Wiley & Sons, Ltd.

Looking for solutions: gender differences in relationship and parenting challenges among low-income, young parents.

PubMed

Albritton, Tashuna; Angley, Meghan; Grandelski, Valen; Hansen, Nathan; Kershaw, Trace

2014-12-01

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes. © 2014 Family Process Institute.

Nutrition information-seeking behaviour of low-income pregnant Maghrebian women.

PubMed

Legault, Anik; Marquis, Marie

2014-01-01

Nutrition information-seeking behaviour was explored among low-income pregnant Maghrebian women living in Montreal. Environmental factors likely to influence nutrition information-seeking behaviour during pregnancy are discussed. Data were collected in face-to-face interviews with 14 primigravid pregnant women recruited via the Montreal Diet Dispensary, a nonprofit agency with the mission of promoting health among low-income pregnant women. Data collection was part of a larger project on pregnant women's nutrition decision-making. Environmental factors likely to influence information-seeking behaviour were identified. They were grouped within two major themes: culture and interactions with individuals from the social environment. The culture theme was divided into three minor themes: eating habits, food beliefs, and religious beliefs. The interactions with individuals from the social environment theme was divided into two minor themes: interactions with health care providers and interactions with family members. Understanding the influence of these environmental factors should help registered dietitians tailor communication strategies to pregnant immigrant women's specific information needs.

Low-Income Mothers' Food Practices with Young Children: A Qualitative Longitudinal Study

ERIC Educational Resources Information Center

Harden, Jeni; Dickson, Adele

2015-01-01

Objective: Young children living in socioeconomically deprived areas of Scotland have an increased risk of becoming overweight or obese. To enhance understanding of the wider contexts within which family food practices are developed, this study examined the experiences of low-income mothers with young children. Design: Qualitative longitudinal…

A social marketing approach to improving the nutrition of low-income women and children: an initial focus group study.

PubMed

Hampson, Sarah E; Martin, Julia; Jorgensen, Jenel; Barker, Mary

2009-09-01

To identify approaches for interventions to improve the nutrition of low-income women and children. Seven focus groups were conducted with low-income women caring for young children in their households. They discussed shopping, eating at home, eating out and healthy eating. The discussions were recorded and subjected to qualitative thematic analysis. A semi-rural community in Oregon, USA. There were seventy-four women (74% White), most of whom were 18-29 years old. Four broad themes were identified, i.e. cost-consciousness, convenience, social influences and health issues. The target population would benefit from improved understanding of what constitutes a balanced diet, with a greater emphasis on a more central role for fruit and vegetables. To persuade this population to change their eating habits, it will be necessary to convince them that healthful food can be low-cost, convenient and palatable for children. Comparing findings from the present study with a similar one in the UK suggests that the US women faced many of the same barriers to healthy eating but displayed less helplessness.

Comparison of Depressive Symptom Severity Scores in Low-Income Women

PubMed Central

Kneipp, Shawn M.; Kairalla, John A.; Stacciarini, Jeanne Marie R.; Pereira, Deidre; Miller, M. David

2010-01-01

Background The Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9) are considered reliable and valid for measuring depressive symptom severity and screening for a depressive disorder. Few studies have examined the convergent or divergent validity of these two measures, and none have been conducted among low-income women – even though rates of depression in this group are extremely high. Moreover, variation in within-subject scores suggests these measures may be less comparable in select subgroups. Objective We sought to compare these two measures in terms of construct validity, and examine whether within-subject differences in depressive symptom severity scores could be accounted for by select characteristics in low-income women. Method In a sample of 308 low-income women, construct validity was assessed using a multitrait-monomethod matrix approach, between-instrument differences in continuous symptom severity scores were regressed on select characteristics using backward stepwise selection, and differences in depressive symptom classification were assessed using the Mantel-Haenszel test. Results Convergent validity was high (rs = 0.80, p < .001). Among predictors that included age, race, education, number of chronic health conditions, history of depression, perceived stress, anxiety, and/or the number of generalized symptoms, none explained within-subject differences in depressive symptom scores between the BDI-II and PHQ-9 (p > .05, R2 < 0.04). Similarly, there was consistency in depressive symptom classification (X2 = 172 and 172.6, p < .0001). Discussion These findings demonstrate the BDI-II and PHQ-9 perform similarly among low-income women in terms of depressive symptom severity measurement and classifying levels of depressive symptoms, and do not vary across subgroups based on select demographics. PMID:21048482

Healthy eating for rural low-income toddlers: caregivers' perceptions.

PubMed

Omar, M A; Coleman, G; Hoerr, S

2001-01-01

Caregivers exert a powerful influence on young children's eating habits. This qualitative study used focus groups to assess nutritional needs and barriers in establishing healthy eating habits in toddlers. Three focus groups were conducted with rural, low-income caregivers, 2 with men and 1 with women, in 3 rural Michigan counties. Four major themes emerged: (a) barriers to providing healthy meals, (b) division of responsibility, (c) mealtime behavior, and (d) desired nutrition education. The major barriers identified were work schedules; cost of food; inadequate time to shop, plan, and prepare nutritious meals; or a combination thereof. Caregivers expressed concern for the nutritional well-being of their toddlers. The perceived needs and perceptions of low-income caregivers need to be considered when providing nutrition education. Findings from this study provided the basis for developing a nutrition education intervention for low-income parents of young children.

Health needs and health care utilization among rural, low-income women.

PubMed

Simmons, Leigh Ann; Anderson, Elaine A; Braun, Bonnie

2008-01-01

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.

[Healthy eating, schooling and being overweight among low-income women].

PubMed

Lins, Ana Paula Machado; Sichieri, Rosely; Coutinho, Walmir Ferreira; Ramos, Eloane Gonçalves; Peixoto, Maria Virginia Marques; Fonseca, Vânia Matos

2013-02-01

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

Neighborhood deprivation, supermarket availability, and BMI in low-income women: a multilevel analysis.

PubMed

Ford, Paula B; Dzewaltowski, David A

2011-10-01

High levels of neighborhood deprivation and lack of access to supermarkets have been associated with increased risk of obesity in women. This multilevel study used a statewide dataset (n = 21,166) of low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children to determine whether the association between neighborhood deprivation and BMI is mediated by the availability of retail food stores, and whether this relationship varied across the urban rural continuum. Residence in a high deprivation neighborhood was associated with a 0.94 unit increase in BMI among women in metropolitan areas. The relationship between tract deprivation and BMI was not linear among women in micropolitan areas, and no association was observed in rural areas. The presence of supermarkets or other retail food stores did not mediate the association between deprivation and BMI among women residing in any of the study areas. These results suggest that level of urbanity influences the effect of neighborhood condition on BMI among low-income women, and that the availability of supermarkets and other food stores does not directly influence BMI among low-income populations.

Multidisciplinary Perspectives towards the Education of Young Low-Income Immigrant Children

ERIC Educational Resources Information Center

Isik-Ercan, Zeynep; Demir-Dagdas, Tuba; Cakmakci, Huzeyfe; Cava-Tadik, Yasemin; Intepe-Tingir, Seyma

2017-01-01

This paper examines the issues surrounding low-income immigrants in the U.S. and the ways they shape the educational experiences of their young children. Using a multidisciplinary lens including sociology, family studies, education, and mental health, the authors analyse multiple perspectives towards the educational experiences of children in…

Knowledge Gaps of the Health Benefits of Beans among Low-Income Women.

PubMed

Palmer, Shelly M; Winham, Donna M; Hradek, Christine

2018-01-01

We determined knowledge of the health benefits of consuming beans, and assessed if awareness varied by acculturation status among Hispanic and non-Hispanic low-income women. We used a self-administered survey with Iowa women aged 18-65 years who were eligible to receive income-based services through 2 healthcare clinics, a WIC clinic, and Extension Outreach. Chi-square and ANOVA were used to compare bean health benefit knowledge, demographics, health-risk factors, nutrition information seeking, and self-efficacy by acculturation categories. Of the 158 women who completed the survey, 58% were Hispanic, with a mean age of 36 years. In terms of acculturation, 24% were Hispanic-dominant, 30% bicultural, and 46% English dominant. Over 50% of all respondents did not know bean consumption lowered cholesterol, aided blood glucose control, or reduced some cancer risks. Responses for 5 of 7 knowledge statements differed significantly by acculturation. Hispanic-dominant and bicultural women reported significantly better health, higher bean consumption, and less cigarette smoking than English-dominant women. Bicultural and English-dominant women were more likely to use the Internet for nutrition information. There are knowledge gaps about the health benefits of bean consumption among low-income women. Nutrition education to improve their knowledge may lead to increased bean consumption, reducing health disparities and improving nutrition.

Attitudes towards Intimate Partner Violence against Women among Women and Men in 39 Low- and Middle-Income Countries

PubMed Central

Tran, Thach Duc; Nguyen, Hau; Fisher, Jane

2016-01-01

Background Violence against women perpetrated by an intimate partner (IPV) is prevalent in low- and middle-income countries (LAMIC). The aim was to describe the attitudes of women and men towards perpetration of physical violence to women by an intimate partner, in a large group of low- and middle-income countries. Methods and Findings We used data from Round Four of the UNICEF Multiple Indicator Cluster Surveys. Attitudes towards IPV against women were assessed by a study-specific scale asking if ‘wife beating’ is justified in any of five circumstances. Overall, data from 39 countries (all had data from women and 13 countries also had data from men) were included in the analyses. The proportions of women who held attitudes that ‘wife-beating’ was justified in any of the five circumstances varied widely among countries from 2.0% (95% CI 1.7;2.3) in Argentina to 90.2% (95% CI 88.9;91.5) in Afghanistan. Similarly, among men it varied from 5.0% (95% CI 4.0;6.0) in Belarus to 74.5% (95% CI 72.5;76.4) in the Central African Republic. The belief that ‘wife-beating’ is acceptable was most common in Africa and South Asia, and least common in Central and Eastern Europe and Latin America and the Caribbean. In general this belief was more common among people in disadvantaged circumstances, including being a member of a family in the lowest household wealth quintile, living in a rural area and having limited formal education. Young adults were more likely to accept physical abuse by a man of his intimate partner than those who were older, but people who had never partnered were less likely to have these attitudes. Conclusions Violence against women is an international priority and requires a multicomponent response. These data provide evidence that strategies should include major public education programs to change attitudes about the acceptability of IPV against women, and that these should be addressed to women and girls as well as to boys and men. PMID:27893861

Population density, distance to public transportation, and health of women in low-income neighborhoods.

PubMed

DeGuzman, Pamela B; Merwin, Elizabeth I; Bourguignon, Cheryl

2013-01-01

The purpose of this research was to determine the impact of two neighborhood walkability (the extent to which the built environment is pedestrian friendly) metrics on health outcomes of women living in low-income urban neighborhoods, both before and after accounting for individual and neighborhood factors. A cross-sectional, retrospective design was used. The sample of 1800 low-income women was drawn from Welfare, Children and Families: A Three-City Study (a study of low-income women from three U.S. cities). Using multilevel modeling and geographic information systems, the study sought to determine the effect of distance to public transportation and residential density on health status, mental health symptoms, and health-related limitations. No significant relationship was found between the two walkability metrics and health outcomes. Instead, neighborhood problems that affect crime and safety impacted health status and mental health symptoms. As cities make changes to the built environment with the hope of affecting residents' health outcomes, public health nurses need to be aware that changing walkability characteristics in a neighborhood may not affect the health of residents of high crime, low-income neighborhoods. Without first addressing neighborhood crime, efforts to improve walkability in low-income neighborhoods may fail. © 2013 Wiley Periodicals, Inc.

Facebook is an effective strategy to recruit low-income women to online nutrition education.

PubMed

Lohse, Barbara

2013-01-01

Nutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders. An ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use. Of 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71. Facebook appears to be an effective tool to recruit low-income women to nutrition education projects. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

HIV prevention and low-income Chilean women: machismo, marianismo and HIV misconceptions.

PubMed

Cianelli, Rosina; Ferrer, Lilian; McElmurry, Beverly J

2008-04-01

Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fifty low-income Chilean women participated in a survey and twenty were selected to participate in prevention, in-depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV.

Predictors of health-related quality of life among low-income midlife women.

PubMed

Ham, Ok Kyung

2011-02-01

The purpose of this study was to determine whether any of the sociodemographic, biomedical, psychosocial, and medical-care factors independently predict health-related quality of life (HRQoL) among low-income women. Cross-sectional data were used to predict factors that determine HRQoL. A survey was conducted targeting a convenience sample of 200 midlife women. Blood samples were drawn from all participants, who also received a physical examination. Hierarchical multiple regression analysis was used to test the independent effects of each factor. The study found that sociodemographic and psychosocial factors were independently associated with HRQoL. Compared to married women, widowed or divorced women had significantly lower HRQoL, whereas those with higher levels of stress perception and those not performing regular exercise had significantly lower HRQoL (p < .01). The full model accounted for 44.7% of the variance in HRQoL. The HRQoL of low-income midlife women was associated with multiple factors, with stress perception exerting the major influence.

Concepts of anemia among low income Nicaraguan women.

PubMed

Ailinger, Rita L; Moore, Jean B; Pawloski, Lisa; Cortés, Lidya Ruth Zamora

2009-01-01

Anemia is a common health problem among women throughout the world, however, there has been minimal research on women's concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

How motivation influences breastfeeding duration among low-income women.

PubMed

Racine, Elizabeth F; Frick, Kevin D; Strobino, Donna; Carpenter, Laura M; Milligan, Renee; Pugh, Linda C

2009-05-01

In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed women's motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling.

Does modifying the household food budget predict changes in the healthfulness of purchasing choices among low- and high-income women?

PubMed

Inglis, Victoria; Ball, Kylie; Crawford, David

2009-04-01

Food cost has a strong influence on food purchases and given that persons of low income often have more limited budgets, healthier foods may be overlooked in favour of more energy-dense lower-cost options. The aim of this study was to investigate whether modifications to the available household food budget led to changes in the healthfulness of food purchasing choices among women of low and high income. A quasi-experimental design was used which included a sample of 74 women (37 low-income women and 37 high-income women) who were selected on the basis of their household income and sent an itemised shopping list in order to calculate their typical weekly household shopping expenditure. The women were also asked to indicate those foods they would add to their list if they were given an additional 25% of their budget to spend on food and those foods they would remove if they were restricted by 25% of their budget. When asked what foods they would add with a larger household food budget, low-income women chose more foods from the 'healthier' categories whereas high-income women chose more foods from the less 'healthier' categories. However, making the budgets of low- and high-income women more 'equivalent' did not eradicate income differences in overall healthfulness of food purchasing choices. This study highlights the importance of cost when making food purchasing choices among low- and high-income groups. Public health strategies aimed at reducing income inequalities in diet might focus on promoting healthy diets that are low cost.

Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries.

PubMed

Xi, Bo; Liang, Yajun; Liu, Yunxia; Yan, Yinkun; Zhao, Min; Ma, Chuanwei; Bovet, Pascal

2016-11-01

Tobacco use is an important risk factor for non-communicable diseases worldwide. However, the global extent and prevalence of tobacco use in adolescents is poorly described. Using previously collected survey data, we aimed to assess tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years in 68 low-income and middle-income countries. We used data from the Global School-based Student Health Survey (2006-13) and the China Global Tobacco Youth Survey (2013), which are school-based surveys of young adolescents aged 12-15 years that assess health behaviours using a standardised, anonymous, self-reported questionnaire. We calculated the prevalence of current tobacco use and exposure to second-hand smoke in young adolescents from 68 low-income and middle-income countries that collected these data in the surveys. We used a multilevel model to estimate the association between parental tobacco use, second-hand smoke, and adolescent tobacco use, adjusting for sex, age, school, school class, country's purchasing power parity, smoking initiation age, national prevalence of tobacco use among adults, year the WHO FCTC was ratified for each country, proxy of socioeconomic status, and survey year. The mean prevalence of current tobacco use was 13·6%, ranging from 2·8% in Tajikistan to 44·7% in Samoa. In most countries, the prevalence of tobacco use was higher for boys than girls, and higher for adolescents aged 14-15 years than for those aged 12-13 years. The overall prevalence of second-hand smoke exposure was 55·9%, ranging from 16·4% in Tajikistan to 85·4% in Indonesia. Parental tobacco use (as reported by the young adolescents), especially maternal use, was associated with tobacco use in young adolescents (odds ratio 2·06, 95% CI 1·93-2·19, for maternal and 1·29, 1·23-1·35 for paternal use). Second-hand smoke exposure was also a risk factor for young adolescents' tobacco use (2·56, 2·43-2·69). However, the prevalence of tobacco use was not

Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes.

PubMed

Oza-Frank, Reena; Conrey, Elizabeth; Bouchard, Jo; Shellhaas, Cynthia; Weber, Mary Beth

2018-07-01

Introduction An important yet understudied component of postpartum type 2 diabetes risk reduction among high risk women is experiences with the healthcare system. Our objective was to describe the healthcare experiences of a diverse, low-income sample of women with prior GDM, including their suggestions for improving care. Methods Focus groups were conducted among African American, Hispanic, and Appalachian women who were diagnosed with GDM within the past 10 years. Participants were recruited from community and medical resources. Twelve focus groups were conducted, four within each race-ethnic group. Results Three broad themes were identified around barriers to GDM care, management, and follow-up: (1) communication issues; (2) personal and environmental barriers; and (3) type and quality of healthcare. Many women felt communication with their provider could be improved, including more education on the severity of GDM, streamlining information to be less overwhelming, and providing additional support through referrals to community resources. Although women expressed interest in receiving more actionable advice for managing GDM during pregnancy and for preventing type 2 diabetes postpartum, few women reported changing behaviors. Barriers to behavior change were related to cost, transportation, and competing demands. Several opportunities for improved care were elucidated. Discussion Our findings suggest that across all racial and ethnic representations in our sample, low-income women with GDM experience similar communication, personal, and environmental barriers related to the healthcare they receive for their GDM. Considering the increased exposure to the health care system during a GDM-affected pregnancy, there are opportunities to address barriers among women with GDM across different race-ethnic groups.

Designing prenatal care messages for low-income Mexican women.

PubMed Central

Alcalay, R; Ghee, A; Scrimshaw, S

1993-01-01

Communication theories and research data were used to design cross-cultural health education messages. A University of California Los Angeles-Universidad Autonoma in Tijuana, Mexico, research team used the methods of ethnographic and survey research to study behaviors, attitudes, and knowledge concerning prenatal care of a sample of pregnant low-income women living in Tijuana. This audience provided information that served as a framework for a series of messages to increase awareness and change prenatal care behaviors. The message design process was guided by persuasion theories that included Petty and Caccioppo's elaboration likelihood model, McGuire's persuasion matrix, and Bandura's social learning theory. The results from the research showed that poor women in Tijuana tend to delay or not seek prenatal care. They were not aware of symptoms that could warn of pregnancy complications. Their responses also revealed pregnant women's culturally specific beliefs and behaviors regarding pregnancy. After examination of these and other results from the study, prenatal care messages about four topics were identified as the most relevant to communicate to this audience: health services use, the mother's weight gain, nutrition and anemia, and symptoms of high-risk complications during pregnancy. A poster, a calendar, a brochure, and two radio songs were produced and pretested in focus groups with low-income women in Tijuana. Each medium included one or more messages addressing informational, attitudinal, or behavioral needs, or all three, of the target population. PMID:8497574

Breastfeeding support - the importance of self-efficacy for low-income women.

PubMed

Entwistle, Francesca; Kendall, Sally; Mead, Marianne

2010-07-01

Breastfeeding is a key determinant in promoting public health and reducing health inequality. Low-income women have a significantly lower level of breastfeeding. Midwives in the UK have been encouraged to implement the World Health Organization/United Nations Children's Fund's Ten Steps to Successful Breastfeeding, but to date, there has been no evaluation of the impact of the training initiative on the breastfeeding behaviours of low-income women. As part of a wider study, this qualitative component was designed to answer the question - what are the views and experiences of low-income women (defined by Jarman scores) in relation to their breastfeeding support received in the post-natal period? A sample of seven women was interviewed. The in-depth interviews were analysed using a qualitative, thematic approach based on the self-efficacy theory. The four themes that emerged from the data were the following: breastfeeding related to the woman's self-confidence, the social environment in which the woman lived, knowledge of breastfeeding and the influence of maternity services on breastfeeding outcomes. These themes were interpreted in relation to the self-efficacy theory. The findings suggest that the components that inform self-efficacy are consistent with the themes from the data, suggesting that midwives and other health professionals should take the psychosocial aspects of breastfeeding support into account. As this important feature of breastfeeding support is not explicitly part of the current Ten Steps to Successful Breastfeeding, we suggest that further research and debate could inform expansion of these minimum standards to include the psychosocial aspects.

Low-Income US Women Under-informed of the Specific Health Benefits of Consuming Beans.

PubMed

Winham, Donna M; Armstrong Florian, Traci L; Thompson, Sharon V

2016-01-01

Bean consumption can reduce chronic disease risk and improve nutrition status. Consumer knowledge of bean health benefits could lead to increased intakes. Low-income women have poorer health and nutrition, but their level of knowledge about bean health benefits is unknown. Beans are a familiar food of reasonable cost in most settings and are cultural staples for Hispanics and other ethnicities. Study objectives were to assess awareness of bean health benefits among low-income women, and to evaluate any differences by acculturation status for Hispanic women in the Southwestern United States. A convenience sample of 406 primarily Mexican-origin (70%) low-income women completed a survey on knowledge of bean health benefits and general food behaviors. Principal components analysis of responses identified two summary scale constructs representing "bean health benefits" and "food behaviors." Acculturation level was the main independent variable in chi-square or ANOVA. The survey completion rate was 86% (406/471). Most women agreed or strongly agreed that beans improved nutrition (65%) and were satiating (62%). Over 50% answered 'neutral' to statements that beans could lower LDL cholesterol (52%), control blood glucose (56%) or reduce cancer risk (56%), indicating indifference or possible lack of knowledge about bean health benefits. There were significant differences by acculturation for beliefs that beans aid weight loss and intestinal health. Scores on the bean health benefits scale, but not the food behavior scale, also differed by acculturation. Limited resource women have a favorable view of the nutrition value of beans, but the majority did not agree or disagreed with statements about bean health benefits. Greater efforts to educate low-income women about bean health benefits may increase consumption and improve nutrition.

Cardiovascular Risk Factors Among Low-Income Women: A Population-Based Study in China from 1991 to 2011.

PubMed

Lu, Hongyan; Bai, Lingling; Zhan, Changqing; Yang, Li; Tu, Jun; Gu, Hongfei; Shi, Min; Wang, Jinghua; Ning, Xianjia

2016-12-01

Data on long-term trends in the prevalence and clustering of cardiovascular disease (CVD) risk factors among women in China are rare, especially among low-income women. The aim of this study was to investigate the secular trends in the prevalence of CVD risk factors among low-income women in northern China. The prevalence and clustering of CVD risk factors, including hypertension, diabetes, obesity, current smoking status, and alcohol consumption, were assessed and compared in women aged 35-74 years in northern China in 1991 and 2011. The age-adjusted prevalence of cardiovascular risk factors among women was significantly higher in 2011 than in 1991, with increases of 31% (53.6% vs. 41.1%) for hypertension, 148% (20.9% vs. 8.4%) for obesity, 256% (11.7% vs. 3.3%) for diabetes, and 1634% (4.5% vs. 0.3%) for alcohol consumption. Over the 21-year period, there were significant differences in the prevalence of clustering of ≥1, ≥2, and 3 risk factors in all age groups. The greatest increase was observed among women aged 35-44 years, with a 7.3-fold increase in the prevalence of clustering of three risk factors. Simultaneously, the prevalence of clustering of ≥1 risk factors among women aged 35-44 years was 1.7-fold higher in 2011 than in 1991; the prevalence of clustering of ≥2 risk factors was raised by 5.5-fold among elderly women. Our findings suggest that it is crucial to emphasize the prevention and control of cardiovascular risk factors among young women in rural China to reduce the burden of CVDs.

Comparing Psychiatric Service Use among Low-Income Women and Women in a General Household Population

ERIC Educational Resources Information Center

Rosen, Daniel; Warner, Lynn A.; Tolman, Richard M.

2006-01-01

This article examines the use of outpatient mental health services in a sample of low-income women (Mothers' Well-Being Study [MWS]) and compares the findings with a sample of similar-aged women in the general population (National Comorbidity Survey [NCS]). Overall, the prevalence of any 12-month mental health disorder was significantly greater…

Fresh Start, a postpartum weight loss intervention for diverse low-income women: design and methods for a randomized clinical trial.

PubMed

Rosal, Milagros C; Haughton, Christina F; Estabrook, Barbara B; Wang, Monica L; Chiriboga, Germán; Nguyen, Oahn H T; Person, Sharina D; Lemon, Stephenie C

2016-09-09

Overweight and obesity are prevalent among young women and are greater among minority and low-income women. The postpartum period is critical in women's weight trajectories as many women do not lose their pregnancy weight, and others lose some and then plateau or experience weight gain. Excess weight puts women at greater risk of chronic disease and thus weight loss in the postpartum period may be key to the long-term health of young women. This paper describes the design and methods of a randomized clinical trial of Fresh Start, an innovative narrative-based group intervention aimed at promoting postpartum weight loss among low-income, diverse women. Study participants were recruited from the five sites of the Women, Infants and Children (WIC) program in central Massachusetts. Participants were English-speaking, age ≥ 18 years, 6 weeks to 6 months postpartum, with a body mass index (BMI) ≥ 27 kg/m(2). The Fresh Start postpartum weight loss intervention, adapted from the Diabetes Prevention Program (DPP) in collaboration with WIC staff and clients, consisted of an 8-week group-based curriculum followed by nine monthly telephone calls. It included a narrative component (i.e., storytelling), group discussions, print materials and access to exercise facilities. The study is a two-arm randomized controlled trial. The control condition included print materials and access to exercise facilities. In-person assessments were conducted at baseline and at 6 and 12 months following the eight-week intervention phase. The Fresh Start intervention translated key elements of an evidence-based weight loss protocol into a format that is hypothesized to be relevant, acceptable and effective for the target audience of low-SES postpartum women. This novel intervention was developed in collaboration with WIC to be sustainable within the context of its clinics, which reach approximately 9 million individuals per year across the U.S. via 10,000 clinics. clinicaltrials

Employment Transitions, Child Care Conflict, and the Mental Health of Low-Income Urban Women With Children.

PubMed

Jacobs, Anna W; Hill, Terrence D; Tope, Daniel; O'Brien, Laureen K

2016-01-01

Although studies suggest that employment promotes mental health, it is unclear whether this pattern extends to low-income urban women with children who are disproportionately employed in unstable jobs and often unable to obtain child care. In this paper, we consider whether becoming employed reduces symptoms of psychological distress among low-income women with children. We also assess whether having trouble securing adequate child care offsets these benefits. We use longitudinal data from the Welfare, Children, and Families project, a probability sample of low-income women with children living in Boston, Chicago, and San Antonio, to test whether becoming employed reduces symptoms of psychological distress over time and whether having trouble securing child care moderates this association. We find that employment is associated with lower levels of distress among women who have no trouble with child care and higher levels of distress among women who struggle with child care. Taken together, our results suggest that valuing the benefits of paid work over unpaid work is an oversimplification and that the emphasis on placing poor women with children into paid work could be misguided. Policies that focus on moving low-income women off of government assistance and into paid work could be more effective if greater resources were devoted to increasing access to quality child care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

An environmental intervention aimed at increasing physical activity levels in low-income women.

PubMed

Speck, Barbara J; Hines-Martin, Vicki; Stetson, Barbara A; Looney, Stephen W

2007-01-01

Regular physical activity is a health promotion and disease prevention behavior. Of all demographic groups, low-income women report the lowest levels of physical activity. The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. The research design was mixed methodology: (1) quantitative (quasi-experimental, pretest-posttest, cohort design in which no treatment partitioning was possible) and (2) qualitative (focus groups). The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. The sample consisted of 104 women (comparison group, n = 53; intervention group, n = 51) between the ages of 18 and 63 years who were residents of neighborhoods served by the community center. No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol (P = .007) and perception of physical activity (P = .033) were observed. Significant intervention group increases from pretest to posttest were found related to advanced registered nurse practitioner support, friend support, and more positive physical activity environment at the community center. Qualitative data supported and enriched the quantitative data. Physical activity levels were not significantly different between the groups. In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

Excess mortality in women of reproductive age from low-income countries: a Swedish national register study.

PubMed

Esscher, Annika; Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

2013-04-01

Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. In this national study, based on the Swedish Cause of Death Register, we studied 27,957 women of reproductive age (aged 15-49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100,000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. The total age-standardized mortality rate per 100,000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8-20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6-16.5) for women born in low-income countries, as compared to Swedish-born women. Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research.

Excess mortality in women of reproductive age from low-income countries: a Swedish national register study

PubMed Central

Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

2013-01-01

Background: Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. Methods: In this national study, based on the Swedish Cause of Death Register, we studied 27 957 women of reproductive age (aged 15–49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100 000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. Results: The total age-standardized mortality rate per 100 000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8–20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6–16.5) for women born in low-income countries, as compared to Swedish-born women. Conclusions: Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research. PMID:22850186

About Eating: an online program with evidence of increased food resource management skills for low-income women.

PubMed

Lohse, Barbara; Belue, Rhonda; Smith, Stephanie; Wamboldt, Patricia; Cunningham-Sabo, Leslie

2015-01-01

Produce and evaluate About Eating (AE), an online program for low-income women aligned with the Satter eating competence model, congruent with best practices for nutrition education of low-income audiences. Responses from iterative cognitive interviews and online surveys with diverse samples of low-income women informed lesson revisions. The researchers conducted a randomized controlled trial of AE with low-income women to determine its impact on dietary behavior and food security. In all, 284 women reviewed at least 1 AE lesson and endorsed it. After AE, women (n = 288) increased in use of food resource management skills (eg, using a budget [P = .008] and planning meals to include all food groups [P = .002]). About Eating participants who were food secure had more confidence in managing money for food (P = .002) and keeping track of food-related purchases (P = .02) than food-insecure persons. Mixed-methods research with life stage and geodiverse samples confirmed the usefulness of AE. Food security assessment may enhance interpretation of intervention effectiveness. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Does medicaid coverage matter?: A qualitative multi-state study of abortion affordability for low-income women.

PubMed

Dennis, Amanda; Manski, Ruth; Blanchard, Kelly

2014-11-01

Medicaid is designed to ensure low-income populations can afford health care. However, not all health services are covered by the program. Most state Medicaid programs restrict abortion coverage, though a small number of state programs offer such coverage. Little is known about how low-income women are affected by differing Medicaid coverage policies regarding abortion. We conducted in depth interviews with 98 low-income women who had abortions. We found that women's impressions about abortion costs and the availability of Medicaid coverage are generally accurate and that women rely predominantly on abortion facilities for confirmatory cost and coverage information. Additionally, when abortion is out of financial reach, women and the people in their lives experience numerous emotional and financial harms. Policies that aim to ensure abortion is affordable largely prevent these harms, though the availability of Medicaid coverage does not always guarantee access to affordable care. Findings can help advance evidence-based policies

A Qualitative Study of Survival Strategies Used by Low-Income Black Women Who Experience Intimate Partner Violence

PubMed Central

St. Vil, Noelle M.; Sabri, Bushra; Nwokolo, Vania; Alexander, Kamila A.; Campbell, Jacquelyn C.

2017-01-01

Women who experience intimate partner violence (IPV) are often portrayed as helpless victims. Yet many women who experience IPV implement strategies to help them survive the abuse. This qualitative study sought to explore the survivor strategies used by low-income black women who experience IPV. Authors used a semistructured interview guide to survey 26 survivors who reported being in an IPV relationship in the past two years. Thematic analysis revealed three types of survivor strategies used by low-income black women: (1) internal (use of religion and becoming self-reliant), (2) interpersonal (leave the abuser or fight back), and (3) external (reliance on informal, formal, or both kinds of sources of support). This article informs social work practitioners of the strategies used by low-income black women in surviving IPV so that practitioners can develop interventions that support these strategies. PMID:28395046

Economic Stress and Cortisol Among Postpartum Low-Income Mexican American Women: Buffering Influence of Family Support.

PubMed

Jewell, Shannon L; Luecken, Linda J; Gress-Smith, Jenna; Crnic, Keith A; Gonzales, Nancy A

2015-01-01

Low-income Mexican American women experience significant health disparities during the postpartum period. Contextual stressors, such as economic stress, are theorized to affect health via dysregulated cortisol output. However, cultural protective factors including strong family support may buffer the impact of stress. In a sample of 322 low-income Mexican American women (mother age 18-42; 82% Spanish-speaking; modal family income $10,000-$15,000), we examined the interactive influence of economic stress and family support at 6 weeks postpartum on maternal cortisol output (AUCg) during a mildly challenging mother-infant interaction task at 12 weeks postpartum, controlling for 6-week maternal cortisol and depressive symptoms. The interaction significantly predicted cortisol output such that higher economic stress predicted higher cortisol only among women reporting low family support. These results suggest that family support is an important protective resource for postpartum Mexican American women experiencing elevated economic stress.

Locus of control and self-esteem in depressed, low-income African-American women.

PubMed

Goodman, S H; Cooley, E L; Sewell, D R; Leavitt, N

1994-06-01

Depressed, schizophrenic, and well low-income, African-American women were studied in an effort to extend previous hypotheses of the association between depression and the two personality constructs of low self-esteem and externality to this population. Subjects were 113 low income African-American women including 26 who had been diagnosed as depressed, 54 diagnosed as schizophrenic, and 33 well women. Locus of control was measured with the Adult Nowicki-Strickland Internal-External Control Scale (Nowicki & Duke, 1974). Self-esteem was measured with the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Contrary to predictions, a diagnosis of schizophrenia, but not depression, was associated with more external locus of control. For self-esteem, severity of disturbance, rather than diagnosis, seemed to be of primary importance. Also, lower self-esteem scores were correlated significantly with higher levels of externality for both depressed and schizophrenic women but not for well controls. The present study indicates that self-esteem and locus of control are related to depression differently in low socio-economic status (SES) African-American women than in previously studied middle SES depressed whites. The findings emphasize the need for more normative studies to clarify the complex relations among SES, race, emotional disturbance, self-esteem, and locus of control.

Preventive care for low-income women in massachusetts post-health reform.

PubMed

Clark, Cheryl R; Soukup, Jane; Riden, Heather; Tovar, Dora; Orton, Piper; Burdick, Elisabeth; Capistran, Mary Ellen; Morisset, Jennifer; Browne, Elizabeth E; Fitzmaurice, Garrett; Johnson, Paula A

2014-06-01

Before enacting health insurance reform in 2006, Massachusetts provided free breast, cervical cancer, and cardiovascular risk screening for low-income uninsured women through a federally subsidized program called the Women's Health Network (WHN). This article examines whether, as women transitioned to insurance to pay for screening tests after health reform legislation was passed, cancer and cardiovascular disease screening changed among WHN participants between 2004 and 2010. We examined claims data from the Massachusetts health insurance exchange and chart review data to measure utilization of mammography, Pap smear, and blood pressure screening among WHN participants in five community health centers in greater Boston. We conducted a longitudinal analysis, by insurance type, using generalized estimating equations to examine the likelihood of screening at recommended intervals in the postreform period compared to the prereform period. Pre- and postreform, we found a high prevalence of recommended mammography (86% vs. 88%), Pap smear (88% vs. 89%), and blood pressure screening (87% vs. 91%) that was similar or improved for most women postreform. Screening use differed by insurance type. Recommended mammography screening was statistically significantly increased among women with state-subsidized private insurance (odds ratio [OR] 1.58, p<0.05). Women with unsubsidized private insurance or Medicare had decreased Pap smear use postreform. Although screening prevalence was high, 31% of women required state safety-net funds to pay for screening tests. Our results suggest a continued need for safety-net programs to support preventive screening among low-income women after implementation of healthcare reform.

Physical abuse in low-income women in Aleppo, Syria.

PubMed

Maziak, Wasim; Asfar, Taghrid

2003-04-01

Violence against women is a vicious practice present in all societies. Yet data about its occurrence and associated factors are scarce in the Arab world. In this study, we attempt to determine the spread of physical abuse and its sociodemographic correlates among low-income women in Aleppo, Syria. A sample of 411 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97%, mean age of participants 28 +/- 8 years, and most women (88%) were married. A special questionnaire was used including questions about physical abuse, the self-reporting questionnaire (SRQ-20), and questions about relevant sociodemographic information. Current physical abuse (battering at least 3 times during the previous year) was found in 23% of the investigated and among 26% of married women, while regular abuse (battering at least once weekly) was found in 3.3% of married women. Correlates of physical abuse were women's education, religion, age, marital status, economic status, mental distress, smoking, and residence. Our data show that physical abuse is prevalent in this population and that women's education is the most important modifiable factor.

Closing the Gap in Mammogram Screening: An Experimental Intervention among Low-Income Hispanic Women in Community Health Clinics

ERIC Educational Resources Information Center

Deavenport, Alexis; Modeste, Naomi; Marshak, Helen Hopp; Neish, Christine

2011-01-01

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received…

Use of a photoessay to teach low-income African American women about mammography.

PubMed

Paskett, E D; Tatum, C; Wilson, A; Dignan, M; Velez, R

1996-01-01

Although incidence rates of breast cancer are lower among African American women than white women, mortality rates among African American women are higher, especially for women of lower socioeconomic levels. Reasons for this situation include the lesser use of breast cancer screening examinations by low-income, primarily African American women, late stage of diagnosis, and delays in treatment. As part of community outreach and public health clinic inreach programs for the Forsyth County Cancer Screening Project, approximately 908 African American women who reside in low-income housing communities were targeted for educational efforts related to breast cancer screening. Early in the project, it was discovered that many of the women were unfamiliar with mammography and had very little awareness of how the entire examination was conducted. This low level of knowledge was particularly important because it was a barrier for obtaining regular mammography. A photoessay depicting the process of getting a mammogram was developed and used in community outreach efforts in three formats: in educational classes, as a display in the housing communities, and in physicians' offices. The acceptability of this photoessay to communicate knowledge of and reduce fears about mammography was assessed through evaluation surveys in interviews with a sample of 47 women from the target population. Overall, these women liked the photoessay and felt that it provided knowledge about mammography and reduced fears associated with anticipating mammography. Strategies such as this may be ideal to communicate important information about cancer prevention and control in low-literacy populations.

Meaning of the Terms "Overweight" and "Obese" Among Low-Income Women

PubMed Central

Ellis, Samantha; Rosenblum, Katherine; Miller, Alison; Peterson, Karen E.; Lumeng, Julie C.

2013-01-01

Objective To determine how low-income United States women understand the meanings of the terms “overweight” and “obese”. Methods Low-income women [n = 145; 72% white, 12% black, 8% Hispanic; 59% obese, 21% overweight] each participated in an individual semi-structured interview during which they were asked to explain what the terms overweight and obese mean to them. Responses were transcribed and the constant comparative method was used to identify themes. Results Three themes emerged: (1) The terms are offensive and describe people who are unmotivated, depressed and do not care about themselves; (2) Obese is an extreme weight (e.g. 500 pounds and being immobile); (3) Being overweight is a matter of opinion; if a woman is “comfortable in her own skin” and “feels healthy” she is not overweight. Conclusions and Implications Health education focused on obesity should consider that vulnerable populations might consider the terms "overweight" and "obese" offensive and stigmatizing. PMID:24135314

Adherence of Low-income Women to Cancer Screening Recommendations

PubMed Central

O'Malley, Ann S; Forrest, Christopher B; Mandelblatt, Jeanne

2002-01-01

BACKGROUND African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold. PARTICIPANTS Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships

Tobacco Industry Marketing to Low Socio-economic Status Women in the US

PubMed Central

Brown-Johnson, Cati G.; England, Lucinda J.; Glantz, Stanton A.; Ling, Pamela M.

2014-01-01

Objectives Describe tobacco companies’ marketing strategies targeting low socioeconomic-status (SES) females in the US. Methods Analysis of previously secret tobacco industry documents. Results Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, “discount-susceptible” older female smokers, and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females, and promoting luxury images to low SES African American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands. Conclusions Tobacco companies used numerous marketing strategies to reach low SES females in the US for at least four decades. Strategies to counteract marketing to low SES women could include: 1) counter-acting price discounts and direct mail coupons that reduce the price of tobacco products, 2) instituting restrictions on point-of-sale advertising and retail display, and 3) creating counter-advertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women. PMID:24449249

Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control.

PubMed

Khoury, Amal J; Moazzem, S Wakerul; Jarjoura, Chad M; Carothers, Cathy; Hinton, Agnes

2005-01-01

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA.

PubMed

Rojjanasrirat, Wilaiporn; Sousa, Valmi D

2010-07-01

To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school. Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care. Qualitative study using focus group interviews. The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6. Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions.  Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness. Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work. © 2010 Blackwell

Factors Distinguishing Positive Deviance Among Low-Income African American Women: A Qualitative Study on Infant Feeding.

PubMed

Barbosa, Cecilia E; Masho, Saba W; Carlyle, Kellie E; Mosavel, Maghboeba

2017-05-01

Positive deviant individuals practice beneficial behaviors in spite of having qualities characterizing them as high risk for unhealthy behaviors. This study aimed to identify and understand factors distinguishing low-income African American women who breastfeed the longest (positive deviants) from those who breastfeed for a shorter duration or do not breastfeed. Seven mini-focus groups on infant-feeding attitudes and experiences were conducted with 25 low-income African American women, grouped by infant-feeding practice. Positive deviants, who had breastfed for 4 months or more, were compared with formula-feeding participants who had only formula fed their babies and short-term breastfeeding participants who had breastfed for 3 months or less. Positive deviant women had more schooling, higher income, breastfeeding intention, positive breastfeeding and unfavorable formula-feeding attitudes, higher self-efficacy, positive hospital and Special Supplemental Nutrition Program for Women, Infants, and Children experiences, more exclusive breastfeeding, and greater comfort breastfeeding in public. Short-term breastfeeding women varied in breastfeeding intention and self-efficacy, seemed to receive insufficient professional breastfeeding support, and supplemented breastfeeding with formula. Some showed ambivalence, concern with unhealthy behaviors, and discomfort with breastfeeding in public. Formula-feeding women intended to formula feed, feared breastfeeding, thought their behaviors were incompatible with breastfeeding, were comfortable with and found formula convenient, and received strong support to formula feed. Tapping into the strengths of positive deviants; tailoring interventions to levels of general and breastfeeding self-efficacy; increasing social, institutional, and community supports; and removing inappropriate formula promotion may offer promising strategies to increase breastfeeding among low-income African American women.

Views of Low-Income Women of Color at Increased Risk for Breast Cancer.

PubMed

E Anderson, Emily; Tejada, Silvia; B Warnecke, Richard; Hoskins, Kent

2018-01-01

Individual risk assessment (IRA) for breast cancer may increase adherence to risk-appropriate screening and prevention measures. However, knowledge gaps exist regarding how best to communicate IRA results and support women at increased risk in future health care decisions, in part because patients conceptualize and make meaning of risk differently from the medical community. Better understanding the views of low-income women of color identified as being at increased risk for breast cancer can inform efforts to conduct IRA in an ethical and respectful manner. We conducted in-depth interviews with 13 low-income African American and Latina women who receive care at a federally qualified health center (FQHC) and had recently learned of their increased risk for breast cancer. These interviews explored their experience of the IRA process, their interpretation of what being at increased risk means, and their reactions to provider recommendations. Eight key themes were identified. We conclude with recommendations for the implementation of IRA for breast cancer in underserved primary care settings.

Perceived stress, unhealthy eating behaviors, and severe obesity in low-income women.

PubMed

Richardson, Andrea S; Arsenault, Joanne E; Cates, Sheryl C; Muth, Mary K

2015-12-03

Stress has been associated with poor eating behaviors and diet quality, as well as high body mass index (BMI). Low-income women may be particularly vulnerable to stress and severe obesity. Yet it is unknown how stress increases the risk of severe obesity through disordered eating behaviors and poor diet quality or through mechanisms independent of diet. We examined cross-sectional data from women (n = 101) with a child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in Cumberland County, North Carolina (spring 2012). We collected measured heights and weights to calculate BMI. Using structural equation modeling, we differentiated pathways from stress to weight status: (1) indirectly through eating behaviors (cognitive restraint, emotional eating, and uncontrolled eating) and diet quality, which we examined with the Healthy Eating Index 2010 and 24-h dietary recalls, and (2) directly through possible unmeasured risk factors independent of diet. The analysis controlled for race/ethnicity, income, age, whether the dietary recall day was typical, and whether the respondent completed one or two 24-h dietary recalls. Perceived stress was positively associated with uncontrolled eating (β = 0.38, p < 0.001) and emotional eating (β = 0.50, p < 0.001). However, higher stress was not associated with weight status through eating behaviors and diet quality. Independent of eating behaviors and diet quality, stress was positively associated with severe obesity (β = 0.26, p = 0.007). Improving stress coping strategies for low-income women may improve eating behaviors and reduce severe obesity.

Welfare reform, employment, and drug and alcohol use among low-income women.

PubMed

Meara, Ellen

2006-01-01

In 1996 welfare reform legislation transformed income assistance for needy families by imposing work requirements, time-limited benefits, and explicit provisions allowing states to sanction recipients who fail to meet program requirements. Though they represent a minority of the welfare population, women with substance use disorders (SUDs) experience multiple, and more severe, employment barriers than other Temporary Assistance to Needy Families (TANF) recipients. This review of welfare reform, substance abuse, and employment documents the evidence to date regarding the employment patterns of women with SUDs before and after welfare reform, and proposes several topics for further research. Based on higher rates of unemployment, less work experience, and lower earnings when working, women with SUDs have worse employment records than other TANF recipients. Despite elevated employment barriers, women with SUDs left TANF after 1996 as fast as, or faster than, other women. Since the 1996 welfare reform, women with SUDs have increased their employment and earnings, but by less than similar women without SUDs. Future research should describe how specific state welfare policies relate to employment of low-income women with SUDs, how the well-being of these women and their children changes with employment, and how welfare and employment interact to affect access to health insurance among this population.

On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women.

PubMed

Kimbro, Rachel Tolbert

2006-01-01

As both employed and breastfeeding mothers increase, more women are facing the decision of whether and how to combine the behaviors. This paper examines three hypotheses for a sample of low-income women: 1) Mothers who expect to return to work after the birth of their baby will be less likely to initiate breastfeeding; 2) The timing of the return to work and quitting breastfeeding will coincide; 3) Mothers in professional jobs and Stay-at-Home (SAH) Moms will breastfeed for longer durations than mothers with other types of jobs. The Fragile Families and Child Wellbeing Study, a sample of mostly low-income, unmarried U.S. mothers, offers a unique opportunity to study this issue, as there is reason to believe that employment may impact breastfeeding differently for low-income women. Logistic regression determines the relationship between the expectation of work and breastfeeding initiation, and discrete-time logit models examine breastfeeding duration, the timing of the return to work, and occupation type. Expecting to work in the year after the baby's birth does not impact breastfeeding initiation. The timing of quitting breastfeeding and the return to work are closely and powerfully linked, and mothers in administrative and manual positions quit earlier than other women. Interestingly, women in service occupations do not differ in breastfeeding duration from SAH mothers or professionals. This research demonstrates that low-income women are having difficulty combining work and breastfeeding, which has important health implications for their infants, and that women working in administrative and manual occupations may face special constraints.

Equitable health services for the young? A decomposition of income-related inequalities in young adults' utilization of health care in Northern Sweden.

PubMed

Mosquera, Paola A; Waenerlund, Anna-Karin; Goicolea, Isabel; Gustafsson, Per E

2017-01-18

need factors and socioeconomic conditions accounted for the pro-poor concentration of GP visits. The distribution of GP visits among young people in Northern Sweden slightly favored the low-income group, and thus seems to meet the premises of horizontal equity. In contrast, the findings suggest substantial pro-rich horizontal inequity in the utilization of youth clinics among young women, which are largely rooted in socioeconomic inequalities.

Oxytocin, Social Support and Sleep Quality In Low Income Minority Women Living with HIV

PubMed Central

Fekete, Erin M.; Seay, Julia; Antoni, Michael H.; Mendez, Armando J.; Fletcher, Mary Ann; Szeto, Angela; Schneiderman, Neil

2013-01-01

Sleep disturbances are highly prevalent in women with HIV and few studies examine potential protective factors that may reduce risk for sleep disturbances in this high-risk population. We predicted that HIV-specific social support from various sources (i.e., friends, family, spouses), as well as oxytocin (OT), would explain sleep quality in 71 low income minority women living with HIV. Social support from family members was associated with better sleep quality in women. For women with high OT, support from friends was associated with better sleep quality, while for women with low OT, support from friends was associated with poorer sleep quality. Women with low OT may not effectively interpret and utilize available support resources, which may be associated with sleep disturbances. PMID:23799864

Factors related to noncompliance with screening mammogram appointments among low-income African-American women.

PubMed Central

Crump, S. R.; Mayberry, R. M.; Taylor, B. D.; Barefield, K. P.; Thomas, P. E.

2000-01-01

Despite current mammography recommendations, screening rates among African-American women are suboptimal. The purpose of this case-control study was to identify the psychological, demographic, and health care system barriers to screening mammography use among low-income African-American women. A total of 574 women with screening mammogram appointments at an urban hospital were interviewed to determine the predictors of mammogram appointment noncompliance. Predictor variables included: demographics; breast cancer knowledge, attitudes, beliefs, and screening practices; and type of health care provider making the referral. Age was inversely related to mammogram appointment noncompliance. Relative to women 40 to 49 years old, women 70 years of age and older were the least likely to miss their appointments (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2, 0.5). Women referred for mammography by a physician's assistant or nurse practitioner were less likely to miss their appointments than women referred by a physician (OR, 0.3; 95% CI, 0.1, 0.8). Embarrassment, lack of breast symptoms, and forgetfulness also contributed to noncompliance. Key demographic, attitudinal, and health care system factors hinder low-income African-American women from obtaining screening mammograms. These findings have significant health education and policy implications for health care delivery to women in this population. PMID:10881473

A multilevel analysis of individual, household, and neighborhood correlates of intimate partner violence among low-income pregnant women in Jefferson county, Alabama.

PubMed

Li, Qing; Kirby, Russell S; Sigler, Robert T; Hwang, Sean-Shong; Lagory, Mark E; Goldenberg, Robert L

2010-03-01

We examined individual, household, and neighborhood correlates of intimate partner violence (IPV) before and during pregnancy. We used multilevel modeling to investigate IPV among 2887 pregnant women in 112 census tracts who sought prenatal care in 8 public clinics in Jefferson County, Alabama, from 1997 through 2001. Data were collected from the Perinatal Emphasis Research Center project, the 2000 Census, and the local Sheriff and Police Departments Uniform Crime Reports for 1997 through 2001. Participants were predominantly young, African American, on Medicaid, and residents of low-income neighborhoods. The prevalence of past-year male partner-perpetrated physical or sexual violence was 7.4%. Neighborhood residential stability, women performing most of the housework (lack of involvement among partners), being unmarried (being in an uncommitted relationship), and alcohol use were positively associated with elevated IPV risk. Significant protective factors for IPV included older age at first vaginal intercourse and a greater sense of mastery (e.g., the perception of oneself as an effective person). Both neighborhood contextual and individual and household compositional effects are associated with IPV among low-income pregnant women. The results imply that combined interventions to improve neighborhood conditions and strengthen families may effectively reduce IPV.

Community-based fortified dietary intervention improved health outcomes among low-income African-American women.

PubMed

Salihu, Hamisu M; Adegoke, Korede K; Das, Rachita; Wilson, Ronee E; Mazza, Jessica; Okoh, Jennifer O; Naik, Eknath; Berry, Estrellita Lo

2016-08-01

Poor dietary exposure disproportionately affects African-Americans and contributes to the persistence of disparities in health outcomes. In this study, we hypothesized that fortified dietary intervention (FDI) will improve measured dietary and related health outcomes and will be acceptable among low-income African-American women living in Tampa, FL. These objectives were tested using a prospective experimental study using pretest and posttest design with a control group, using a community-based participatory research approach. The intervention (FDI) was designed by the community through structural modification of a preexisting, diet-based program by the addition of a physical and mental health component. Paired sample t tests were used to examine preintervention and postintervention changes in study outcomes. A total of 49 women participated in the study, 26 in the FDI group and 23 controls. Two weeks postintervention, there were significant improvements in waist circumference and health-related quality of life related to physical health (P< .0001), physical fitness subscores (P= .002), and nutritional subscores (P= .001) in the FDI group. Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted. In the control group, a decrease in waist circumference was observed. Implementation of the FDI through a community-based participatory research approach is feasible and effective among low-income African-American women in general and overweight/obese women in particular. Social reengineering of a nutritional intervention coupled with community-based approach will enhance health outcomes of low-income women. Copyright © 2016 Elsevier Inc. All rights reserved.

Acculturation Influences Postpartum Eating, Activity, and Weight Retention in Low-Income Hispanic Women.

PubMed

Martin, Chantel L; Tate, Deborah F; Schaffner, Andrew; Brannen, Anna; Hatley, Karen Erickson; Diamond, Molly; Munoz-Christian, Karen; Pomeroy, Jeremy; Sanchez, Teresa; Mercado, Adrian; Hagobian, Todd; Phelan, Suzanne

2017-12-01

Low-income Hispanic women experience elevated rates of high postpartum weight retention (PPWR), which is an independent risk factor for lifetime obesity. Sociocultural factors might play an important role among Hispanic women; however, very few studies have examined this association. The purpose of our study was to examine the associations between acculturation and maternal diet, physical activity, and PPWR. This is a cross-sectional study of baseline data from 282 Hispanic women participating in the FitMoms/Mamás Activas study, a randomized controlled trial examining the impact of primarily an internet-based weight control program, in reducing PPWR among low-income women. We performed multivariable linear regression to examine the association of acculturation with diet quality, physical activity, and PPWR at study entry. A total of 213 (76%) women had acculturation scores reflecting Mexican orientation or bicultural orientation, whereas 69 (24%) had scores that represented assimilation to Anglo culture. Women who were more acculturated had lower intakes of fruits and vegetables, lower HEI scores, and lower physical activity levels than women who were less acculturated (p < 0.05). We found an association between acculturation and PPWR in that for every 1-unit increase in acculturation score, PPWR increased, on average, by 0.80 kg. Higher acculturation was associated with poorer diet and physical activity behaviors and greater PPWR.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

PubMed

Jun, Shinyoung; Thuppal, Sowmyanarayanan V; Maulding, Melissa K; Eicher-Miller, Heather A; Savaiano, Dennis A; Bailey, Regan L

2018-03-08

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible ( n = 3142) and ineligible ( n = 3168) adult women (19-70 years) nationwide and SNAP-Ed participating women in Indiana ( n = 2623), using the NHANES 2007-2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Overweight and obesity among low-income women in rural West Virginia and urban Los Angeles County.

PubMed

Robles, Brenda; Frost, Stephanie; Moore, Lucas; Harris, Carole V; Bradlyn, Andrew S; Kuo, Tony

2014-10-01

We described the prevalence of overweight and obesity among low-income women in rural West Virginia (WV) and urban Los Angeles County (LA County). Both communities participated in the national Communities Putting Prevention to Work program during 2010-2012. In each community, we completed health assessments on adult women recruited from public-sector clinics serving low-income populations. All participants answered survey questions regarding socio-demographics and diets. In both jurisdictions, we assessed obesity using objectively measured height and weight (calculated BMI). As part of each community case study, we performed multivariable regression analyses to describe the relationships between overweight and obesity and selected covariates (e.g., dietary behaviors). Overweight and obesity were prevalent among low-income women from WV (73%, combined) and LA County (67%, combined). In both communities, race and ethnicity appeared to predict the two conditions; however, the associations were not robust. In LA County, for example, African American and Hispanic women were 1.4 times (95% CI=1.12, 1.81) more likely than white women to be overweight and obese. Collectively, these subpopulation health data served as an important guide for further planning of obesity prevention efforts in both communities. These efforts became a part of the subsequent Community Transformation Grants portfolio. Copyright © 2014 Elsevier Inc. All rights reserved.

International summit on the nutrition of adolescent girls and young women: consensus statement.

PubMed

Krebs, Nancy; Bagby, Susan; Bhutta, Zulfiqar A; Dewey, Kathryn; Fall, Caroline; Gregory, Fred; Hay, William; Rhuman, Lisa; Caldwell, Christine Wallace; Thornburg, Kent L

2017-07-01

An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low- and middle-income countries was held in Portland, Oregon in 2015. Sixty-seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient-rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world. © 2017 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of New York Academy of Sciences.

Recruiting low-income postpartum women into two weight loss interventions: in-person versus Facebook delivery.

PubMed

Silfee, Valerie J; Lopez-Cepero, Andrea; Lemon, Stephenie C; Estabrook, Barbara; Nguyen, Oanh; Rosal, Milagros C

2018-02-21

Several studies, such as the Diabetes Prevention Program (DPP), have provided foundational evidence for the efficacy of lifestyle interventions on weight loss and cardiometabolic prevention. However, translating these interventions to real-world settings and engaging at-risk populations has proven difficult. Social media-delivered interventions have high potential for reaching high-risk populations, but there remains a need to understand the extent to which these groups are interested in social media as a delivery mode. One potential way to this is by examining recruitment rates as a proxy for interest in the intervention delivery format. The aim of this study was to describe the recruitment rates of overweight and obese low-income postpartum women into two asynchronous behavioral weight loss interventions: one delivered in-person and the other delivered via Facebook. Both interventions used the same recruitment methods: participants were overweight low-income postpartum women who were clients of Women, Infants, and Children (WIC) clinics in Worcester, MA, screened for the study by nutritionists during routine WIC visits. Similarly, eligibility criteria were the same for both interventions except for a requirement for the Facebook-delivered intervention to currently use Facebook at least once per week. Among women pre-eligible for the in-person intervention, 42.6% gave permission to be contacted to determine full eligibility and 24.1% of eligible women enrolled. Among women pre-eligible for the Facebook intervention, 31.8% gave permission to be contacted and 28.5% of eligible women enrolled. Recruitment rates for a Facebook-based weight loss intervention were similar to recruitment rates for an in-person intervention, suggesting similar interest in the two program delivery modes among low-income postpartum women.

Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women.

PubMed

Michaelsen, Kim F; Dewey, Kathryn G; Perez-Exposito, Ana B; Nurhasan, Mulia; Lauritzen, Lotte; Roos, Nanna

2011-04-01

With increasing interest in the potential effects of n-6 and n-3 fatty acids in early life, there is a need for data on the dietary intake of polyunsaturated fatty acids (PUFA) in low-income countries. This review compiles information on the content in breast milk and in foods that are important in the diets of low-income countries from the few studies available. We also estimate the availability of fat and fatty acids in 13 low-income and middle-income countries based on national food balance sheets from the United Nations' Food and Agriculture Organization Statistical Database (FOASTAT). Breast milk docosahexaenoic acid content is very low in populations living mainly on a plant-based diet, but higher in fish-eating countries. Per capita supply of fat and n-3 fatty acids increases markedly with increasing gross domestic product (GDP). In most of the 13 countries, 70-80% of the supply of PUFA comes from cereals and vegetable oils, some of which have very low α-linolenic acid (ALA) content. The total n-3 fatty acid supply is below or close to the lower end of the recommended intake range [0.4%E (percentage of energy supply)] for infants and young children, and below the minimum recommended level (0.5%E) for pregnant and lactating women in the nine countries with the lowest GDP. Fish is important as a source of long-chain n-3 fatty acids, but intake is low in many countries. The supply of n-3 fatty acids can be increased by using vegetable oils with higher ALA content (e.g. soybean or rapeseed oil) and by increasing fish production (e.g. through fish farming). © 2011 Blackwell Publishing Ltd.

The Sexual and Reproductive Health of Young People in Low and Middle Income Countries

ERIC Educational Resources Information Center

Edwards, Orain; Peterson, Nicholas

2013-01-01

Young people ages 10-24 account for 25 percent of the world's population: a total of 1.8 billion, most of whom are living in low- and middle-income countries. They face significant challenges, including HIV, sexually transmitted infections (STIs), adolescent pregnancy, unsafe abortion, and gender-based violence. Youth have the right to lead…

Medicalization, reproductive agency, and the desire for surgical sterilization among low-income women in urban Brazil.

PubMed

de Bessa, Gina Hunter

2006-01-01

This article draws on data from ethnographic fieldwork in an urban housing project to examine the social context and meanings of surgical sterilization for low-income women in Brazil. Low-income women resort to sterilization because they distrust or are unsatisfied with alternative methods and because it helps them to fulfill the requirements of modern, responsible motherhood. Although sterilization is an option among few alternatives, and one that has subjected women to greater medical management and intervention, I argue that sterilization also represents poor women's active struggle to improve their lives and to resist the burdens placed on them by unequal gender relations. This article contributes to a growing anthropological literature that demonstrates how reproduction has become a central site where social values are constituted and contested, and it details women's diverse responses to the process of medicalization.

HIV-Associated Histories, Perceptions, and Practices Among Low-Income African American Women: Does Rural Residence Matter?

PubMed Central

Crosby, Richard A.; Yarber, William L.; DiClemente, Ralph J.; Wingood, Gina M.; Meyerson, Beth

2002-01-01

Objectives. This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. Methods. A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. Results. Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P = .001), that a sex partner had not been tested for HIV (P = .005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P = .02), not using condoms (P = .009), and a belief that their partner was HIV negative, despite lack of testing (P = .04). Conclusions. This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs. PMID:11919067

Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries.

PubMed

Denny, Lynette; de Sanjose, Silvia; Mutebi, Miriam; Anderson, Benjamin O; Kim, Jane; Jeronimo, Jose; Herrero, Rolando; Yeates, Karen; Ginsburg, Ophira; Sankaranarayanan, Rengaswamy

2017-02-25

Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Phenomenological Inquiry into the Financial Education Experiences of Young, Low-Income Credit Union Members

ERIC Educational Resources Information Center

Santangelo, Dan

2012-01-01

This qualitative phenomenological study engaged 20 young, low-income credit union members who participated in financial education classes at Denver Community Credit Union. The study explored learning experiences that generated changes in money management behaviors and sought evidence of transformational learning in a nonformal education setting.…

Nutrition interventions in women in low-income groups in the UK.

PubMed

Anderson, Annie S

2007-02-01

In the UK the mental and physical health and well-being of millions of women are influenced by living in poverty. Low educational attainment, unemployment, low pay and poor areas of residence exacerbate the challenges of obtaining optimal food choices, dietary intake and healthy eating patterns. Poorer women are more likely to eat low amounts of fruits and vegetables, whole grains and fish, and higher amounts of sugar and sweetened drinks compared with more affluent women. Diet contributes to the health inequalities evident in high rates of diet-related morbidity (including obesity) and mortality (including IHD and stroke) and in maternal and child health considerations (including breast-feeding and family diet practices). There is a dearth of research on effective interventions undertaken with low-income women, reflecting some of the challenges of engaging and evaluating programmes with this 'hard to reach' subpopulation. Intervention programmes from the USA, including WISEWOMAN, the Women's Health Initiative, the American Special Supplemental Food Program for Women, Infants and Children and the Expanded Food and Nutrition Education Program provide models for changing behaviour amongst women in the UK, although overall effects of such programmes are fairly modest. Lack of evidence does not mean that that policy work should be not be undertaken, but it is essential that policy work should be evaluated for its ability to engage with target groups as well as for the behavioural change and health outcomes.

In Crisis: Low Income Black Women in the U.S. Workplace. Working Paper No. 131.

ERIC Educational Resources Information Center

Woody, Bette; Malson, Michelene

Patterns of employment in U.S. industry today were studied in order to explore factors behind the low income and lagging occupational status of black women workers. The data collected for this group were contrasted with similar data for white women workers. The study found (1) substantial underrepresention in hiring black women at all income…

Physical and mental health correlates of adverse childhood experiences among low-income women.

PubMed

Cambron, Christopher; Gringeri, Christina; Vogel-Ferguson, Mary Beth

2014-11-01

The present study used secondary data gathered from a statewide random sample of 1,073 adult women enrolled in Utah's single-parent cash assistance program and logistic regression to examine associations between self-reported physical, emotional, and sexual abuse during childhood and later life physical and mental health indicators. Results demonstrated significant associations between low-income women's self-reports of physical, emotional, or sexual abuse in childhood, and current and lifetime anxiety disorder, domestic violence, current posttraumatic stress disorder, bipolar disorder, physical health or mental health issues, and any mental health diagnosis. These results build on previous research to paint a fuller picture of the associations between childhood abuse and physical and mental health for low-income women in Utah. Consistent with research by the Centers for Disease Control and Prevention, findings suggest the applicability of conceptualizing childhood abuse as a public health issue. Social workers can play an integral role in promoting and implementing broader screening practices, connecting affected individuals with long-term interventions, and applying research findings to the design and provision of services within a public health model.

Doula care supports near-universal breastfeeding initiation among diverse, low-income women.

PubMed

Kozhimannil, Katy B; Attanasio, Laura B; Hardeman, Rachel R; O'Brien, Michelle

2013-01-01

Breastfeeding initiation rates in the United States have risen in recent years. However, there are notable disparities by socioeconomic status and race/ethnicity. Previous research has suggested that care from a doula (a trained professional who provides nonmedical support during the perinatal period) may increase breastfeeding initiation. The goal of this analysis was to study whether doula support may be associated with breastfeeding initiation among low-income, diverse women. We compared breastfeeding initiation rates (means and 95% confidence intervals) for 1069 women who received doula care from Everyday Miracles, a Minnesota-based organization that employs a diverse group of certified doulas, to a state-based sample of women with Medicaid coverage who gave birth in 2009 or 2010 and participated in the Minnesota Pregnancy Risk Assessment Monitoring System survey (weighted n = 51,721). Women who had doula-supported births had near-universal breastfeeding initiation (97.9%), compared with 80.8% of the general Medicaid population. Among African American women, 92.7% of those with doula support initiated breastfeeding, compared with 70.3% of the general Medicaid population. These results suggest that access to culturally appropriate doula care may facilitate higher rates of breastfeeding initiation. When supported in their nonmedical needs by birth doulas, the diverse, low-income patients of midwives and other maternity care providers may have a greater likelihood of initiating breastfeeding and experiencing the maternal and infant health benefits associated with breastfeeding. © 2013 by the American College of Nurse-Midwives.

Adherence to hysterosalpingogram appointments following hysteroscopic sterilization among low income women

PubMed Central

Leyser-Whalen, Ophra; Berenson, Abbey B.

2013-01-01

Background The few studies on post-Essure hysterosalpingogram (HSG) adherence rates show inconsistent results. This study examined associations between sociodemographic variables not examined in prior studies and HSG adherence among low income women. Study Design Medical records of 286 women who underwent sterilization between August 31, 2005 and September 30, 2011 were reviewed. Chi-square and Mann-Whitney tests were used to determine variable associations with HSG adherence. Results The adherence rate for the first HSG was 85.0% (243/286). Variables associated with adherence were: lower education level (p=.01), not working outside the home (p=.04), being married (p<.0001), lower gravidity (p=.03), fewer lifetime number of sexual partners (p<.0001), no sexually transmitted infection history (p<.01), Hispanic ethnicity (p<.0001), Spanish as a primary language (p<.0001) and living further from the clinic (p<.01). Conclusions This study demonstrates that achieving high rates of adherence with the recommended HSG following Essure placement is feasible among low income populations. Furthermore, not speaking English or having to commute a far distance to the clinic do not appear to be barriers. This is encouraging considering the importance of this test to confirm tubal occlusion. PMID:24012097

Concepts of healthful food among low-income African American women.

PubMed

Lynch, Elizabeth B; Holmes, Shane; Keim, Kathryn; Koneman, Sylvia A

2012-01-01

Describe beliefs about what makes foods healthful among low-income African American women. In one-on-one interviews, 28 low-income African American mothers viewed 30 pairs of familiar foods and explained which food in the pair was more healthful and why. Responses were grouped into codes describing concepts of food healthfulness. Nutrient content, physical effects of food, and food categories were used to judge the healthfulness of foods. Fruits, vegetables, and dairy foods were considered the most healthful and starchy foods the least healthful because they were believed to cause weight gain. Beliefs about which foods contain which nutrients and which foods have particular physical effects varied widely across participants. Participants demonstrated awareness of which foods are healthful but lacked understanding of why those foods are more healthful than others. Knowledge about the health effects of foods may be necessary to motivate individuals to choose healthful foods. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Extension of the behavioral model of healthcare utilization with ethnically diverse, low-income women.

PubMed

Keenan, Lisa A; Marshall, Linda L; Eve, Susan

2002-01-01

Psychosocial vulnerabilities were added to a model of healthcare utilization. This extension was tested among low-income women with ethnicity addressed as a moderator. Structured interviews were conducted at 2 points in time, approximately 1 year apart. The constructs of psychosocial vulnerability, demographic predisposing, barriers, and illness were measured by multiple indicators to allow use of Structural Equation Modeling to analyze results. The models were tested separately for each ethnic group. Community office. African-American (N = 266), Euro-American (N = 200), and Mexican-American (N = 210) women were recruited from the Dallas Metropolitan area to participate in Project Health Outcomes of Women, a multi-year, multi-wave study. Face-to-face interviews were conducted with this sample. Participants had been in heterosexual relationships for at least 1 year, were between 20 and 49 years of age, and had incomes less than 200% of the national poverty level. Healthcare utilization, defined as physician visits and general healthcare visits. Illness mediated the effect of psychosocial vulnerability on healthcare utilization for African Americans and Euro-Americans. The model for Mexican Americans was the most complex. Psychosocial vulnerability on illness was partially mediated by barriers, which also directly affected utilization. Psychosocial vulnerabilities were significant utilization predictors for healthcare use for all low-income women in this study. The final models for the 2 minority groups, African Americans and Mexican Americans, were quite different. Hence, women of color should not be considered a homogeneous group in comparison to Euro-Americans.

Risk factors for major antenatal depression among low-income African American women.

PubMed

Luke, Sabrina; Salihu, Hamisu M; Alio, Amina P; Mbah, Alfred K; Jeffers, Dee; Berry, Estrellita Lo; Mishkit, Vanessa R

2009-11-01

Data on risk factors for major antenatal depression among African American women are scant. In this study, we seek to determine the prevalence and risk factors for major antenatal depression among low-income African American women receiving prenatal services through the Central Hillsborough Healthy Start (CHHS). Women were screened using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of > or =13 as positive for risk of major antenatal depression. In total, 546 African American women were included in the analysis. We used logistic regression to identify risk factors for major antenatal depression. The prevalence of depressive symptomatology consistent with major antenatal depression was 25%. Maternal age was identified as the main risk factor for major antenatal depression. The association between maternal age and risk for major antenatal depression was biphasic, with a linear trend component lasting until age 30, at which point the slope changed markedly tracing a more pronounced likelihood for major depression with advancing age. Women aged > or =30 were about 5 times as likely to suffer from symptoms of major antenatal depression as teen mothers (OR = 4.62, 95% CI 2.23-9.95). The risk for major antenatal depression increases about 5-fold among low-income African American women from age 30 as compared to teen mothers. The results are consistent with the weathering effect resulting from years of cumulative stress burden due to socioeconomic marginalization and discrimination. Older African American mothers may benefit from routine antenatal depression screening for early diagnosis and intervention.

Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment.

PubMed

Gelman, Amanda; Rosenfeld, Elian A; Nikolajski, Cara; Freedman, Lori R; Steinberg, Julia R; Borrero, Sonya

2017-03-01

Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services. A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women's responses to them. Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions. Women's reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women's abortion experiences. Copyright © 2016 by the Guttmacher Institute.

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India

PubMed Central

Mody, Sheila K; Nair, Saritha; Dasgupta, Anindita; Raj, Anita; Donta, Balaiah; Saggurti, Niranjan; Naik, DD; Silverman, Jay G

2014-01-01

Objective To examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. Study Design We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data was collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization. Results Postpartum women aged 17–45 years (N=1049) completed the survey; 44.5% (n= 467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and who had experienced physical violence or forced sex were more likely to not use postpartum contraception (AORs = 1.47–1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum and the most common method used was condoms 77.8% (n=126). Conclusion Contraception non-use was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling. Implications This original research study is a unique contribution to the literature because it presents data regarding the non-use of postpartum contraception among women seeking immunizations for

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India.

PubMed

Mody, Sheila K; Nair, Saritha; Dasgupta, Anindita; Raj, Anita; Donta, Balaiah; Saggurti, Niranjan; Naik, D D; Silverman, Jay G

2014-06-01

The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization. Postpartum women aged 17-45 years (N=1049) completed the survey; 44.5% (n=467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47-1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum, and the most common method used was condoms 77.8% (n=126). Contraception nonuse was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling. This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers

Food choice, eating behavior, and food liking differs between lean/normal and overweight/obese, low-income women.

PubMed

Dressler, Heidi; Smith, Chery

2013-06-01

The higher rate of obesity among low-income women has widely been attributed to environmental barriers; however, many low-income women are still able to maintain a healthy weight despite obesogenic environments. To better understand personal and behavioral attributes related to food choice and weight, overweight/obese women and lean/normal weight women living in similar low-income environments, participated in focus groups, and taste testing sessions to investigate food liking (n=83). During focus groups, lean/normal weight participants reported that health was influential in food choice, while overweight/obese participants expressed cost as being more of a factor. Both BMI (kg/m(2)) groups reported that taste was of greatest importance. Personal factors, like emotional eating, and overeating were also discussed with differences noted between BMI (kg/m(2)) groups. Quantitative data also showed cost to be more important for overweight/obese women. Taste testing results revealed that overweight/obese participants had a higher overall liking for both healthy and less healthy foods, as well as other food categories. Additionally, these women had a higher liking of fat in the context of spreadable fats. Our results show that a variety of complex factors interact to influence eating behavior and present weight status of women living in similarly impoverished environments. However, findings from this exploratory study should be confirmed through further research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Knowledge of Abortion Laws and Services Among Low-Income Women in Three United States Cities.

PubMed

Lara, Diana; Holt, Kelsey; Peña, Melanie; Grossman, Daniel

2015-12-01

Low-income women and women of color are disproportionately affected by unintended pregnancy. Lack of knowledge of abortion laws and services is one of several factors likely to hinder access to services, though little research has documented knowledge in this population. Survey with convenience sample of 1,262 women attending primary care or full-scope Ob/Gyn clinics serving low-income populations in three large cities and multivariable analyses with four knowledge outcomes. Among all participants, 53% were first-generation immigrants, 25% identified the correct gestational age limit, 41% identified state parental consent laws, 67% knew partner consent is not required, and 55% knew where to obtain abortion services. In multivariable analysis, first-generation immigrants and primarily Spanish speakers were significantly less likely than higher-generation or primarily English speakers to display correct knowledge. Design and evaluation of strategies to improve knowledge about abortion, particularly among migrant women and non-primary English speakers, is needed.

Informal support networks of low-income senior women living alone: evidence from Fort St. John, BC.

PubMed

Ryser, Laura; Halseth, Greg

2011-01-01

Within the context of an aging Canadian rural and small-town landscape, there is a growing trend of low-income senior women living alone. While there is a perception that rural seniors have well-developed social networks to meet their daily needs, some research suggests that economic and social restructuring processes have impacted the stability of seniors' support networks in small places. While much of the research on seniors' informal networks focuses upon small towns in decline, booming resource economies can also produce challenges for low-income senior women living alone due to both a higher cost of living and the retrenchment of government and service supports. Under such circumstances, an absence of informal supports can impact seniors' health and quality of life and may lead to premature institutionalization. Drawing upon a household survey in Fort St. John, British Columbia, we explore informal supports used by low-income senior women living alone in this different context of the Canadian landscape. Our findings indicate that these women not only have a support network that is comparable to other groups, but that they are also more likely to draw upon such supports to meet their independent-living needs. These women rely heavily on family support, however, and greater efforts are needed to diversify both their formal and informal sources of support as small family networks can quickly become overwhelmed.

Knowledge produced on the health of low-income older women: an integrative review.

PubMed

Tavares, Renata Evangelista; Jesus, Maria Cristina Pinto de; Cordeiro, Samara Macedo; Machado, Daniel Rodrigues; Braga, Vanessa Augusta; Merighi, Miriam Aparecida Barbosa

2017-01-01

to identify the knowledge produced on the health of low-income older women. an integrative review was conducted in February 2016 on the SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE databases, and in the SciELO journals directory. After the application of inclusion and exclusion criteria, 24 articles were selected. the knowledge produced comprises two main themes: "health in face of economic adversities" and "reciprocity in social support between low-income older women and their social network". health professionals, especially nurses, should be attentive to aspects related to social determinants and the health of low-income older women, highlighting the fact that they are not always the recipients of care. identificar o conhecimento produzido sobre a saúde das mulheres idosas de baixa renda. revisão integrativa realizada em fevereiro de 2016, nas bases de dados SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE e no diretório de revistas SciELO. Após aplicação dos critérios de inclusão e exclusão, foram selecionados 24 artigos. o conhecimento produzido congrega dois temas principais: "a saúde diante das adversidades econômicas" e "reciprocidade no apoio social entre as mulheres idosas de baixa renda e sua rede social". os profissionais de saúde, em especial o enfermeiro, devem atentar para aspectos relacionados aos determinantes sociais e de saúde de mulheres idosas de baixa renda, destacando-se que elas, nem sempre, são apenas receptoras de cuidado.

Global women's health: current clinical trials in low- and middle-income countries.

PubMed

Merriel, A; Harb, H M; Williams, H; Lilford, R; Coomarasamy, A

2015-01-01

Clinical trials in low- and middle-income countries (LMICs) are necessary to develop evidence-based approaches to improve women's health. Understanding what research is currently being conducted will allow the identification of research gaps, avoidance of duplication, planning of future studies, collaboration amongst research groups, and geographical targeting for research investments. To provide an overview of active women's health trials in LMICs. The World Health Organization's International Clinical Trials Registry Platform was searched for trials registered between 1 April 2012 and 31 March 2014. Selected trials were randomised, conducted in LMICs, active, and with a women's health intervention or a significant outcome for the woman. Two reviewers extracted data. Analysis included geographical spread, speciality areas, pre-enrolment registration, study size, and funders. Of the 8966 records, 509 were eligible for inclusion. Gynaecology trials made up 57% of the research, whereas the remaining 43% of trials were in obstetrics. Research activity focused on fertility (17%), the antenatal period (15%), benign gynaecology (14%), intrapartum care (9%), and pre-invasive disease and cancers (8%). The majority of trials (84%) took place in middle-income countries (MICs). In low-income countries (LICs) 83% of research investigated obstetrics, and in MICs 60% of research investigated gynaecology. Most trials (80%) had a sample size of 500 or fewer participants. The median size of trials in LICs was 815 compared with 128 in MICs. Pre-enrolment registration occurred in 54% of trials. The majority (62%) of trials were funded locally. Many LMICs are active in women's health research. The majority of registered trials are located in MICs; however, the trials in LICs are often larger. The focus of research in MICs may be driven by local priorities and funding, with fertility being highly researched. In LICs, pregnancy is the focus, perhaps reflecting the international

Food Insecurity, Not Stress is Associated with Three Measures of Obesity in Low-Income, Mexican-American Women in South Texas.

PubMed

Salinas, Jennifer J; Shropshire, William; Nino, Ana; Parra-Medina, Deborah

2016-01-01

To determine the relationship between obesity, food insecurity and perceived stress in very low income Mexican American women. Cross-sectional baseline data analysis of a randomized clinical trial. Texas-Mexico border region of South Texas. Very Low Income Mexican American Women. The relationship between obesity and food insecurity in a sample of very low income Hispanic women living in South Texas depends on the measure of obesity and the dimension of food insecurity. The only measure of food insecurity associated with all measures of obesity was often not having enough money to afford to eat balanced meals. Waist circumference was associated with the most dimensions of food insecurity, while BMI had the least associations. Finally, perceived stress was not significantly associated with BMI, waist circumference or percent body fat when adjusted for other covariates. We have found a strong and significant relationship between food insecurity related to having enough resources to eat a balanced diet and BMI, waist circumference, and percent body fat in low-income Mexican American women. While behavioural change is an important strategy for reducing obesity, consideration may need to be made as to how food access with high nutritional value, may be in and of itself a contributing factor in obesity in low income populations.

Prenatal tobacco prevention and cessation interventions for women in low- and middle-income countries.

PubMed

Oncken, Cheryl A; Dietz, Patricia M; Tong, Van T; Belizán, José M; Tolosa, Jorge E; Berghella, Vincenzo; Goldenberg, Robert L; Lando, Harry A; Samet, Jonathan M; Bloch, Michele H

2010-01-01

Although the prevalence of tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries. The health and economic burden of increasing tobacco use and dependence is predictable and will have devastating effects in countries with limited resources, particularly for vulnerable populations such as pregnant women. We sought to review effective tobacco prevention and intervention strategies for decreasing tobacco use and secondhand smoke exposure before and during pregnancy in high-, middle-, and low-income countries. We reviewed several types of interventions, including population-level efforts (increasing tobacco prices, implementing tobacco control policies), community interventions, clinical interventions, and pharmacological treatments. A second purpose of this report is to present findings of an international expert working group that was convened to review the evidence and to establish research priorities in the following areas: (a) preventing the uptake and reducing tobacco use among girls and women of reproductive age; and (b) reducing tobacco use and secondhand smoke exposure among pregnant women. The working group considered the evidence on existing interventions in terms of burden of disease, intervention impact, intervention costs, feasibility of integration into existing services, uniqueness of the contribution, and overall feasibility. Finally, we present the working group's recommendations for intervention research priorities.

Assessing the Reproductive Health-Related Information-Seeking Behavior of Low-Income Women: Describing a Two-Step Information-Seeking Process.

PubMed

Zimmerman, Margaret S

2018-01-01

This paper explores the reproductive health-related information seeking of low-income women that has been found to be affected by digital divide disparities. A survey conducted with 70 low-income women explores what information sources women use for reproductive health-related information seeking, what process they go through to find information, and if they are using sources that they trust. The findings of this study detail a two-step information-seeking process that typically includes a preference for personal, informal sources. Women of this income group often rely upon sources that they do not consider credible. While there have been many studies on the end effects of a lack of accurate and accessible reproductive health information, little research has been conducted to examine the reproductive healthcare information-seeking patterns of women who live in poverty.

“I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women

PubMed Central

Gordon, Allegra R.; Austin, S. Bryn; Krieger, Nancy; White Hughto, Jaclyn M.; Reisner, Sari L.

2016-01-01

The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18–31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants’ access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention. PMID:27518756

Who Meets the Contraceptive Needs of Young Women in Sub-Saharan Africa?

PubMed

Radovich, Emma; Dennis, Mardieh L; Wong, Kerry L M; Ali, Moazzam; Lynch, Caroline A; Cleland, John; Owolabi, Onikepe; Lyons-Amos, Mark; Benova, Lenka

2018-03-01

Despite efforts to expand contraceptive access for young people, few studies have considered where young women (age 15-24) in low- and middle-income countries obtain modern contraceptives and how the capacity and content of care of sources used compares with older users. We examined the first source of respondents' current modern contraceptive method using the most recent Demographic and Health Survey since 2000 for 33 sub-Saharan African countries. We classified providers according to sector (public/private) and capacity to provide a range of short- and long-term methods (limited/comprehensive). We also compared the content of care obtained from different providers. Although the public and private sectors were both important sources of family planning (FP), young women (15-24) used more short-term methods obtained from limited-capacity, private providers, compared with older women. The use of long-term methods among young women was low, but among those users, more than 85% reported a public sector source. Older women (25+) were significantly more likely to utilize a comprehensive provider in either sector compared with younger women. Although FP users of all ages reported poor content of care across all providers, young women had even lower content of care. The results suggest that method and provider choice are strongly linked, and recent efforts to increase access to long-term methods among young women may be restricted by where they seek care. Interventions to increase adolescents' access to a range of FP methods and quality counseling should target providers frequently used by young people, including limited-capacity providers in the private sector. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Low-Income Women's Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study.

PubMed

Savage, Jennifer S; Neshteruk, Cody D; Balantekin, Katherine N; Birch, Leann L

2016-12-01

Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the "one size fits most" approach. Lastly, mothers reported relying on their "instincts" and that "all babies are different" when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother-child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.

"I have to constantly prove to myself, to people, that I fit the bill": Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women.

PubMed

Gordon, Allegra R; Austin, S Bryn; Krieger, Nancy; White Hughto, Jaclyn M; Reisner, Sari L

2016-09-01

The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18-31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants' access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Tobacco industry marketing to low socioeconomic status women in the U.S.A.

PubMed

Brown-Johnson, Cati G; England, Lucinda J; Glantz, Stanton A; Ling, Pamela M

2014-11-01

Describe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the U.S.A. Analysis of previously secret tobacco industry documents. Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, 'discount-susceptible' older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands. Tobacco companies used numerous marketing strategies to reach low SES females in the U.S.A. for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment

PubMed Central

Gelman, Amanda; Rosenfeld, Elian A.; Nikolajski, Cara; Freedman, Lori R.; Steinberg, Julia R.; Borrero, Sonya

2017-01-01

CONTEXT Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services. METHODS A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women’s responses to them. RESULTS Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions. CONCLUSIONS Women’s reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women’s abortion experiences. PMID:27984674

Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England.

PubMed

McFadden, Alison; Green, Josephine M; Williams, Victoria; McLeish, Jenny; McCormick, Felicia; Fox-Rushby, Julia; Renfrew, Mary J

2014-02-11

Good nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners. The multi-method study conducted in England in 2011/2012 included focus group discussions with 49 health practitioners, an online consultation with 620 health and social care practitioners, service managers, commissioners, and user and advocacy groups, and qualitative participatory workshops with 85 low-income women. Additional focus group discussions and telephone interviews included the views of 25 women who did not speak English and three women from Traveller communities. Women reported that Healthy Start vouchers increased the quantity and range of fruit and vegetables they used and improved the quality of family diets, and established good habits for the future. Barriers to registration included complex eligibility criteria, inappropriate targeting of information about the programme by health practitioners and a general low level of awareness among families. Access to the programme was particularly challenging for women who did not speak English, had low literacy levels, were in low paid work or had fluctuating incomes. The potential impact was undermined by the rising price of food relative to voucher value. Access to registered retailers was problematic in rural areas, and there was low registration among smaller shops and market stalls, especially those serving culturally diverse communities. Our evaluation of the Healthy Start programme in England suggests that a food subsidy programme can provide an important nutritional safety net and potentially improve nutrition for pregnant women and young

Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England

PubMed Central

2014-01-01

nutrition for pregnant women and young children living on low incomes. Factors that could compromise this impact include erosion of voucher value relative to the rising cost of food, lack of access to registered retailers and barriers to registering for the programme. Addressing these issues could inform the design and implementation of food subsidy programmes in high income countries. PMID:24517737

Effects of Social Injustice on Breast Health–Seeking Behaviors of Low-Income Women

PubMed Central

Bowen, Shelly-Ann; Williams, Edith M.; Stoneberg-Cooper, Chayah M.; Glover, Saundra H.; Williams, Michelle S.; Byrd, Michael D.

2014-01-01

Purpose The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity. Design Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up. Setting Individual telephone interviews were conducted with 16 women with confirmed breast anomaly. Participants Low-income women screened through a national breast cancer early detection program. Method Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package. Results For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants’ health decisions. Conclusion The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development. PMID:23448411

Race, homelessness, and other environmental factors associated with the food-purchasing behavior of low-income women.

PubMed

Dammann, Kristen Wiig; Smith, Chery

2010-09-01

Observance of the hunger-obesity paradox in urban Minnesota has ignited interest in the quality of low-income households' food purchases. This cross-sectional study investigated low-income, urban Minnesotan women's past-month food purchases and their associations with race, homelessness, and aspects of the food system, including food shelf (ie, food pantry) and food store usage, factors believed to influence food choice and grocery shopping behavior. The survey included demographics, the US Department of Agriculture's 18-item Household Food Security Survey Module, and grocery shopping questions related to food purchases and food stores visited in the past month. Participants were a convenience sample of 448 low-income, urban Minnesotan women, and data were collected from February through May 2008. The sample was 44% African American, 35% American Indian, 10% white, and 11% other/mixed race; 37% were homeless. Rates of "less healthy" food group purchases were higher compared to "healthy" food group purchases. Significant racial differences were found with respect to purchasing healthy protein food groups (P<0.05 to P<0.01) but not fruits, vegetables, or whole grains. Homelessness reduced the odds of purchasing most food groups, regardless of nutrient density (P<0.05 to P<0.001). Food shelf and food store usage mainly increased the odds of purchasing "less healthy" food groups (P<0.05 to P<0.01). These findings may help registered dietitians strategize with low-income, urban women how to make best use of food resources within their local food system. Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Income, income inequality and youth smoking in low- and middle-income countries.

PubMed

Li, David X; Guindon, G Emmanuel

2013-04-01

To examine the relationships between income, income inequality and current smoking among youth in low- and middle-income countries. Pooled cross-sectional data from the Global Youth Tobacco Surveys, conducted in low- and middle-income countries, were used to conduct multi-level logistic analyses that accounted for the nesting of students in schools and of schools in countries. A total of 169 283 students aged 13-15 from 63 low- and middle-income countries. Current smoking was defined as having smoked at least one cigarette in the past 30 days. Gross domestic product (GDP) per capita was our measure of absolute income. Contemporaneous and lagged (10-year) Gini coefficients, as well as the income share ratio of the top decile of incomes to the bottom decile, were our measures of income inequality. Our analyses reveal a significant positive association between levels of income and youth smoking. We find that a 10% increase in GDP per capita increases the odds of being a current smoker by at least 2.5%, and potentially considerably more. Our analyses also suggest a relationship between the distribution of incomes and youth smoking: youth from countries with more unequal distributions of income tend to have higher odds of currently smoking. There is a positive association between gross domestic product and the odds of a young person in a low- and middle-income country being a current smoker. Given the causal links between smoking and a wide range of youth morbidities, the association between smoking and income inequality may underlie a substantial portion of the health disparities observed that are currently experiencing rapid economic growth. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Gender Distrust and Intimate Unions among Low-Income Hispanic and African American Women

ERIC Educational Resources Information Center

Estacion, Angela; Cherlin, Andrew

2010-01-01

This article investigates levels of generalized distrust of men among low-income non-Hispanic African American, Mexican, Puerto Rican, Dominican and non-Hispanic White women in a three-city survey. The results reveal substantial variation. Hispanics' overall levels of distrust are found to be higher than levels for either African Americans or…

Healthy eating behaviors and the cognitive environment are positively associated in low-income households with young children.

PubMed

Pieper, Joy Rickman; Whaley, Shannon E

2011-08-01

The purpose of this research was to examine relationships between eating behaviors and the cognitive environment in primarily Hispanic low-income households with young children receiving WIC benefits in Los Angeles County. Survey data were collected from 3645 low-income families with children age 12-65 mo in Los Angeles County. Eating behaviors were measured through questions about fruit, vegetable, milk, soft drink, and fast food intake. The cognitive environment was evaluated through questions on the home literacy environment (HLE), reading frequency, and preschool enrollment. All healthy eating behaviors measured were significantly and positively associated with reading frequency and HLE scores after adjustment for confounders. HLE and reading frequency scores were 18% and 14% higher, respectively, in children eating two or more servings of fruit per day and 12% and 9% higher, respectively, in children eating three or more servings of vegetables per day. Preschool enrollment was not significantly associated with any eating behavior. Outcomes varied by language-ethnic groups and child sex. Results suggest that healthy eating behaviors are positively associated with stronger cognitive environments in low-income Hispanic families with young children. Interventions to prevent childhood obesity in this group may therefore benefit from including a home literacy component. Copyright © 2011 Elsevier Ltd. All rights reserved.

Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis.

PubMed

Messinger, Chelsea Jordan; Mahmud, Ilias; Kanan, Sushama; Jahangir, Yamin Tauseef; Sarker, Malabika; Rashid, Sabina Faiz

2017-01-14

As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and

Prenatal nutrition intervention to reduce mutans streptococci among low-income women.

PubMed

Reisine, Susan; Douglass, Joanna; Aseltine, Robert; Shanley, Ellen; Thompson, Colleen; Thibodeau, Edward

2012-01-01

The objective of this study is to assess the effectiveness of a prenatal nutrition intervention to reduce sugar intake and mutans streptococci (mutans) among low-income women. Pregnant women were recruited from the obstetrics service at a community health center in Connecticut. Inclusion criteria were ≥18 years of age; mutans levels >10, 000 colony forming units/ml as determined by Dentocult SM® kits (Orion Diagnostica Oy, Espoo, Finland); and >3 months pregnant. Women were randomized to receive education alone [education intervention (EI)] or education and a 1-hour nutrition group session at 9 months and 6 weeks postpartum [education and nutrition intervention (EIN)]. Mutans and questionnaire data were collected at baseline, 9 months, 6 weeks, and 3 months postpartum. One hundred twenty completed the baseline visit and 93 (77%) completed all four visits. Sugar intake was assessed by the Food Frequency Questionnaire and clinical information was abstracted from medical charts. Mean age was 26.3 years [standard deviation (SD)= 6], 73% were Hispanic, 29% had lived in the United States < 6 years; 48% completed high school; 27% were married; mean total sugar intake at baseline was 149g (SD = 85). Repeated measures analysis of variance showed that mutans levels declined significantly in both groups, but that the EI group had significantly lower mutans levels at the final assessment compared with EIN. Sugar intake also declined significantly, but there were no significant differences between groups. The study demonstrated the following: a) the feasibility of conducting the intervention at community health center sites among low-income pregnant women; b) the effectiveness of education to reduce mutans/sugar intake; and c) the need to improve the nutrition intervention to obtain additional gains in mutans reduction. © 2011 American Association of Public Health Dentistry.

Predictors of dietary quality in low-income pregnant women: a path analysis.

PubMed

Fowles, Eileen R; Bryant, Miranda; Kim, SungHun; Walker, Lorraine O; Ruiz, Roberta Jeanne; Timmerman, Gayle M; Brown, Adama

2011-01-01

Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (β = .36) and a direct (β = -.23) and indirect effect on dietary quality (β = -.30). Poor eating habits had a direct effect on dietary quality (β = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (β = .39) and nutritional knowledge (β = .18) and an indirect effect on dietary quality (total effect, β = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Facebook Is an Effective Strategy to Recruit Low-Income Women to Online Nutrition Education

ERIC Educational Resources Information Center

Lohse, Barbara

2013-01-01

Objective: Nutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders. Methods: An ad appeared on…

Sociocultural construction of food ways in low-income Mexican-American women with diabetes: a qualitative study

PubMed Central

Benavides-Vaello, Sandra; Brown, Sharon A.

2017-01-01

Aims and objectives The aim of the study was to explore how low-income Hispanic women, with at least 10 years of having type 2 diabetes, successfully manage the disease within a sociocultural context, especially in relation to foodways. Background Managing type 2 diabetes is challenging, particularly for underserved populations such as low-income Hispanic women. This population segment has higher rates of type 2 diabetes, diabetes-related complications, obesity, and sedentary lifestyles than the general U.S. population. Dietary management is a critical aspect of diabetes care, but it is perhaps the most difficult health behaviour to modify. Design A qualitative and ethnographically based study was used. Methods Participant observation and individual interviews explored the interrelationships of culture, food habits and type 2 diabetes among 12 low-income Hispanic women residing in an impoverished rural community located on the Texas-Mexico border. Results Hispanic women used unique strategies to adjust their diet, particularly portion control; for example, they emphasised the ‘use of the fork’, based on the notion that Hispanic finger foods are less healthy. Women categorised foods as bad or acceptable, depending on the context, such as important family or social gatherings. Those with years of diabetes experience confidently took charge of the disease based on knowledge of their bodies and a desire to avoid complications, while acknowledging brief infractions of dietary ‘rules’ and balancing various social roles and expectations. Conclusions Hispanic women manage their type 2 diabetes within a sociocultural environment. Those with expertise make changes in how they eat to care for their diabetes, but also continue to maintain traditional foodways. PMID:27301464

Food Store Environment Modifies Intervention Effect on Fruit and Vegetable Intake among Low-Income Women in North Carolina

PubMed Central

Gustafson, Alison A.; Sharkey, Joseph; Samuel-Hodge, Carmen D.; Jones-Smith, Jessica C.; Cai, Jianwen; Ammerman, Alice S.

2012-01-01

Background. The aim of the study is to determine how the food store environment modifies the effects of an intervention on diet among low-income women. Study Design. A 16-week face-to-face behavioral weight loss intervention was delivered among low income midlife women. Methods. The retail food environment for all women was characterized by (1) the number and type of food stores within census tracts; (2) availability of healthy foods in stores where participants shop; (3) an aggregate score of self-reported availability of healthy foods in neighborhood and food stores. Statistical Analyses. Multivariable linear regression was used to model the food store environment as an effect modifier between the intervention effect of fruit and vegetable serving change. Results. Among intervention participants with a low perception of availability of healthy foods in stores, the intervention effect on fruit and vegetable serving change was greater [1.89, 95% CI (0.48, 3.31)] compared to controls. Among intervention participants residing in neighborhoods with few super markets, the intervention effect on fruit and vegetable serving change was greater [1.62, 95% CI (1.27, 1.96)] compared to controls. Conclusion. Results point to how the food store environment may modify the success of an intervention on diet change among low-income women. PMID:22315676

Association between Adult Stature and Energy Expenditure in Low-Income Women from Northeastern Brazil.

PubMed

Albuquerque, Fabiana Cristina Alves; Bueno, Nassib Bezerra; Clemente, Ana Paula Grotti; Ferriolli, Eduardo; Florêncio, Telma Maria Menezes Toledo; Hoffman, Daniel; Sawaya, Ana Lydia

2015-01-01

Perinatal undernutrition may lead to important metabolic adaptations in adult life, short stature being the most visible. The present study aimed to evaluate the association between stature and total energy expenditure of low-income women. Women aged 19-45 years from low-income communities in Maceió-AL were recruited. A sample of 67 volunteers was selected and divided into either short stature (≤ 152.4 cm; n = 34) or non-short stature (≥ 158.7 cm; n = 33) group. Data on socioeconomic status, anthropometric variables, and hormonal profiles was collected. Total energy expenditure and body composition were assessed by the doubly labeled water technique with multiple points over 14 days. In addition, physical activity levels were measured with triaxial accelerometers and dietary intake data were collected using three 24-hour food records. The mean subject age was 30.94 years. Women of short stature had lower body weight and lean body mass compared to non-short women, but there were no differences in thyroid hormone concentrations or daily energy intake between the two groups. Short-stature women showed lower total energy expenditure (P = 0.01) and a significantly higher physical activity level (P = 0.01) compared to non-short women. However, the difference in total energy expenditure was no longer significant after statistical adjustment for age, lean body mass, and triiodothyronine concentrations. Women with short stature present the same energy intake, but lower total energy expenditure than non-short women, even with a higher physical activity level, which suggests that they are more prone to weight gain.

Psychological distress among low-income U.S.- and foreign-born women of Mexican descent: impact of acculturation.

PubMed

Bekteshi, Venera; Xu, Qingwen; Van Tran, Thanh

2015-01-01

After testing the capacity of Kessler's psychological distress (K6) scale to measure equally across low-income Mexican-born women (n=881) and U.S.-born women of Mexican descent (n=317), this study assesses the impact of acculturation on this group's psychological distress. We employ descriptive and confirmatory factor analyses to test the cross-cultural equivalence of K6. Multivariate and logistic regression is used to test the association between acculturation and psychological distress among low-income, Mexican-American women. The cross-cultural equivalence analysis shows that some of the scale's items have the capacity to measure psychological distress equally among participants. Regression results indicate that the more acculturated these women become, the greater their psychological distress is. The study recommends that researchers emphasize the cross-cultural equivalence of their measures and suggests a heightened awareness among practitioners of the multidimensional impact of acculturation on clients of Mexican descent. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Stepped-Care, Community Clinic Interventions to Promote Mammography Use among Low-Income Rural African American Women

ERIC Educational Resources Information Center

West, Delia Smith; Greene, Paul; Pulley, LeaVonne; Kratt, Polly; Gore, Stacy; Weiss, Heidi; Siegfried, Nicole

2004-01-01

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…

Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women

PubMed Central

León-Maldonado, Leith; Wentzell, Emily; Brown, Brandon; Allen-Leigh, Betania; Torres-Ibarra, Leticia; Salmerón, Jorge; Billings, Deborah L.; Thrasher, James F.; Lazcano-Ponce, Eduardo

2016-01-01

Background HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico’s early cervical cancer detection program (ECDP). Research on Mexican women’s perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants. Methods We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women’s understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender. Results Women’s confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men’s sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes’ desire for sex as natural but understood men’s negative practices of masculinity, like infidelity, as the causes of women’s HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission. Conclusions These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women’s negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could

Reproductive coercion, sexual risk behaviours and mental health symptoms among young low-income behaviourally bisexual women: implications for nursing practice.

PubMed

Alexander, Kamila A; Volpe, Ellen M; Abboud, Sarah; Campbell, Jacquelyn C

2016-12-01

To describe prevalence of reproductive coercion, sexual risk behaviours and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men. Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner's gender may provide indications of broader health implications. Cross-sectional survey of low-income Black women ages 18-25 recruited from six community-based sites for a parent study focused on intimate partner violence and health. We analysed survey data from participants who reported lifetime sexual experiences with men and women (N = 42) and compared their outcomes to those of women reporting sexual experiences with men only (N = 107). A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms. Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols and counselling strategies for intimate partner violence and mental health among women who have sex with women and men. Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community-based settings should include a longitudinal understanding of sexual behaviour and gender of sex partners. �

Reproductive Coercion, Sexual Risk Behaviors, and Mental Health Symptoms among Young Low-Income Behaviorally Bisexual Women: Implications for Nursing Practice

PubMed Central

Alexander, Kamila A.; Volpe, Ellen M.; Abboud, Sarah; Campbell, Jacquelyn C.

2016-01-01

Aims and Objective To describe prevalence of reproductive coercion, sexual risk behaviors, and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men. Background Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner’s gender may provide indications of broader health implications. Design Cross-sectional survey of low-income Black women ages 18 to 25 recruited from three community-based sites for a parent study focused on intimate partner violence and health. Methods We analyzed survey data from participants who reported lifetime sexual experiences with men and women (N=42) and compared their outcomes to those of women reporting sexual experiences with men only (N=107). Results A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms. Conclusions Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols, and counseling strategies for intimate partner violence and mental health among women who have sex with women and men. Relevance to Clinical Practice Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community

Feasibility of Internet-based Parent Training for Low-income Parents of Young Children.

PubMed

McGoron, Lucy; Hvizdos, Erica; Bocknek, Erika L; Montgomery, Erica; Ondersma, Steven J

2018-01-01

Parent training programs promote positive parenting and benefit low-income children, but are rarely used. Internet-based delivery may help expand the reach of parent training programs, although feasibility among low-income populations is still unclear. We examined the feasibility of internet-based parent training, in terms of internet access/use and engagement, through two studies. In Study 1, 160 parents recruited from Women, Infants, and Children (WIC) centers completed a brief paper survey regarding internet access and use (all parents received government aid). We found high levels of access, openness, and comfort with the internet and internet-enabled devices. In Study 2, a pilot study, we assessed use of an online parenting program in a project with a sample of 89 predominately low-income parents (75% received government aid). Parents learned about a new, online parenting program (the "5-a-Day Parenting Program") and provided ratings of level of interest and program use 2-weeks and 4-weeks later. Local website traffic was also monitored. At baseline, parents were very interested in using the web-based program, and the majority of parents (69.6%) reported visiting the website at least once. However, in-depth use was rare (only 9% of parents reported frequent use of the online program). Results support the feasibility of internet-based parent training for low-income parents, as most parent were able to use the program and were interested in doing so. However, results also suggest the need to develop strategies to promote in-depth program use.

Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women.

PubMed

Chang, Mei-Wei; Brown, Roger; Nitzke, Susan; Smith, Barbara; Eghtedary, Kobra

2015-05-01

This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.

Stress mediates the relationship between past drug addiction and current risky sexual behavior among low income women

PubMed Central

Wu, Z. Helen; Tennen, Howard; Hosain, Monawar; Coman, Emil; Cullum, Jerry; Berenson, Abbey B.

2014-01-01

This study examined the role of stress as a mediator of the relationship between prior drug addiction and current high risk sexual behavior. Eight hundred twenty women aged 18 to 30 years, who received care at community-based family planning clinics were interviewed using the Composite International Diagnostic Interview and the Sexual Risk Behavior Assessment Schedule. They also completed the brief version of the Self-Control Scale as a measure of problem-solving strategies, and measures of recent stressful events, daily hassles, and ongoing chronic stress. Regardless of addiction history, stress exposure during the previous 12 months was associated with risky sexual behavior during the previous 12 months. Structural equation modeling revealed that 12-month stress levels mediated the relationship between past drug addiction and 12-month high risk sexual behaviors, as well as the negative relationship between problem-solving strategies and high risk sexual behaviors. Problem-solving strategies did not moderate the relationship between drug addiction and high risk sexual behaviors. These findings suggest that stress management training may help reduce risky behavior among young, low-income women PMID:24985341

An Evaluation of Program M in Rio De Janeiro, Brazil: An Analysis of Change in Self-Efficacy in Interpersonal Relationships, Gender Equity, and Self-Reported Risky Behaviors among Women in Two Low-Income Communities

ERIC Educational Resources Information Center

Rocha, Valeria

2011-01-01

This quantitative study examined whether Program M, an intervention targeting young women in a low-income community in the city of Rio de Janeiro, Brazil, promoted changes in gender equitable attitudes and self-efficacy in interpersonal relationships among program participants. Further, it investigated whether the program influenced these young…

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.

PubMed

Hansotte, Elinor; Payne, Shirley I; Babich, Suzanne M

2017-01-01

Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum

Household Risk and Child Sexual Abuse in a Low Income, Urban Sample of Women.

ERIC Educational Resources Information Center

Rowland, David L.; Zabin, Laurie S.; Emerson, Mark

2000-01-01

Explored the impact of household environment and childhood sexual abuse (CSA) on psychosocial development. Data on low-income, urban CSA victims, and non-CSA women indicated that household conditions indicative of parental dysfunction, antisocial behavior, and instability set the stage for CSA by interfering with parental protection. Victims'…

Sociocultural construction of food ways in low-income Mexican-American women with diabetes: a qualitative study.

PubMed

Benavides-Vaello, Sandra; Brown, Sharon A

2016-08-01

The aim of the study was to explore how low-income Hispanic women, with at least 10 years of having type 2 diabetes, successfully manage the disease within a sociocultural context, especially in relation to foodways. Managing type 2 diabetes is challenging, particularly for underserved populations such as low-income Hispanic women. This population segment has higher rates of type 2 diabetes, diabetes-related complications, obesity, and sedentary lifestyles than the general U.S. Dietary management is a critical aspect of diabetes care, but it is perhaps the most difficult health behaviour to modify. A qualitative and ethnographically based study was used. Participant observation and individual interviews explored the interrelationships of culture, food habits and type 2 diabetes among 12 low-income Hispanic women residing in an impoverished rural community located on the Texas-Mexico border. Hispanic women used unique strategies to adjust their diet, particularly portion control; for example, they emphasised the 'use of the fork', based on the notion that Hispanic finger foods are less healthy. Women categorised foods as bad or acceptable, depending on the context, such as important family or social gatherings. Those with years of diabetes experience confidently took charge of the disease based on knowledge of their bodies and a desire to avoid complications, while acknowledging brief infractions of dietary 'rules' and balancing various social roles and expectations. Hispanic women manage their type 2 diabetes within a sociocultural environment. Those with expertise make changes in how they eat to care for their diabetes, but also continue to maintain traditional foodways. Foodways are critical to most cultural groups and modifying dietary behaviours can be challenging. Clinicians must develop self-management guidance within the sociocultural context of the patient if diabetes outcomes are to improve and be sustained. © 2016 John Wiley & Sons Ltd.

Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis

PubMed Central

2014-01-01

Background Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. Methods We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). Results Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman’s access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. Conclusions Barriers to the uptake of the HPV vaccine have implications for young women’s future sexual, physical and reproductive health. Interventions to

Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK.

PubMed

Stockley, Lynn; Lund, Vivien

2008-08-01

To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women. Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand. Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available. Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.

Primary Care Attributes and Care for Depression Among Low-Income African American Women

PubMed Central

O’Malley, Ann S.; Forrest, Christopher B.; Miranda, Jeanne

2003-01-01

Objectives. We examined the association between attributes of primary care providers and care for depression, from a patients’ perspective, among a sample of predominantly low-income African American women. Methods. Computer-assisted telephone interviews were conducted among a population-based sample of 1202 women residing in Washington, DC. Results. Respondents whose primary care physicians provided more comprehensive medical services were more likely to be asked about and treated for depressive symptoms than women whose providers were less medically comprehensive. Women who rated their providers as having more respect for them also were more likely to be asked about and treated for depression. Conclusions. More comprehensive primary care delivery and a physician–patient relationship focused on mutual respect are associated with greater rates of physician inquiry about and treatment for depression among vulnerable women. PMID:12893623

Psychiatric disorders and treatment in low-income pregnant women.

PubMed

Cook, Cynthia A Loveland; Flick, Louise H; Homan, Sharon M; Campbell, Claudia; McSweeney, Maryellen; Gallagher, Mary Elizabeth

2010-07-01

This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.

Prevalence and Perceived Financial Costs of Marijuana versus Tobacco use among Urban Low-Income Pregnant Women.

PubMed

Beatty, Jessica R; Svikis, Dace S; Ondersma, Steven J

2012-09-30

To examine the relative prevalence of marijuana and tobacco use among low-income post-partum women, using self-report, urine, and hair testing data; and to further explore perceptions of the substances among postpartum women by evaluating perceived risk and monetary cost of prenatal marijuana versus tobacco use. Data from two studies were available for a total of 100 (Study 1) and 50 (Study 2) low-income, primarily African-American post-partum women. Study 1 participants completed brief self-report measures of substance use as well as urine and hair samples; study 2 participants completed a brief opinion survey regarding the risks and monetary costs of prenatal marijuana use. In Study 1, the self-reported prevalence of any tobacco or marijuana use in the past three months was 17% and 11%, respectively. However, objectively-defined marijuana use was more prevalent than self-reported tobacco use: 14% tested positive for marijuana by urinalysis, and 28% by hair analysis. Study 2 participants were more likely to believe that there is a safe level of marijuana use during pregnancy, and nearly half believed that using marijuana during pregnancy was less expensive than smoking cigarettes. Marijuana use may be as or more prevalent than tobacco use among low-income, African-American pregnant women. These findings may in part be attributable to perceptions of roughly equivalent cost and the lack of a clear public health message regarding prenatal marijuana use, combined with growing pro-marijuana advocacy. A broader public health response to address prenatal marijuana use, along with other substances of abuse, is needed.

Interrelationships between education, occupational class and income as determinants of sickness absence among young employees in 2002-2007 and 2008-2013.

PubMed

Sumanen, Hilla; Pietiläinen, Olli; Lahti, Jouni; Lahelma, Eero; Rahkonen, Ossi

2015-04-08

A low socioeconomic position (SEP) is consistently associated with ill health, sickness absence (SA) and permanent disability, but studies among young employees are lacking. We examined the interrelationships between education, occupational class and income as determinants of SA among 25-34-year-old employees. We also examined, whether the association between SEP and SA varied over time in 2002-2007 and 2008-2013. The analyses covered young, 25-34-year-old women and men employed by the City of Helsinki over the time periods 2002-2007 and 2008-2013. Four-level education and occupational class classifications were used, as well as income quartiles. The outcome measure was the number of annual SA days. Education had the strongest and most consistent independent association with SA among women and men in both periods under study. Occupational class had weaker independent and less consistent association with SA. Income had an independent association with SA, which strengthened over time among the men. The interrelationships between the SEP indicators and SA were partly explained by prior or mediated through subsequent SEP indicators. Socioeconomic differences followed only partially a gradient for occupational class and also for income among men. Preventive measures to reduce the risk of SA should be considered, especially among young employees with a basic or lower-secondary education.

Intention to breastfeed in low-income pregnant women: the role of social support and previous experience.

PubMed

Humphreys, A S; Thompson, N J; Miner, K R

1998-09-01

The purpose of this study was to describe the relationship between breastfeeding intention among socioeconomically disadvantaged pregnant women and maternal demographics, previous breastfeeding experience, and social support. A cross-sectional, convenience sampling strategy was employed for data collection. Low-income women (n = 1001) in a public hospital completed a six-page questionnaire about their infant feeding plans, demographics, and social support. Simple regression analyses were conducted to compare maternal breastfeeding intention with the hypothesized correlates. Breastfeeding intention was positively correlated with older maternal age, higher education, more breastfeeding experience, Hispanic ethnicity, and hearing about breastfeeding benefits from family members, the baby's father, and lactation consultants, but not from other health professionals. Health professionals' attitudes were less influential on women's infant feeding decisions than the attitudes and beliefs of members of women's social support networks. When controlling for breastfeeding experience (none vs any), some findings, varied, indicating a need for breastfeeding interventions tailored to women's level of experience. Use of peer counselors and lactation consultants, inclusion of a woman's family members in breastfeeding educational contacts, and creation of breastfeeding classes tailored to influential members of women's social support networks may improve breastfeeding rates among low-income women, especially those with no breastfeeding experience, more effectively than breastfeeding education to pregnant women that is solely conducted by health professionals.

Hmong Food Helps Us Remember Who We Are: Perspectives of Food Culture and Health among Hmong Women with Young Children

ERIC Educational Resources Information Center

Vue, Wa; Wolff, Cindy; Goto, Keiko

2011-01-01

Objective: To examine perspectives on food habits, acculturation, and health among Hmong women with young children in northern California. Methods: Qualitative interviews were conducted with 15 Hmong mothers with young children in a low-income community of northern California. The interviews were transcribed and coded based on the principles of…

Learning from "Knocks in Life": Food Insecurity among Low-Income Lone Senior Women.

PubMed

Green-Lapierre, Rebecca J; Williams, Patricia L; Glanville, N Theresa; Norris, Deborah; Hunter, Heather C; Watt, Cynthia G

2012-01-01

Building on earlier quantitative work where we showed that lone senior households reliant on public pensions in Nova Scotia (NS), Canada lacked the necessary funds for a basic nutritious diet, here we present findings from a qualitative study involving in-depth interviews with eight low-income lone senior women living in an urban area of NS. Using a phenomenological inquiry approach, in-depth interviews were used to explore lone senior women's experiences accessing food with limited financial resources. Drawing upon Bronfenbrenner's Ecological Systems Theory, we explored their perceived ability to access a nutritionally adequate and personally acceptable diet, and the barriers and enablers to do so; as well in light of our previous quantitative research, we explored their perceptions related to adequacy of income, essential expenses, and their strategies to manage personal finances. Seven key themes emerged: world view, income adequacy, transportation, health/health problems, community program use, availability of family and friends, and personal food management strategies. World view exerted the largest influence on seniors' personal perception of food security status. The implications of the findings and policy recommendations to reduce the nutritional health inequities among this vulnerable subset of the senior population are considered.

Healthy Mothers, Healthy Babies: A Compendium of Program Ideas for Serving Low-Income Women.

ERIC Educational Resources Information Center

Healthy Mothers, Healthy Babies Coalition, Washington, DC.

The Healthy Mothers, Healthy Babies survey conducted in spring 1985 drew responses from over 1,500 programs active in maternal and child health efforts directed toward low-income women and their families. The executive summary of this report identifies the major goals, common strategies, and needs of program respondents. Chapter 1 summarizes a…

Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking.

PubMed

Solomon, L J; Scharoun, G M; Flynn, B S; Secker-Walker, R H; Sepinwall, D

2000-07-01

This study tested the impact of free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. A total of 214 Medicaid-eligible women smokers of childbearing age were randomized to receive free nicotine patches through the mail or free nicotine patches through the mail plus the provision of proactive support by telephone from a woman ex-smoker for up to 3 months. Assessments were conducted by telephone at baseline, 10 days, and 3 and 6 months after enrollment. At the 3-month follow-up, significantly more women in the patch plus proactive telephone support condition were abstinent (42%) compared to the patch only condition (28%) (P = 0.03). Similarly, more women in the experimental condition were abstinent at both the 10-day and 3-month assessments (32 v 19%, P = 0.02). However, differences were not found at the 6-month follow-up, suggesting that the addition of proactive telephone peer support enhanced short-term, but not long-term cessation. This is the first study to demonstrate a beneficial effect for the addition of proactive telephone support as an adjunct to free nicotine replacement in a low-income population. Copyright 2000 American Health Foundation and Academic Press.

Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn.

PubMed

Gurgel, Cristiane Santos Sânzio; Grilo, Evellyn C; Lira, Larissa Q; Assunção, Débora G F; Oliveira, Priscila G; Melo, Larisse R M de; de Medeiros, Silvia V; Pessanha, Luanna C; Dimenstein, Roberto; Lyra, Clélia O

To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20μg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400μgRAE/day were considered as insufficient for term newborns. The mean maternal vitamin A intake during pregnancy was 872.2±639.2μgRAE/day in low-income women and 1169.2±695.2μgRAE/day for high-income women (p<0.005). The prevalence of vitamin A deficiency was 6.9% (n=18) in the low-income group and 3.7% (n=6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3μgRAE/day (85.8% AI) and 427.2μgRAE/day (106.8% AI), respectively. Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Learner-centered nutrition education improves folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age.

PubMed

Cena, Emily R; Joy, Amy Block; Heneman, Karrie; Espinosa-Hall, Gloria; Garcia, Linda; Schneider, Connie; Wooten Swanson, Patti C; Hudes, Mark; Zidenberg-Cherr, Sheri

2008-10-01

Recent studies suggest low-income women of childbearing age may be at risk of suboptimal folate intake. To evaluate the effect of learner-centered nutrition education on folate intake and food-related behaviors among nonpregnant, low-income women of childbearing age, compared to education unrelated to nutrition. Participants were randomly assigned by recruitment site to receive either the nutrition lesson or a control lesson about resource management. Nonpregnant, low-income (< or =185% federal poverty level) women of childbearing age (18 to 45 years, n=155) from five California counties. Changes in folate intake and other food-related behaviors. Analysis of covariance, adjusting for baseline responses and potential confounders. Adjusting for baseline, participants who received the nutrition education had greater increases in folate intake and use of the Nutrition Facts label than the control group. Change in intake of specific folate-rich foods differed by ethnicity. Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children who received the nutrition education increased folate intake but had no significant changes in other food-related behaviors. Food stamp recipients who received the nutrition education had no significant changes in folate intake but did increase the frequency of eating more than one kind of vegetable each day, compared to controls. This study supports the use of learner-centered approaches to nutrition education for low-income audiences, compared to education unrelated to nutrition. Future work is needed to compare learner-centered techniques to traditional pedagogical nutrition education, and to determine whether observed changes from this study persist over the long term.

Prevalence and correlates of pubic hair grooming among low-income Hispanic, Black, and White women

PubMed Central

DeMaria, Andrea L.; Berenson, Abbey B.

2013-01-01

The purpose of this paper was to describe pubic hair grooming behaviors (shaving, waxing, trimming or dyeing) and the extent to which grooming was related to demographic characteristics and sexual history among low-income Hispanic, Black, and White women. Data were collected from 1,677 women aged 16 to 40 years between July 2010 and August 2011 as part of a larger study. Participants completed a cross-sectional written survey. Multivariable analyses were used to identify correlates of pubic hair grooming. Being a current groomer was associated with being White, a younger age, under or normal weight, having a yearly household income > $30,000, and having 5 or more lifetime sexual partners. Overall, we discovered pubic hair grooming was extremely common among women of varying demographics. It is important for health and research professionals to understand pubic hair grooming practices so they can address behavioral and clinical concerns. PMID:23394967

Low-income women's reproductive weight patterns empirically based clusters of prepregnant, gestational, and postpartum weights.

PubMed

Walker, Lorraine O

2009-01-01

Women have varying weight responses to pregnancy and the postpartum period. The purpose of this study was to derive sub-groups of women based on differing reproductive weight clusters; to validate clusters by reference to adequacy of gestational weight gain (GWG) and postpartum incremental weight shifts; and to examine associations between clusters and demographic, behavioral, and psychosocial variables. A cluster analysis was conducted of a multi-ethnic/racial sample of low-income women (n = 247). Clusters were derived from three weight variables: prepregnant body mass index, GWG, and postpartum retained weight. Five clusters were derived: Cluster 1, normal weight-high prenatal gain-average retain; cluster 2, normal weight-low prenatal gain-zero retain; cluster 3, high normal weight-high prenatal gain-high retain; cluster 4, obese-low prenatal gain-average retain; and cluster 5, overweight-very high prenatal gain-very high retain. Clusters differed with regard to postpartum weight shifts (p < .001), with clusters 3, 4, and 5, mostly gaining weight between 6 weeks and 12 months postpartum, whereas clusters 1 and 2 were losing weight. Clusters were also associated with race/ethnicity (p < .01), breastfeeding immediately postdelivery (p < .01), smoking at 12 months (p < .05), and reaching weight goals at 6 and 12 months (p < .001), but not depressive symptoms, fat intake habits, or physical activity. In a five-cluster solution, postpartum weight shifts, ethnicity, and initial breastfeeding were among factors associated with clusters. Monitoring of weight and appropriate intervention beyond the 6 weeks after birth is needed for low-income women in high normal weight, overweight, and obese clusters.

Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care.

PubMed

Mazul, Mary C; Salm Ward, Trina C; Ngui, Emmanuel M

2017-02-01

Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women's perspectives on barriers and facilitators to receiving PNC in an urban setting. We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes. Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support. Findings suggest important components in an ideal PNC model to engage low-income African-American women.

Depressive symptoms and long-term income: The Young Finns Study.

PubMed

Hakulinen, Christian; Elovainio, Marko; Pulkki-Råback, Laura; Böckerman, Petri; Viinikainen, Jutta; Pehkonen, Jaakko; Raitakari, Olli T; Keltikangas-Järvinen, Liisa; Hintsanen, Mirka

2016-11-01

Higher depressive symptoms have been associated with lower future income. However, studies examining this issue have had limited follow-up times and have used self-reported measures of income. Also, possible confounders or mediators have not been accounted. 971 women and 738 men were selected from the ongoing prospective Young Finns Study (YFS) that began in 1980. Depressive symptoms were measured in 1992 when participants were from 15 to 30 years old. Information on annual income and earnings from 1993 to 2010 were obtained from the Finnish Longitudinal Employer-Employee Data (FLEED) of Statistics Finland and linked to the YFS. Higher depressive symptoms were associated with lower future income and earnings. For men, the associations were robust for controlling childhood parental socioeconomic status, history of unemployment, and adulthood health behavior, but attenuated circa 35% when three major temperament traits were taken into account. For women, similar pattern was found, however, in the models adjusted for temperament traits the associations did not remain statistically significant. The association between depressive symptoms and earnings was three times stronger for men than women. Previous depressive episodes could have influenced on some participants' economic and educational choices. Higher depressive symptoms in adolescence and early adulthood lead to significant future losses of total income and earnings, and this association is particularly strong for men. Copyright © 2016 Elsevier B.V. All rights reserved.

Food insecurity and the metabolic syndrome among women from low income communities in Malaysia.

PubMed

Shariff, Zalilah Mohd; Sulaiman, Norhasmah; Jalil, Rohana Abdul; Yen, Wong Chee; Yaw, Yong Heng; Taib, Mohd Nasir Mohd; Kandiah, Mirnalini; Lin, Khor Geok

2014-01-01

This cross-sectional study examined the relationship between household food insecurity and the metabolic syndrome (MetS) among reproductive-aged women (n=625) in low income communities. The Radimer/Cornell Hunger and Food Insecurity instrument was utilized to assess food insecurity. Anthropometry, diet diversity, blood pressure and fasting venous blood for lipid and glucose profile were also obtained. MetS was defined as having at least 3 risk factors and is in accordance with the Harmonized criteria. The prevalence of food insecurity and MetS was 78.4% (household food insecure, 26.7%; individual food insecure, 25.3%; child hunger, 26.4%) and 25.6%, respectively. While more food secure than food insecure women had elevated glucose (food secure, 54.8% vs food insecure, 37.3-46.1%), total cholesterol (food secure, 54.1% vs food insecure, 32.1-40.7%) and LDL-cholesterol (food secure, 63.7% vs food insecure, 40.6-48.7%), the percentage of women with overweight/ obesity, abdominal obesity, hypertension, high triglyceride, low HDL-cholesterol and MetS did not vary significantly by food insecurity status. However, after controlling for demographic and socioeconomic covariates, women in food insecure households were less likely to have MetS (individual food insecure and child hunger) (p<0.05), abdominal obesity (individual food insecure and child hunger) (p<0.01), elevated glucose (household food insecure), total cholesterol (child hunger) (p<0.05) and LDL-cholesterol (household food insecure and child hunger) (p<0.05) compared to food secure women. Efforts to improve food insecurity of low income households undergoing nutrition transition should address availability and accessibility to healthy food choices and nutrition education that could reduce the risk of diet-related chronic diseases.

Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: a pilot study.

PubMed

Fowles, Eileen R; Stang, Jamie; Bryant, Miranda; Kim, Sunghun

2012-10-01

Maternal diet quality influences birth outcomes. Yet, little research exists that assesses women's diet quality during the first trimester of pregnancy, a crucial time of placental and fetal development. This cross-sectional study, describing diet quality and its relationship with stress, depression, social support, and eating habits in the first trimester, may identify low-income women needing intensive dietary intervention. Seventy-one low-income women completed validated instruments measuring stress, depression, social support, and eating habits; had their height and weight measured; received training on portion-size estimation; and completed three 24-hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) from July 2009 to February 2010. Comparative and correlational analyses were done. Women with diet quality scores below the median (n=35) had more depression (9.6±5.1 vs 6.7±5.1) and stress (22.1±5.4 vs 19.3±4.8) and less control over meal preparation (5.0±1.5 vs 4.2±1.5) and support from others (52.0±12.0 vs 57.4±7.2) than did women with high diet quality scores (n=36). Diet quality was negatively related to depression (r=-0.41), stress (r=-0.35), skipping meals (r=-0.41), and control over meal preparation (r=-0.33), and positively related to support from others (r=0.38). Low-income women experiencing life stressors represent an at-risk group for low diet quality and may need intensive dietary intervention before and during pregnancy. More research designed to improve diet quality in low-income pregnant women is needed. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Feminist Relational Advocacy: Processes and Outcomes from the Perspective of Low-Income Women with Depression

ERIC Educational Resources Information Center

Goodman, Lisa A.; Glenn, Catherine; Bohlig, Amanda; Banyard, Victoria; Borges, Angela

2009-01-01

This article describes a qualitative study of how low-income women who are struggling with symptoms of depression experience feminist relational advocacy, a new model that is informed by feminist, multicultural, and community psychology theories. Using qualitative content analysis of participant interviews, the authors describe the processes and…

Verbal abuse and physical violence among a cohort of low-income pregnant women.

PubMed

O'Campo, P; Gielen, A C; Faden, R R; Kass, N

1994-01-01

We report on the occurrence of verbal abuse and physical violence during pregnancy for 358 low-income women. Overall, 65% of the women in our study experienced either verbal abuse or physical violence during their pregnancies. Twenty percent of the women in our sample experienced moderate or severe violence. Perpetrators, although primarily male partners, included family members and friends. These rates varied by age, with younger women experiencing significantly higher rates of verbal abuse and physical violence. There was no association between verbal abuse or physical violence and birth weight or gestational age. Prenatal care may be one of the only opportunities that women, and especially disadvantaged women, may have to get proper assistance with domestic violence. We conclude that enhanced screening, counseling, and referral by obstetricians and other health care providers are some of the immediate activities that could be implemented in prenatal care settings to address the compelling problems of violence during pregnancy.

Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines

USDA-ARS?s Scientific Manuscript database

Low-income Hispanic women are at a greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program (SNAP) participation and dietary intake among 661 Hispanic women aged 26–44 years living in Texas. Cross-sectional data was collected us...

Prices of unhealthy foods, Food Stamp Program participation, and body weight status among U.S. low-income women.

PubMed

Zhang, Qi; Chen, Zhuo; Diawara, Norou; Wang, Youfa

2011-06-01

This paper examines the interactive effect between the price of unhealthy foods and Food Stamp Program participation on body weight status among low-income women in the United States. We merged the panel data of the National Longitudinal Survey of Youth 1979 cohort in 1985-2002 and the Cost of Living Index data compiled by the American Chamber of Commerce Researchers Association by using geographic identifiers. Using the merged data, we used panel econometric models to examine the impact of unhealthy food prices on the food stamp-eligible U.S. population. Our results indicate that higher prices for unhealthy food can partially offset the positive association between Food Stamp Program participation and bodyweight among low-income women.

Stress Mediates the Relationship Between Past Drug Addiction and Current Risky Sexual Behaviour Among Low-income Women.

PubMed

Wu, Z Helen; Tennen, Howard; Hosain, G M Monawar; Coman, Emil; Cullum, Jerry; Berenson, Abbey B

2016-04-01

This study examined the role of stress as a mediator of the relationship between prior drug addiction and current high-risk sexual behaviour. Eight hundred twenty women aged 18 to 30 years, who received care at community-based family planning clinics, were interviewed using the Composite International Diagnostic Interview and the Sexual Risk Behavior Assessment Schedule. They also completed the brief version of the Self-Control Scale as a measure of problem-solving strategies and measures of recent stressful events, daily hassles and ongoing chronic stress. Regardless of addiction history, stress exposure during the previous 12 months was associated with risky sexual behaviour during the previous 12 months. Structural equation modelling revealed that 12-month stress levels mediated the relationship between past drug addiction and 12-month high-risk sexual behaviours, as well as the negative relationship between problem-solving strategies and high-risk sexual behaviours. Problem-solving strategies did not moderate the relationship between drug addiction and high-risk sexual behaviours. These findings suggest that stress management training may help reduce risky behaviour among young, low-income women. Copyright © 2014 John Wiley & Sons, Ltd.

Low-income, pregnant, African American women's views on physical activity and diet.

PubMed

Groth, Susan W; Morrison-Beedy, Dianne

2013-01-01

This research was conducted to gain insight into how low-income, pregnant, African American women viewed physical activity and approached nutrition during pregnancy. Three focus groups with a total of 26 women were conducted utilizing open-ended questions related to physical activity and diet during pregnancy. Content analysis was used to analyze the verbatim transcripts. Groups were compared and contrasted at the within-group and between-group levels to identify themes. Two themes that related to physical activity during pregnancy were identified: 1) fatigue and low energy dictate activity and 2) motivation to exercise is not there. Three themes were identified that related to diet: 1) despite best intentions, appetite, taste, and cravings drive eating behavior; 2) I'll decide for myself what to eat; and 3) eating out is a way of life. Women reported that being physically active and improving their diets was not easy. Women indicated that their levels of physical activity had decreased since becoming pregnant. Attempts at improving their diets were undermined by frequenting fast food restaurants and cravings for highly dense, palatable foods. Women ceded to the physical aspects of pregnancy, often choosing to ignore the advice of others. A combination of low levels of physical activity and calorie-dense diets increased the risk of excessive gestational weight gain in this sample of women, consequently increasing the risk for weight retention after pregnancy. Health care providers can promote healthy eating and physical activity by building on women's being "in tune with and listening to" their bodies. They can query women about their beliefs regarding physical activity and diet and offer information to ensure understanding of what contributes to healthy pregnancy outcomes. Intervention can focus on factors such as cravings and what tastes good, suggesting ways to manage pregnancy effects within a healthy diet. © 2013 by the American College of Nurse-Midwives.

Maternal employment in low- and middle-income countries is associated with improved infant and young child feeding.

PubMed

Oddo, Vanessa M; Ickes, Scott B

2018-03-01

Women's employment improves household income, and can increase resources available for food expenditure. However, employed women face time constraints that may influence caregiving and infant and young child feeding (IYCF) practices. As economic and social trends shift to include more women in the labor force in low- and middle-income countries (LMICs), a current understanding of the association between maternal employment and IYCF is needed. We investigated the association between maternal employment and IYCF. Using cross-sectional samples from 50 Demographic and Health Surveys, we investigated the association between maternal employment and 3 indicators of IYCF: exclusive breastfeeding (EBF) among children aged <6 mo (n = 47,340) and minimum diet diversity (MDD) and minimum meal frequency (MMF) (n = 137,208) among children aged 6-23 mo. Mothers were categorized as formally employed, informally employed, or nonemployed. We used meta-analysis to pool associations across all countries and by region. According to pooled estimates, neither formal [pooled odds ratio (POR) = 0.91; 95% CI: 0.81, 1.03] nor informal employment (POR = 1.05; 95% CI: 0.95, 1.16), compared to nonemployment, was associated with EBF. Children of both formally and informally employed women, compared to children of nonemployed women, had higher odds of meeting MDD (formal POR = 1.47; 95% CI: 1.35, 1.60; informal POR = 1.11; 95% CI: 1.03, 1.20) and MMF (formal POR = 1.18; 95% CI: 1.10, 1.26; informal POR = 1.15; 95% CI: 1.06, 1.24). Sensitivity analyses indicated that compared to nonemployed mothers, the odds of continued breastfeeding at 1 y were lower among formally employed mothers (POR = 0.82; 95% CI: 0.73, 0.98) and higher among informally employed mothers (POR = 1.19; 95% CI: 1.01, 1.40). Efforts to promote formalized employment among mothers may be an effective method for improving diet diversity and feeding frequency in LMICs. Formally employed mothers may benefit from

Are women deciding against home births in low and middle income countries?

PubMed

Amoako Johnson, Fiifi; Padmadas, Sabu S; Matthews, Zoë

2013-01-01

Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

An Exploratory Mixed Method Assessment of Low Income, Pregnant Hispanic Women's Understanding of Gestational Diabetes and Dietary Change

ERIC Educational Resources Information Center

Rhoads-Baeza, Maria Elena; Reis, Janet

2012-01-01

Objective: To describe and assess low income, healthy, pregnant Hispanic women's understanding of gestational diabetes (GDM) and willingness to change aspects of their diet. Design: One-on-one, in-person interviews conducted in Spanish with 94 women (primarily Mexican). Setting: Federal Qualified Community Health Center's prenatal clinic. Method:…

Anger as a moderator of safer sex motivation among low-income urban women.

PubMed

Schroder, Kerstin E E; Carey, Michael P

2005-10-01

Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median split). The theoretically expected "rational pattern" was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an "irrational pattern" emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge- and risk-based decisions regarding safer sex may be limited to low-anger women.

Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors

PubMed Central

Chidyaonga-Maseko, Fresier; Chirwa, Maureen Leah; Muula, Adamson Sinjani

2015-01-01

This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries. PMID:26523173

Prediction of Postpartum Weight in Low-Income Mexican-Origin Women From Childhood Experiences of Abuse and Family Conflict.

PubMed

Luecken, Linda J; Jewell, Shannon L; MacKinnon, David P

The postpartum period represents a crucial transition period in which weight gain or loss can affect lifetime obesity risk. This study examined the prevalence of obesity and the influence of childhood abuse and family conflict on postpartum weight among low-income Mexican-origin women. Depressive symptoms and partner support were evaluated as mediators. At a prenatal assessment, low-income Mexican-origin women (N = 322; mean [SD] age, 27.8 [6.5]) reported on childhood abuse and family conflict. Weight was measured 7 times between 6 weeks and 2 years postpartum and calculated as body mass index. Regression and growth models were used to estimate the impact of childhood abuse, childhood family conflict, partner support, and depressive symptoms on weight and weight change. Higher family conflict predicted higher weight across the first (β = .12; p = .037) and second (β = .16; p = .012) postpartum years. Family conflict (β = .17; p = .018) and low partner support (β = -.16; p = .028) also predicted increasing weight in the first year. Partner support partially mediated the effect of childhood abuse on weight change in the first year (p = .031). Depressive symptomatology mediated the effects of childhood abuse and family conflict on weight status in the second year (abuse: p = .005; conflict: p = .023). For low-income Mexican-origin women with a history of childhood abuse or high family conflict, depression and low partner support may be important targets for obesity prevention efforts in the postpartum period.

Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children

PubMed Central

Armijos, Rodrigo X.; Racines, Marcia; Cevallos, William; Castro, Nancy P.

2016-01-01

Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI) has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1), mental health (MHI-5), blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition. PMID:27752266

Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children.

PubMed

Weigel, M Margaret; Armijos, Rodrigo X; Racines, Marcia; Cevallos, William; Castro, Nancy P

2016-01-01

Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI) has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1), mental health (MHI-5), blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition.

The family planning attitudes and experiences of low-income women.

PubMed

Forrest, J D; Frost, J J

1996-01-01

A 1995 telephone survey of 1,852 low-income women aged 18-34 who were sexually active and at risk of unintended pregnancy found that 83% were currently practicing contraception. They were more likely to do so if they held positive attitudes toward contraceptive use, if they talked frequently about intimate matters with their partners and girlfriends and if they were very satisfied with the services they received at their last gynecologic visit. Seventy percent of current users said they were very satisfied with their method. Women whose last visit was to a clinic, who were very satisfied with the care they received and who used the pill or a long-acting method were more likely than others to report being very satisfied with their contraceptive. Women very satisfied with their gynecologic care were more likely to use oral contraceptives and to take them consistently, but were less likely to report that their partner used condoms or, if they did, used them consistently. Most women had made a medical visit for gynecologic or contraceptive care in the past year (86%), and 80% were very satisfied overall with their care at their last visit. Women were more likely to be very satisfied if the staff was courteous, helpful and respectful and made an effort to find out their needs, if their clinician's gender matched their own preference and if the facility was clean and services were organized.

Learning from “Knocks in Life”: Food Insecurity among Low-Income Lone Senior Women

PubMed Central

Green-LaPierre, Rebecca J.; Williams, Patricia L.; Glanville, N. Theresa; Norris, Deborah; Hunter, Heather C.; Watt, Cynthia G.

2012-01-01

Building on earlier quantitative work where we showed that lone senior households reliant on public pensions in Nova Scotia (NS), Canada lacked the necessary funds for a basic nutritious diet, here we present findings from a qualitative study involving in-depth interviews with eight low-income lone senior women living in an urban area of NS. Using a phenomenological inquiry approach, in-depth interviews were used to explore lone senior women's experiences accessing food with limited financial resources. Drawing upon Bronfenbrenner's Ecological Systems Theory, we explored their perceived ability to access a nutritionally adequate and personally acceptable diet, and the barriers and enablers to do so; as well in light of our previous quantitative research, we explored their perceptions related to adequacy of income, essential expenses, and their strategies to manage personal finances. Seven key themes emerged: world view, income adequacy, transportation, health/health problems, community program use, availability of family and friends, and personal food management strategies. World view exerted the largest influence on seniors' personal perception of food security status. The implications of the findings and policy recommendations to reduce the nutritional health inequities among this vulnerable subset of the senior population are considered. PMID:22997580

Community Engagement Compared With Technical Assistance to Disseminate Depression Care Among Low-Income, Minority Women: A Randomized Controlled Effectiveness Study

PubMed Central

Sherbourne, Cathy; Chung, Bowen; Tang, Lingqi; Wright, Aziza L.; Whittington, Yolanda; Wells, Kenneth; Miranda, Jeanne

2016-01-01

Objectives. To compare the effectiveness of a (CEP) versus a technical assistance approach (Resources for Services, or RS) to disseminate depression care for low-income ethnic minority women. Methods. We conducted secondary analyses of intervention effects for largely low-income, minority women subsample (n = 595; 45.1% Latino and 45.4% African American) in a matched, clustered, randomized control trial conducted in 2 low-resource communities in Los Angeles, California, between 2010 and 2012. Outcomes assessed included mental health, socioeconomic factors, and service use at 6- and 12-month follow-up. Results. Although we found no intervention difference for depressive symptoms, there were statistically significant effects for mental health quality of life, resiliency, homelessness risk, and financial difficulties at 6 months, as well as missed work days, self-efficacy, and care barriers at 12 months favoring CEP relative to RS. CEP increased use of outpatient substance abuse services and faith-based depression visits at 6 months. Conclusions. Engaging health care and social community programs may offer modest improvements on key functional and socioeconomic outcomes, reduce care barriers, and increase engagement in alternative depression services for low-income, predominantly ethnic minority women. PMID:27552274

"Let Me Count the Ways:" Fostering Reasons for Living among Low-Income, Suicidal, African American Women

ERIC Educational Resources Information Center

West, Lindsey M.; Davis, Telsie A.; Thompson, Martie P.; Kaslow, Nadine J.

2011-01-01

Protective factors for fostering reasons for living were examined among low-income, suicidal, African American women. Bivariate logistic regressions revealed that higher levels of optimism, spiritual well-being, and family social support predicted reasons for living. Multivariate logistic regressions indicated that spiritual well-being showed…

Household disrepair and the mental health of low-income urban women.

PubMed

Burdette, Amy M; Hill, Terrence D; Hale, Lauren

2011-02-01

We employ longitudinal survey data from the Welfare, Children, and Families project (1999, 2001) to examine the effects of household disrepair (e.g., living with leaky structures, busted plumbing, broken windows, and pests) on psychological distress among low-income urban women with children. Building on previous research, we adjust for related housing concepts, neighborhood disorder, financial hardship, and a host of relevant background factors. We also formally test the mediating influences of social support and self-esteem. Our cross-sectional analysis indicated that household disrepair is positively associated with recent symptoms of psychological distress. Our longitudinal change score analysis demonstrates two important patterns. First, women living with household disrepair at baseline are not necessarily vulnerable to increases in symptoms of psychological distress over the 2-year study period. Second, women who report an increase in disrepair over the study period are also likely to report a concurrent increase in symptoms of distress. Although social support and self-esteem favor mental health in our cross-sectional and longitudinal analyses, these psychosocial resources fail to mediate or explain the association between disrepair and distress.

Greater nutrition knowledge is associated with lower 1-year postpartum weight retention in low-income women.

PubMed

Nuss, Henry; Freeland-Graves, Jeanne; Clarke, Kristine; Klohe-Lehman, Deborah; Milani, Tracey J

2007-10-01

The purpose of this study was to assess nutrition knowledge during early and late postpartum in a sample of low-income and minority women, and to determine if that knowledge had any relationship to weight retention at 1-year postpartum. A questionnaire was developed and validated in a sample of 151 low-income new mothers. This instrument was then administered to a separate sample of mothers (n=140) of similar demographics to assess nutrition knowledge at 0 to 1 days and 12 months postpartum. In addition, a survey of nutrition information sources was administered at both time points. Nutrition knowledge was compared with 12-month postpartum weight retention and demographic variables. Women who retained less than 5% of weight gained during pregnancy had greater knowledge of nutrition at 0 months (53% vs 49%, P<0.05) and 12 months (55% vs 51%, P<0.05) than those who retained 5% or more of weight gained during pregnancy. Whites had higher nutrition knowledge scores than non-Hispanic blacks and Hispanics. Women who lactated 6 months or more had more knowledge than those who lactated less than 6 months. Higher knowledge test scores were observed among women who used the Internet and books/magazines as their source for information. These results indicate that assessment of nutrition knowledge in early postpartum can identify women at risk for significant weight retention.

Families at Risk: Home and Car Smoking Among Pregnant Women Attending a Low-Income, Urban Prenatal Clinic

PubMed Central

Northrup, Thomas F.; Hutchinson, Maria S.; Pedroza, Claudia; Blackwell, Sean C.

2014-01-01

Introduction: Secondhand smoke exposure (SHSe) has been identified as a distinct risk factor for adverse obstetric and gynecological outcomes. This study examined the prevalence of SHSe reduction practices (i.e., home and car smoking bans) among pregnant women in a large U.S. prenatal clinic serving low-income women. Methods: Pregnant women (N = 820) attending a university-based, urban prenatal clinic in Houston, Texas, completed a prenatal questionnaire assessing bans on household and car smoking and a qualitative urine cotinine test as part of usual care. Data were collected from April 2011 to August 2012. Results: Nearly one-third (n = 257) of the sample reported at least 1 smoker living in the home. About a quarter of the women in the full sample did not have a total smoking ban in their home and car. Within smoking households, 44% of the pregnant women reported smoking, 56% reported smoking by another household member, and in 26% of smoking households both the pregnant woman and at least one other person were smoking. Only 43% of women with a household smoker reported a total ban on smoking, with higher rates among Hispanic women. Smoking bans were less common when the pregnant women smoked, when more than 1 smoker resided in the home, and when pregnant with her first child. Conclusions: SHSe among low-income pregnant women is high, and interventions to raise awareness and increase the establishment of smoking bans in homes and cars are warranted. PMID:24692668

Primary relationship scripts among lower-income, African American young adults.

PubMed

Eyre, Stephen L; Flythe, Michelle; Hoffman, Valerie; Fraser, Ashley E

2012-06-01

Research on romantic relationships among lower income, African American young adults has mostly focused on problem behaviors, and has infrequently documented nonpathological relationship processes that are widely studied among middle-class college students, their wealthier and largely European American counterparts [Journal of Black Studies 39 (2009) 570]. To identify nonpathological cultural concepts related to heterosexual romantic relationships, we interviewed 144 low to low-mid income, African American young adults aged 19-22 from the San Francisco Bay Area, CA, metropolitan Chicago, IL, and Greater Birmingham, AL. We identified 12 gender-shared scripts related to the romantic relationship in areas of (1) defining the relationship, (2) processes of joining, (3) maintaining balance, and (4) modulating conflict. Understanding romantic relationship scripts is important as successful romantic relationships are associated with improved mental and physical health among lower income individuals as compared with individuals without romantic partners [Social Science & Medicine 52 (2001) 1501]. © FPI, Inc.

Characteristics and correlates of quitting among black and white low-income pregnant smokers.

PubMed

Ward, Kenneth D; Vander Weg, Mark W; Sell, Marie A; Scarinci, Isabel C; Read, Mary Cocke

2006-01-01

To examine race-specific differences in correlates of cessation in low income pregnant women. Two hundred forty-eight low-income black and white pregnant women who smoked regularly prior to pregnancy were interviewed to assess several potential correlates of quitting. Race differences emerged in characteristics commonly thought to influence quitting including income, education level, marital status, nicotine dependence, and smoking history. However, race was not correlated with having quit smoking, nor did it influence the effect of other variables in quitting. Factors that influence the decision to quit smoking during pregnancy do not appear to differ between low-income black and white women.

Trends and inequities in where women delivered their babies in 25 low-income countries: evidence from Demographic and Health Surveys.

PubMed

Limwattananon, Supon; Tangcharoensathien, Viroj; Sirilak, Supakit

2011-05-01

In low-income countries, the coverage of institutional births is low. Using data from the two most recent Demographic and Health Surveys (1995-2001 and 2001-2006) for 25 low-income countries, this study examined trends in where women delivered their babies--public or private facilities or non-institutional settings. More than half of deliveries were in institutional settings in ten countries, mostly public facilities. In the other 15 countries, the majority of births were in women's homes, which was often their only option. Between the two survey periods, all five Asian countries studied (except Bangladesh) had an increase of 10-20 percentage points in institutional coverage, whereas none of the 19 sub-Saharan African countries saw an increase of more than 10 percentage points. More urban women and more in the richest (least poor) quintile gave birth in public or private facilities than rural and poorest quintile women. The rich-poor gap of institutional births was wider than the urban-rural gap. Inadequate public investment in health system infrastructure in rural areas and lack of skilled health professionals are major obstacles in reducing maternal mortality. Governments in low-income countries must invest more, especially in rural maternity services. Strengthening private, for-profit providers is not a policy choice for poor, rural communities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Eating behaviours among young women.

PubMed

Abraham, S F; Mira, M; Beumont, P J; Sowerbutts, T D; Llewellyn-Jones, D

1983-09-03

Disordered eating and weight-control behaviour is becoming increasingly common among adolescent girls. We studied four groups of young women aged between 15 and 27 years (106 school and university students, 50 ballet school students, 22 patients suffering from anorexia nervosa and 44 patients with bulimia). Our results suggest that most young women diet at some time and lose more than three kg in weight; that they may experience episodes of binge eating and "picking" behaviour; and that they wish to be thinner irrespective of their current body weight. Twenty per cent of young women may fulfil the criteria for an eating disorder (bulimia or anorexia nervosa) at some stage, however briefly, and about 7% abuse laxatives or diuretics in order to achieve a fashionably slim figure. We suggest that most young women may pass through a phase of what is currently called disordered eating, and that this is part of normal development and may not necessarily require treatment. The incidence of disordered eating is greater in those young women who are under pressure to maintain a low body weight.

Anger as a Moderator of Safer Sex Motivation among Low Income Urban Women

PubMed Central

Carey, Michael P.

2005-01-01

Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision-making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational-decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median-split). The theoretically expected “rational pattern” was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an “irrational pattern” emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge and risk-based decisions regarding safer sex may be limited to low-anger women. PMID:16247592

Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country.

PubMed

Rahman, Atif; Sikander, Siham; Malik, Abid; Ahmed, Ikhlaque; Tomenson, Barbara; Creed, Francis

2012-12-01

Poverty may moderate the effect of treatment of depression in low-income countries. To assess poverty and lack of empowerment as moderators of a cognitive-behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan. Using secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n = 791). Predictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors. Our findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully.

Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country

PubMed Central

Rahman, Atif; Sikander, Siham; Malik, Abid; Ahmed, Ikhlaque; Tomenson, Barbara; Creed, Francis

2012-01-01

Background Poverty may moderate the effect of treatment of depression in low-income countries. Aims To assess poverty and lack of empowerment as moderators of a cognitive–behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan. Method Using secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n = 791). Results Predictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors. Conclusions Our findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully. PMID:23137731

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

PubMed

Burke, Heather M; Fernald, Lia C; Gertler, Paul J; Adler, Nancy E

2005-01-01

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

The impact of intimate partner violence, substance use, and HIV on depressive symptoms among abused low-income urban women.

PubMed

Illangasekare, Samantha L; Burke, Jessica G; McDonnell, Karen A; Gielen, Andrea C

2013-09-01

Intimate partner violence (IPV), substance use, and HIV are often co-occuring health problems affecting low-income urban women, and have been described as connected epidemics making up a "syndemic." Research suggests that each issue separately is associated with depressive symptoms, but no studies have examined the combined effect of IPV, substance use and HIV on women's depression. Interviews were conducted with 96 women recruited from community health clinics serving low-income women in an urban U.S. city. All women were over 17, not pregnant, English-speaking, without private insurance and had experienced physical IPV in the past year. Women were primarily African American (82%) and 82% were receiving income assistance. Twenty seven percent were HIV-positive, and 27% had used heroin or cocaine in the past 6 months. Based on the Centers for Epidemiological Studies Depression Scale (CES-D ), 73% were depressed. Women who experienced severe IPV in the past 6 months were compared to women who experienced no IPV or psychological IPV only in the past 6 months; those who experienced severe IPV were 5.3 times more likely to be depressed, controlling for HIV status, drug use, age, and relationship status. Women who experienced severe IPV, were HIV-positive, and used drugs (7.3% of sample) were 7.98 times as likely to be depressed as women without these characteristics. These findings confirm that severe IPV is significantly associated with depression among urban abused women. Furthermore, this research suggests that the syndemic effect of IPV, substance use, and HIV could be even more detrimental to women's mental health. Health practitioners and researchers should be aware of the combined impact of the IPV, substance use, and HIV syndemic and consider how they can address the mental health needs of urban women.

A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.

PubMed

O'Mahen, Heather; Himle, Joseph A; Fedock, Gina; Henshaw, Erin; Flynn, Heather

2013-07-01

Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD). Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month follow-up. Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16-week post-randomization and 3-month follow-up, Cohen's d = -0.71 (95% CI -4.93, -5.70). Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period. © 2013 Wiley Periodicals, Inc.

Prediction of postpartum weight in low-income Mexican-origin women from childhood experiences of abuse and family conflict

PubMed Central

Luecken, Linda J.; Jewell, Shannon L.; MacKinnon, David P.

2016-01-01

Objective The postpartum period represents a crucial transition period in which weight gain or loss can affect lifetime obesity risk. This study examined the prevalence of obesity and the influence of childhood abuse and family conflict on postpartum weight among low-income Mexican-origin women. Depressive symptoms and partner support were evaluated as mediators. Methods At a prenatal assessment, low-income Mexican-origin women (N=322; mean age = 27.8; SD = 6.5) reported on childhood abuse and family conflict. Weight was measured seven times between 6 weeks and 2 years postpartum and calculated as body mass index (BMI). Regression and growth models were used to estimate the impact of childhood abuse, childhood family conflict, partner support, and depressive symptoms on weight and weight change. Results Higher family conflict predicted higher weight across the first (β = .12, p = .037) and second (β = .16, p = .012) postpartum years. Family conflict (β = .17; p = .018) and low partner support (β = −.16, p = .028) also predicted increasing weight in the first year. Partner support partially mediated the effect of childhood abuse on weight change in the first year (p = .031). Depressive symptomatology mediated the effects of childhood abuse and family conflict on weight status in the second year (abuse: p = .005; conflict: p = .023). Conclusions For low-income Mexican-origin women with a history of childhood abuse or high family conflict, depression and low partner support may be important targets for obesity prevention efforts in the postpartum period. PMID:27583713

Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight.

PubMed

Hernandez, Daphne C; Reesor, Layton; Machuca, Iris; Chishty, Misha; Alonso, Yanely

2016-09-01

To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status. Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers. Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight. Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01). Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care. © 2016 Wiley Periodicals, Inc.

International summit on the nutrition of adolescent girls and young women: consensus statement

PubMed Central

Krebs, Nancy; Bagby, Susan; Bhutta, Zulfiqar A.; Dewey, Kathryn; Fall, Caroline; Gregory, Fred; Hay, William; Rhuman, Lisa; Caldwell, Christine Wallace

2017-01-01

An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low‐ and middle‐income countries was held in Portland, Oregon in 2015. Sixty‐seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient‐rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world. PMID:28722768

Childhood Sexual Abuse Moderates the Relationship Between Obesity and Mental Health in Low-Income Women.

PubMed

Ramirez, Jennifer C; Milan, Stephanie

2016-02-01

We examined whether a history of self-reported childhood sexual abuse (CSA) moderates the relationship between obesity and mental health symptoms (depression, anxiety, and posttraumatic stress disorder) in an ethnically diverse sample of low-income women. A community sample of 186 women completed self-report measures and had their weight and height measured. Body mass index and CSA had an interactive effect on all mental health measures, such that obese women with a CSA history reported substantially higher levels of all symptoms. These results give greater specificity to the obesity-mental health link reported in previous studies and provide possible directions for targeted intervention. © The Author(s) 2015.

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

Ethical and social issues facing obstetricians in low-income countries.

PubMed

Ogwuegbu, Chigbu Chibuike; Eze, Onah Hyacinth

2009-06-01

A review of publications on ethical and social issues from low-income countries was done with the aim of highlighting the major ethical and social issues facing obstetricians in these countries. Low-income countries were identified using the World Health Organization income group classification of member nations. Obstetricians in low-income countries face a wide range of special social and ethical issues that reflect the peculiarities of their practice environment characterized by poverty, low education, deep attachment to tradition and culture, low social status of women, and high levels of physician's paternalism.

Women's empowerment and its differential impact on health in low income communities in Mumbai, India

PubMed Central

Davis, Lwendo Moonzwe; Schensul, Stephen L.; Schensul, Jean J.; Verma, Ravi; Nastasi, Bonnie K.; Singh, Rajendra

2015-01-01

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalized area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined. PMID:24766149

Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations.

PubMed

Hambidge, K Michael; Krebs, Nancy F; Garcés, Ana; Westcott, Jamie E; Figueroa, Lester; Goudar, Shivaprasad S; Dhaded, Sangappa; Pasha, Omrana; Aziz Ali, Sumera; Tshefu, Antoinette; Lokangaka, Adrien; Thorsten, Vanessa R; Das, Abhik; Stolka, Kristen; McClure, Elizabeth M; Lander, Rebecca L; Bose, Carl L; Derman, Richard J; Goldenberg, Robert L; Bauserman, Melissa

2017-07-24

Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC). Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m 2 ) was calculated. Z-scores were determined using WHO reference data. A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2-148.9) in Guatemala to 156.0 (152.0-160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9-50.3) in India to 52.7 (46.9-59.8) in Guatemala. Median BMI ranged from 19.4 (17.6-21.9) in India to 24.9 (22.3-28.0) in Guatemala. Percent stunted (<-2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW. Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials. ClinicalTrials.gov # NCT01883193 (18 June 2013

Rural and urban breastfeeding initiation trends in low-income women in North Carolina from 2003 to 2007.

PubMed

Lynch, Suzanne; Bethel, Jeffrey; Chowdhury, Najmul; Moore, Justin B

2012-05-01

Breastfeeding has extensive health benefits for both infants and mothers. Despite these benefits, a significant number of women, disproportionately low-income women, do not initiate breastfeeding. Previous research has also demonstrated that breastfeeding prevalence varies by urbanicity level. The objective was to examine race/ethnicity and urbanicity trends in breastfeeding initiation among low-income women in North Carolina from 2003 to 2007. Breastfeeding initiation data from the North Carolina Pregnancy Nutrition Surveillance System were utilized, with responses from 240,054 women over the 5-year period. Overall, 65.4% of women in mixed-urban counties and 62.1% of women in urban counties initiated breastfeeding compared to only 49.8% of women in rural counties. The disparity between rural and urban counties widened over time, with urban and mixed-urban counties making significantly greater gains in breastfeeding initiation than rural counties. Hispanic and non-Hispanic white women had 6.17 (95% confidence interval [CI], 5.99-6.36) and 1.4 (95% CI, 1.46-1.53) times the odds of initiating breastfeeding as non-Hispanic blacks, respectively. Finally, stratified multivariate regression models identified that the association between race/ethnicity and breastfeeding varied by urbanicity level. The current study provides a clearer picture of rural and urban breastfeeding trends within North Carolina and has implications for states with similar racial/ethnic and urbanicity levels. The research determined that women in rural areas, particularly non-Hispanic blacks, are less likely to initiate breastfeeding. Increased emphasis should be placed on developing breastfeeding interventions for rural communities, particularly targeting the non-Hispanic black population.

Family planning advice and postpartum contraceptive use among low-income women in Mexico.

PubMed

Barber, Sarah L

2007-03-01

In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated. Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for. Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method. Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.

Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya.

PubMed

Luke, Nancy; Goldberg, Rachel E; Mberu, Blessing U; Zulu, Eliya M

2011-10-01

Transactional sex, or the exchange of money and gifts for sexual activities within nonmarital relationships, has been widely considered a contributing factor to the disproportionate prevalence of HIV/AIDS among young women in sub-Saharan Africa. This study applied social exchange theory to premarital relationships in order to investigate the linkages between a variety of young women's resources-including employment and material transfers from male partners-and sexual behaviors. Data on the first month of premarital relationships (N=551 relationships) were collected from a random sample of young adult women ages 18-24 in Kisumu, Kenya, using a retrospective life history calendar. Consistent with the hypotheses, results showed that young women's income increases the likelihood of safer sexual activities, including delaying sex and using condoms consistently. Material transfers from the male partner displayed the opposite effect, supporting the view that resources obtained from within the relationship decrease young women's negotiating power.

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries.

PubMed

Sreeramareddy, Chandrashekhar T; Harper, Sam; Ernstsen, Linda

2018-01-01

Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs. We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification. Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3

Heading for Hardship: Retirement Income for American Women in the Next Century. Mother's Day Report 1990.

ERIC Educational Resources Information Center

Older Women's League, Washington, DC.

Millions of women face bleak retirement futures. In 40 years, when today's 25-year-olds retire, fewer women will be retiring married, and therefore fewer will have access to a husband's retirement income. Young women continue to face a future of significantly lower wages. Caregiving responsibilities continue to fall predominantly on women's…

Family Structure and Income During the Stages of Childhood and Subsequent Prosocial Behavior in Young Adulthood

PubMed Central

Bandy, Robert; Ottoni-Wilhelm, Mark

2012-01-01

This study investigated whether family structure transition and low income are risk factors in the development of prosocial behavior. Models of young adults’ prosocial behavior – charitable giving and volunteering – were estimated as functions of their family structure and income during the stages of childhood. Participants were a representative sample of 1,011 American young adults. In the full sample, family structure transition during adolescence was negatively associated with subsequent charitable giving in young adulthood. Low income during adolescence was negatively associated with both giving and volunteering in young adulthood. European-American young men also exhibited a negative association between family structure transition during adolescence and subsequent volunteering. The results did not seem to describe African-American young adults. Keeping this qualification in mind, the results suggest that adolescence is a sensitive stage in the development of charitable giving and volunteering. PMID:22414561

Maternal depressive symptoms and infant health practices among low-income women.

PubMed

Chung, Esther K; McCollum, Kelly F; Elo, Irma T; Lee, Helen J; Culhane, Jennifer F

2004-06-01

To determine the relationships between maternal depressive symptoms and the use of infant health services, parenting practices, and injury-prevention measures. A prospective, community-based survey of women attending Philadelphia public health centers between February 2000 and November 2001 was conducted. Women were surveyed at 3 time points before and after parturition. Depressive symptoms were determined with the Center for Epidemiologic Studies Depression Scale at each time point. We studied 6 outcomes, clustered into 3 categories: 1) infant health service use (adequate well-child care and ever being hospitalized); 2) parenting practices (breastfeeding for > or =1 month and use of corporal punishment); and 3) injury-prevention measures (having a smoke alarm and using the back sleep position). The sample consisted of 774 largely single (74%), uninsured (63%), African American (65%) women, with a mean age of 24 +/- 6 years and a mean annual income of 8063 dollars. Forty-eight percent of women had depressive symptoms at 1 or 2 time points (ever symptoms) and 12% had depressive symptoms at all points (persistent symptoms). Compared with women who never had depressive symptoms (without symptoms), women with persistent symptoms were nearly 3 times as likely to have their child ever hospitalized (adjusted odds ratio: 2.89; 95% confidence interval: 1.61-5.07) and twice as likely to use corporal punishment (adjusted odds ratio: 1.90; 95% confidence interval: 1.08-3.34). Mothers with persistent depressive symptoms were nearly three-quarters less likely to have smoke alarms in their homes (adjusted odds ratio: 0.28; 95% confidence interval: 0.11-0.70) and one-half as likely to use the back sleep position (adjusted odds ratio: 0.56; 95% confidence interval: 0.35-0.91), compared with women without symptoms. There was no association between maternal depressive symptoms and infant receipt of well-child care or the likelihood of breastfeeding for > or =1 month. Maternal

Sleep Duration, Sleep Quality, Body Mass Index, and Waist Circumference among Young Adults from 24 Low- and Middle-Income and Two High-Income Countries

PubMed Central

Peltzer, Karl; Pengpid, Supa

2017-01-01

Obesity and its comorbidities have emerged as a leading public health concern. The aim of this study was to explore the relationship between body mass index (BMI), waist circumference (WC) and sleep patterns, including duration and disturbances. A cross-sectional questionnaire survey and anthropometric measurements were conducted with undergraduate university students that were randomly recruited in 26 universities in 24 low- and middle-income and two high-income countries. The sample included 18,211 (42.1% male and 57.9% female, mean age 21.0 in male and 20.7 years in female students) undergraduate university students. The overall BMI was a mean of 22.5 kg/m2 for men and 22.0 kg/m2 for women, and the mean WC was 78.4 cm for men and 73.8 cm for women. More than 39% of the students reported short sleep duration (≤6 h/day) and over 30% reported moderate to extreme sleep problems. In a linear multivariable regression, adjusted for sociodemographic and lifestyle factors, short sleep duration was positively associated with BMI in both men and women, and was positively associated with WC among women but not among men. Sleep quality or problems among men were not associated with BMI, while among women mild sleep problems were inversely associated with BMI, and poor sleep quality or problems were positively associated with WC both among men and women. The study confirmed an association between short sleep duration and increased BMI and, among women, increased WC, and an association between poor sleep quality and increased WC but not BMI. Further, differences in the association between sleep characteristics and BMI and WC were found by region and country income. PMID:28587107

Sleep Duration, Sleep Quality, Body Mass Index, and Waist Circumference among Young Adults from 24 Low- and Middle-Income and Two High-Income Countries.

PubMed

Peltzer, Karl; Pengpid, Supa

2017-05-26

Obesity and its comorbidities have emerged as a leading public health concern. The aim of this study was to explore the relationship between body mass index (BMI), waist circumference (WC) and sleep patterns, including duration and disturbances. A cross-sectional questionnaire survey and anthropometric measurements were conducted with undergraduate university students that were randomly recruited in 26 universities in 24 low- and middle-income and two high-income countries. The sample included 18,211 (42.1% male and 57.9% female, mean age 21.0 in male and 20.7 years in female students) undergraduate university students. The overall BMI was a mean of 22.5 kg/m² for men and 22.0 kg/m² for women, and the mean WC was 78.4 cm for men and 73.8 cm for women. More than 39% of the students reported short sleep duration (≤6 h/day) and over 30% reported moderate to extreme sleep problems. In a linear multivariable regression, adjusted for sociodemographic and lifestyle factors, short sleep duration was positively associated with BMI in both men and women, and was positively associated with WC among women but not among men. Sleep quality or problems among men were not associated with BMI, while among women mild sleep problems were inversely associated with BMI, and poor sleep quality or problems were positively associated with WC both among men and women. The study confirmed an association between short sleep duration and increased BMI and, among women, increased WC, and an association between poor sleep quality and increased WC but not BMI. Further, differences in the association between sleep characteristics and BMI and WC were found by region and country income.

Education Modifies the Association of Wealth with Obesity in Women in Middle-Income but Not Low-Income Countries: An Interaction Study Using Seven National Datasets, 2005-2010

PubMed Central

Aitsi-Selmi, Amina; Bell, Ruth; Shipley, Martin J.; Marmot, Michael G.

2014-01-01

Background Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). Methods The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15–49 years collected in the period 2005–2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented Results In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). Conclusions The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects. PMID:24608086

The concept of "silencing the self" in low-income, aging, HIV-infected African American women: a 10-year community-based participatory program of research with results.

PubMed

DeMarco, Rosanna F; Lanier, Latrona R

2014-01-01

Despite a resilient spirit, the challenges that face low-income, aging Black women living with HIV infection are immense. This article describes a 10-year iterative history of using the Theory of Silencing the Self (TSTS) as an explanatory model that was found to be gender sensitive, culturally relevant, and helpful in guiding a community-based participatory research group of low-income, HIV-infected Black women living in Boston, Massachusetts. The group, called Sistah Powah, used the TSTS to design and implement a structured writing intervention in a women's drop-in center targeting low-income, aging Black women living with HIV infection as a way to give them and others a voice. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Low-income women's conceptualizations of food craving and food addiction.

PubMed

Malika, Nipher M; Hayman, Lenwood W; Miller, Alison L; Lee, Hannah J; Lumeng, Julie C

2015-08-01

Food craving and food addiction have been proposed as targets for obesity focused interventions. However, individuals' conceptualizations of these constructs are not well understood and no studies have employed a qualitative approach. Therefore, we sought to understand how women conceptualize food craving and food addiction. Low-income women with preschool-aged children (2-5years old) participated in either a semi-structured individual interview or focus group in which they were asked about their conceptualization of eating behaviors among adults and children. All responses were audio-recorded and transcribed. Themes were identified using the constant comparative method of qualitative analysis. Identified themes revealed that the women perceived food craving to be common, less severe and to a degree more humorous than food addiction. It was not felt that food cravings were something to be guarded against or resisted. Food addiction was described in a very "matter of fact" manner and was believed to be identifiable through its behavioral features including a compulsive need to have certain foods all the time. A more detailed understanding of how the general population perceives food craving and food addiction may enable more refined measurement of these constructs with questionnaire measures in the future. In addition, interventions may be designed to use the language most consistent with participants' conceptualizations of these constructs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Low-Income Women's Conceptualizations of Food Craving and Food Addiction

PubMed Central

Malika, Nipher M.; Hayman, Lenwood W.; Miller, Alison L.; Lee, Hannah J.; Lumeng, Julie C.

2015-01-01

Food craving and food addiction have been proposed as targets for obesity focused interventions. However, individuals' conceptualizations of these constructs are not well understood and no studies have employed a qualitative approach. Therefore, we sought to understand how women conceptualize food craving and food addiction. Low-income women with preschool-aged children (2-5 years old) participated in either a semi-structured individual interview or focus group in which they were asked about their conceptualization of eating behaviors among adults and children. All responses were audio-recorded and transcribed. Themes were identified using the constant comparative method of qualitative analysis. Identified themes revealed that the women perceived food craving to be common, less severe and to a degree more humorous than food addiction. It was not felt that food cravings were something to be guarded against or resisted. Food addiction was described in a very “matter of fact” manner and was believed to be identifiable through its behavioral features including a compulsive need to have certain foods all the time. A more detailed understanding of how the general population perceives food craving and food addiction may enable more refined measurement of these constructs with questionnaire measures in the future. In addition, interventions may be designed to use the language most consistent with participants' conceptualizations of these constructs. PMID:25867800

Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families.

PubMed

Thompson, Sarah M; Jiang, Lu; Hammen, Constance; Whaley, Shannon E

2018-06-01

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N = 1025) were significantly more likely than children of non-depressed women (N = 3564) to receive a "poor" or "fair" maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children's health.

Barriers to weight-related health behaviours: a qualitative comparison of the socioecological conditions between pregnant and post-partum low-income women

PubMed Central

Uesugi, Keriann; Olson, Christine

2015-01-01

The association between socio-ecological factors and poor health outcomes for low-income women and their children has been the focus of disparities research for several decades. This research compares the socio-ecological conditions among low-income women from pregnancy to postpartum and highlights the factors that make weight management increasingly difficult after delivery. As part of the formative research for an online health intervention, group and individual interviews were conducted with low-income pregnant and postpartum women. Five pregnancy group interviews (n=15 women), five postpartum group interviews (n=23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, NY. All interviews were audio-recorded. The constant comparative method was used to code interview notes and identify emergent themes. Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy-weight behaviors. These included unemployment, relationship issues, minimal social support, lack of education, limited healthcare access, pre-existing medical conditions and neighborhood disadvantage. Compared to pregnant women, postpartum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and postpartum related to the family’s medical problems and greater environmental constraints. Many factors detracted from women’s capacity to engage in healthy-weight behaviors postpartum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional postpartum challenges need to be considered in designing programs, policies and interventions that promote healthy weight. PMID:25040706

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

PubMed

Ohly, Heather; Crossland, Nicola; Dykes, Fiona; Lowe, Nicola; Hall-Moran, Victoria

2017-04-21

To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why. A realist review. Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence. A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations. 38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment). This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Families at risk: home and car smoking among pregnant women attending a low-income, urban prenatal clinic.

PubMed

Stotts, Angela L; Northrup, Thomas F; Hutchinson, Maria S; Pedroza, Claudia; Blackwell, Sean C

2014-07-01

Secondhand smoke exposure (SHSe) has been identified as a distinct risk factor for adverse obstetric and gynecological outcomes. This study examined the prevalence of SHSe reduction practices (i.e., home and car smoking bans) among pregnant women in a large U.S. prenatal clinic serving low-income women. Pregnant women (N = 820) attending a university-based, urban prenatal clinic in Houston, Texas, completed a prenatal questionnaire assessing bans on household and car smoking and a qualitative urine cotinine test as part of usual care. Data were collected from April 2011 to August 2012. Nearly one-third (n = 257) of the sample reported at least 1 smoker living in the home. About a quarter of the women in the full sample did not have a total smoking ban in their home and car. Within smoking households, 44% of the pregnant women reported smoking, 56% reported smoking by another household member, and in 26% of smoking households both the pregnant woman and at least one other person were smoking. Only 43% of women with a household smoker reported a total ban on smoking, with higher rates among Hispanic women. Smoking bans were less common when the pregnant women smoked, when more than 1 smoker resided in the home, and when pregnant with her first child. SHSe among low-income pregnant women is high, and interventions to raise awareness and increase the establishment of smoking bans in homes and cars are warranted. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of factors impacting cervical cancer screening among low-income women living with HIV-AIDS.

PubMed

Ogunwale, Abayomi N; Coleman, Maame Aba; Sangi-Haghpeykar, Haleh; Valverde, Ivan; Montealegre, Jane; Jibaja-Weiss, Maria; Anderson, Matthew L

2016-01-01

Very little is currently known about factors impacting the prevalence of cervical cancer screening among women living with HIV-AIDS (WLHA). To better understand this issue, we surveyed low-income, medically underserved women receiving subsidized gynecologic care through an integrated HIV clinic. A self-administered questionnaire was completed by 209 women who self-identified as HIV positive. A total of 179 subjects (85.7%) reported having had a Pap test in the last three years. The majority of WLHA (95%) knew that the Pap test screens for cervical cancer. However, overall knowledge of cervical cancer risk factors, such as multiple sexual partners or sex with a man with multiple partners, was low (43% and 35%, respectively). Unscreened women were younger and more likely to be single with multiple current sexual partners. In multivariable analyses, the only factors associated with Pap testing were a woman's perception that her partner wants her to receive regular screening (aOR 4.64; 95% CI: 1.15-23.76; p = .04), number of clinic visits during the past year (aOR 1.36, 95% CI: 1.05-1.94; p = .04) and knowledge that the need for a Pap test does not depend on whether or not a woman is experiencing vaginal bleeding (aOR 6.52, 95% CI: 1.04-49.71; p = .05). We conclude that support from male partners in addition to effective contact with the health system and knowledge of cervical cancer risk factors influence Pap utilization among low-income WLHA. Future measures to improve the care for this population should increase knowledge of cervical cancer risk factors and encourage social support for cervical cancer screening among WLHA.

A pilot study comparing two weight loss maintenance interventions among low-income, mid-life women

PubMed Central

2013-01-01

Background Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. Methods Low-income midlife women who completed a 16-week weight loss intervention and lost ≥ 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of ≥ 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher’s Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. Results Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of ≥ 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. Conclusions The effectiveness of two pilot 12-month maintenance interventions provides support for further research

A pilot study comparing two weight loss maintenance interventions among low-income, mid-life women.

PubMed

Samuel-Hodge, Carmen D; Johnston, Larry F; Gizlice, Ziya; Garcia, Beverly A; Lindsley, Sara C; Gold, Alison D; Braxton, Danielle F; Keyserling, Thomas C

2013-07-15

Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. Low-income midlife women who completed a 16-week weight loss intervention and lost  ≥ 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of  ≥ 5% of body weight from the start of the weight loss phase and (2) a change in body weight of  < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of  ≥ 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high

Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo, Syria.

PubMed

Maziak, Wasim; Asfar, Taghrid; Mzayek, Fawaz; Fouad, Fouad M; Kilzieh, Nael

2002-05-01

Interest in mental morbidity as an important component of health is increasing worldwide. Women generally suffer more than men from common mental disorders, and discrimination against women adds to their mental sufferings. Studies looking into the socio-demographic correlates of women's mental morbidity are lacking in most Arab countries. In this study we wanted to determine the spread and socio-demographic correlates of mental distress among low-income women in Aleppo, Syria. A sample of 412 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97.2%, mean age of participants 28 + 8.4 years, where married women constituted 87.9%. A special questionnaire was prepared for the study purpose, utilizing the SRQ-20 non-psychotic items and questions about background information considered relevant to the mental health of women in the studied population. Interviews were conducted in an anonymous one-to-one fashion. The prevalence of psychiatric distress in our sample was 55.6%. Predictors of women's mental health in the logistic regression analysis were; physical abuse, women's education, polygamy, residence, age and age of marriage. Among these predictors, women's illiteracy, polygamy and physical abuse were the strongest determinants of mental distress leading to the worse outcomes. Our data show that mental distress is common in the studied population and that it is strongly associated with few, possibly modifiable, factors.

Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project.

PubMed

Albright, Cheryl L; Pruitt, Leslie; Castro, Cynthia; Gonzalez, Alma; Woo, Sandi; King, Abby C

2005-12-01

Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States. This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs. The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 +/- 10 years. More than half the women had not completed high school, and 73% had an annual income less than 20,000 dollars. After 10 months of a home-based intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05). Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce.

Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum.

PubMed

Walker, Lorraine O; Sterling, Bobbie Sue; Guy, Sarah; Mahometa, Michael J

2013-01-01

During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.

Hospitalized for fever? Understanding hospitalization for common illnesses among insured women in a low-income setting.

PubMed

Sinha, Tara; Desai, Sapna; Mahal, Ajay

2014-07-01

Health microinsurance is a financial tool that increases utilization of health care services among low-income persons. There is limited understanding of the illnesses for which insured persons are hospitalized. Analysis of health claims at VimoSEWA, an Indian microinsurance scheme, shows that a significant proportion of hospitalization among insured adult women is for common illnesses—fever, diarrhoea and malaria—that are amenable to outpatient treatment. This study aims to understand the factors that result in hospitalization for common illnesses. The article uses a mixed methods approach. Quantitative data were collected from a household survey of 816 urban low-income households in Gujarat, India. The qualitative data are based on 10 in-depth case studies of insured women hospitalized for common illnesses and interviews with five providers. Quantitative and qualitative data were supplemented with data from the insurance scheme’s administrative records. Socioeconomic characteristics and morbidity patterns among insured and uninsured women were similar with fever the most commonly reported illness. While fever was the leading cause for hospitalization among insured women, no uninsured women were hospitalized for fever. Qualitative investigation indicates that 9 of 10 hospitalized women first sought outpatient treatment. Precipitating factors for hospitalization were either the persistence or worsening of symptoms. Factors that facilitated hospitalization included having insurance and the perceptions of doctors regarding the need for hospitalization. In the absence of quality primary care, health insurance can lead to hospitalization for non-serious illnesses. Deterrents to hospitalization point away from member moral hazard; provider moral hazard cannot be ruled out. This study underscores the need for quality primary health care and its better integration with health microinsurance schemes.

An Investigation into the Social Context of Low-Income, Urban Black and Latina Women: Implications for Adherence to Recommended Health Behaviors

ERIC Educational Resources Information Center

Shelton, Rachel C.; Goldman, Roberta E.; Emmons, Karen M.; Sorensen, Glorian; Allen, Jennifer D.

2011-01-01

Understanding factors that promote or prevent adherence to recommended health behaviors is essential for developing effective health programs, particularly among lower income populations who carry a disproportionate burden of disease. We conducted in-depth qualitative interviews (n = 64) with low-income Black and Latina women who shared the…

A geo-ethnographic analysis of low-income rural and urban women's food shopping behaviors.

PubMed

MacNell, Lillian

2018-06-06

Many scholars have found evidence that low-income neighborhoods contain fewer supermarkets, but there is a lack of consensus regarding whether and how this matters to residents. A few qualitative studies have asked food desert residents about their experiences of their food environments, while a small number of other studies have utilized spatial analyses to examine actual shopping behaviors. To better understand barriers to food access, this study combines the two in a geo-ethnographic analysis. This study draws on data from a USDA-funded project about families and food to combine quantitative geographic data with qualitative interview data of 100 rural and urban low-income mothers of young children. For each participant, the nearest supermarket, as well most-frequented supermarket, was mapped, and distances to stores were calculated. On average, participants traveled more than twice as far as their nearest supermarket to reach a preferred store. Interviews with participants were conducted to assess the motivations and strategies of shoppers, in particular why they chose to bypass their nearest supermarkets. They shared a variety of reasons for doing so; foremost to find lower prices of food in order to stretch income and SNAP benefits. Access to transportation also played a major role in determining where people shopped for food. This research challenges scholars, policymakers, and health practitioners to look beyond proximate food environments to consider the lived experiences of food desert residents. Efforts to address poor food access should aim to increase household income, in addition to providing targeted food and nutrition assistance. Copyright © 2018. Published by Elsevier Ltd.

Efficient Identification of Low-Income Asian American Women at High Risk for Hepatitis B

PubMed Central

Joseph, Galen; Nguyen, Kim; Nguyen, Tung; Stewart, Susan; Davis, Sharon; Kevany, Sebastian; Marquez, Titas; Pasick, Rena

2015-01-01

Hepatitis B disproportionately affects Asian Americans. Because outreach to promote testing and vaccination can be intensive and costly, we assessed the feasibility of an efficient strategy to identify Asian Americans at risk. Prior research with California’s statewide toll-free phone service where low-income women call for free cancer screening found 50% of English- and Spanish-speaking callers were willing to participate in a study on health topics other than cancer screening. The current study ascertained whether Asian Americans could be recruited. Among 200 eligible callers, 50% agreed to take part (95% confidence interval 43%–57%), a rate comparable to our previous study. Subsequent qualitative interviews revealed that receptivity to recruitment was due to trust in the phone service and women’s need for health services and information. This was a relatively low-intensity intervention in that, on average, only five minutes additional call time was required to identify women at risk and provide a brief educational message. Underserved women from diverse backgrounds may be reached in large numbers through existing communication channels. PMID:24185165

I am pregnant and want to do better but i can't: focus groups with low-income overweight and obese pregnant women.

PubMed

Chang, Mei-Wei; Nitzke, Susan; Buist, Diana; Cain, Deborah; Horning, Stefanie; Eghtedary, Kobra

2015-05-01

This study was conducted to identify factors that influenced stress, healthy eating and physical activity among low-income overweight or obese pregnant women. We conducted seven focus groups with 96 low-income overweight and obese pregnant women. Common themes were identified from audio tapes and transcripts. Women said that poor communication affected their relationships with spouses or significant others. They were frustrated or upset with significant others for three key reasons: failure to understand or listen to the pregnant women's pregnancy concerns, refusal to be helpful when asked and being overly concerned with the woman's safety. Most women said that they were emotional and took naps throughout the day after becoming pregnant. Many withdrew from their social interactions. They also faced numerous challenges that made healthy eating more difficult, e.g., craving for unhealthy foods and eating foods for comfort. To eat healthier, some reminded themselves to avoid overeating or stop eating in the car. Women were not physically active because of tiredness, lack of motivation, inadequate social support, or bad weather. Some stayed physically active to prevent excessive pregnancy weight gain and have an easier labor. Women equivocally said weighing themselves to manage weight would add to their stress and make them feel more depressed. When designing interventions to help low-income overweight and obese pregnant women avoid excessive pregnancy weight gain, it is important to include information and practical advice on stress management, emphasizing effective communication skills with significant others and helping them plan effective ways to manage negative feelings.

A Rural Perspective on Perinatal Depression: Prevalence, Correlates, and Implications for Help-Seeking among Low-Income Women

ERIC Educational Resources Information Center

Price, Sarah Kye; Proctor, Enola K.

2009-01-01

Context/Purpose: To examine a low-income sample of women in the rural Midwest (N = 1,086) who were screened for perinatal depression through the outreach and education activities within a Healthy Start Initiative project. Specifically, we describe the frequency and severity of depressive symptoms, explore social and demographic correlates of…

The Feasibility of Personal Digital Assistants (PDAs) to Collect Dietary Intake Data in Low-Income Pregnant Women

ERIC Educational Resources Information Center

Fowles, Eileen R.; Gentry, Breine

2008-01-01

Objectives: To determine the feasibility of using personal digital assistant (PDA)-based technology for tracking and analysis of food intake in low-income pregnant women. Design: Descriptive. Participants provided an initial 24-hour dietary recall and recorded their food intake using a PDA-based software program for 2 days. Setting: Recruitment…

Reproductive tract infections (RTIs) among married non-pregnant women living in a low-income suburb of Beirut, Lebanon.

PubMed

Ramia, Sami; Kobeissi, Loulou; El Kak, Faysal; Shamra, Sarah; Kreidieh, Khalil; Zurayk, Huda

2012-09-17

This study aimed to identify reproductive tract infections (RTIs) in married, non-pregnant women, aged 18 to 49 years, living in a low-income suburb of Beirut, and to investigate the relationship between demographic and socioeconomic factors and these infections. Among 1,015 women recruited for the study, 502 were found eligible and 441 were medically examined. Appropriate specimens were collected for Nisseria gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, candidiasis, and bacterial vaginosis. The results showed a relatively high prevalence of RTIs (28.2%). The prevalence rates of different agents were as follows: 22.9% of the women were positive for T. vaginalis, 8.8% for candidiasis, 4.5% for bacterial vaginosis, and 1% for N. gonorrhea; none of the women were positive for C. trachomatis. Regression analysis showed that women between the ages of 30 and 39 were twice more likely to have T. vaginalis as compared to younger women. Furthermore, women whose husbands were taxi drivers were at higher risk of acquiring T. vaginalis (OR = 2.2) as compared with women whose husbands occupation was listed as skilled/unskilled. This conclusion can be drawn for the odds of developing any RTI (OR = 2.15). Moreover, those participants with the lowest income were twice as likely to have any RTI compared to those with higher incomes. This study shows a relatively high prevalence of RTIs (T. vaginalis mainly). It urges further in-depth research on cultural practices and economic factors to understand the pattern of sexual behavior in this community.

Trends in overweight among women differ by occupational class: results from 33 low- and middle-income countries in the period 1992-2009.

PubMed

Lopez-Arana, S; Avendano, M; van Lenthe, F J; Burdorf, A

2014-01-01

There has been an increase in overweight among women in low- and middle-income countries but whether these trends differ for women in different occupations is unknown. We examined trends by occupational class among women from 33 low- and middle-income countries in four regions. Cross-national study with repeated cross-sectional demographic health surveys. Height and weight were assessed at least twice between 1992 and 2009 in 248,925 women aged 25-49 years. Interviews were conducted to assess occupational class, age, place of residence, educational level, household wealth index, parity, age at first birth and breastfeeding. We used logistic and linear regression analyses to assess the annual percent change in overweight (body mass index >25 kg m(-2)) by occupational class. The prevalence of overweight ranged from 2.2% in Nepal in 1992-1997 to 75% in Egypt in 2004-2009. In all the four regions, women working in agriculture had consistently lower prevalence of overweight, while women from professional, technical, managerial as well as clerical occupational classes had higher prevalence. Although the prevalence of overweight increased in all the occupational classes in most regions, women working in agriculture and production experienced the largest increase in overweight over the study period, while women in higher occupational classes experienced smaller increases. To illustrate, overweight increased annually by 0.5% in Latin America and the Caribbean and by 0.7% in Sub-Saharan Africa among women from professional, technical and managerial classes, as compared with 2.8% and 3.7%, respectively, among women in agriculture. The prevalence of overweight has increased in most low- and middle-income countries, but women working in agriculture and production have experienced larger increases than women in higher occupational classes.

Modeling condom-use stage of change in low-income, single, urban women.

PubMed

Morrison-Beedy, Dianne; Carey, Michael P; Lewis, Brian P

2002-04-01

This study was undertaken to identify and test a model of the cognitive antecedents to condom use stage of change in low-income, single, urban women. A convenience sample of 537 women (M=30 years old) attending two urban primary health care settings in western New York State anonymously completed questionnaires based primarily on two leading social-cognitive models, the transtheoretical model and the information-motivation-behavioral skills model. We used structural equation modeling to examine the direct and indirect effects of HIV-related knowledge, social norms of discussing HIV risk and prevention, familiarity with HIV-infected persons, general readiness to change sexual behaviors, perceived vulnerability to HIV, and pros and cons of condom use on condom-use stage of change. The results indicated two models that differ by partner type. Condom-use stage of change in women with steady main partners was influenced most by social norms and the pros of condom use. Condom-use stage of change in women with "other" types (multiple, casual, or new) of sexual partners was influenced by HIV-related knowledge, general readiness to change sexual behaviors, and the pros of condom use. These findings suggest implications for developing gender-relevant HIV-prevention interventions. Copyright 2002 Wiley Periodicals, Inc.

Social capital, women's autonomy and smoking among married women in low-income urban neighborhoods of Beirut, Lebanon.

PubMed

Afifi, Rema A; Nakkash, Rima T; Khawaja, Marwan

2010-01-01

We sought to examine the associations between social capital, women's empowerment, and smoking behavior among married women in three low-income neighborhoods in Beirut, Lebanon. Data from currently married women aged 15 to 59 years in the 2003 Urban Health Study were used. The dependent variable was cigarette smoking. The main independent variables were five social capital items and three women's empowerment indices. Other socioeconomic variables as well as mental distress, happiness, and community of residence were included as covariates. Bivariate associations were conducted on all variables using chi-square tests. Adjusted odds ratios from binary logistic regression models were then modeled on smoking behavior separately for younger and older women. More than one third (35.9%) of married women reported smoking cigarettes. At the bivariate level, a variety of socioeconomic and demographic variables predicted smoking. With respect to social capital, women who lacked trust and were dissatisfied with the number friends or relatives living nearby were more likely to smoke. As for women's autonomy, high decision making and high mobility were associated with smoking. When analyzed multivariately, social capital items were statistically significant for younger women but not for older women. And the mobility variables were significant for older women but not younger women. Our results support the conclusion that determinants of women's tobacco use are multilayered, and include social capital and women's autonomy. Our results also suggest that younger and older married women may be influenced by differential determinants. Reasons for these differences are explored. Interventions may need to be tailored to each age group separately. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis.

PubMed

Sobhy, Soha; Zamora, Javier; Dharmarajah, Kuhan; Arroyo-Manzano, David; Wilson, Matthew; Navaratnarajah, Ramesan; Coomarasamy, Arri; Khan, Khalid S; Thangaratinam, Shakila

2016-05-01

The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries. In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805. 44 studies (632,556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32,149,636 pregnancies and 36,144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths

Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence : Posttraumatic stress disorder among women exposed to partner violence.

PubMed

Kastello, Jennifer C; Jacobsen, Kathryn H; Gaffney, Kathleen F; Kodadek, Marie P; Bullock, Linda C; Sharps, Phyllis W

2016-06-01

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p < 0.001). Most participants (65 %) identified non-IPV-related traumas as their MDTEs. Psychological (94 %), physical (82 %), and sexual (44 %) violence were not significantly associated with PTSD status. Despite recent exposure to IPV, most participants identified other traumatic events as more disturbing than IPV-related trauma. Further, the risk for PTSD increased with age, suggesting that the cumulative effect of trauma, which may include IPV, increases the risk for PTSD over a lifetime. Implementing comprehensive screening for trauma during prenatal care may lead to the early identification and treatment of PTSD during pregnancy in a community setting.

Aiming for more relevant HIV risk reduction: a black feminist perspective for enhancing HIV intervention for low-income African American women.

PubMed

Gentry, Quinn M; Elifson, Kirk; Sterk, Claire

2005-06-01

The purpose of this study was to examine how various living conditions impact the context within which low-income African American women engage in a diverse range of high-risk behavior that increases their risk for HIV infection. The study, based on 2 years of ethnographic fieldwork, analyzed the living conditions of 45 African American women at risk for HIV infection in a high-risk neighborhood in Atlanta, Georgia. A black feminist perspective guided the study's analytical framework as a way to extend knowledge about the social conditions, the social interactions, and the meaning of high-risk behavior in the lives of African American women. Using black feminist theory and the constant comparison method, two groups emerged: "street" women and "house" women. Street women were defined as the absolute homeless, the rooming housed, and the hustling homeless. House women were defined as the family housed, the heads of household, and the steady-partner housed. Results reveal that various types of living arrangements place women at risk in different ways and suggest that low-income African American women at high risk for HIV infection-a group often considered homogeneous-have unique "within group" needs that must be addressed in HIV prevention intervention research.

"Our Success Is Our Graduates" Case Study of Year Up: A Career Advancement Model for Low-Income Young Adults. Advancement for Low-Wage Workers Report Series

ERIC Educational Resources Information Center

Biswas, Radha Roy

2005-01-01

This report describes the "Year Up" program, an innovative technology training program, that prepares and places low-income, urban young adults in entry-level IT jobs while also preparing them for college. The program targets recent high school graduates and GED recipients between the ages of 18 and 24 who are either unemployed or…

Feeding practices of low-income mothers: How do they compare to current recommendations

USDA-ARS?s Scientific Manuscript database

Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample t...

Intention to Consume Fruits and Vegetables Is Not a Proxy for Intake in Low-Income Women from Pennsylvania

ERIC Educational Resources Information Center

Lohse, Barbara; Wall, Denise; Gromis, Judy

2011-01-01

Intention as an outcome measure for fruit and vegetable nutrition education interventions in low-income women was assessed through dietary assessment 3 weeks after a fruit and vegetable intervention in a federally funded program. Amount and variety of intake were compared to intentions expressed immediately following intervention. Findings…

Pain, sensory function, and neurogenic inflammatory response in young women with low mood.

PubMed

Lehoux, Cory P; Abbott, Frances V

2011-03-01

To determine the relationship of mood status to pain complaints, sensory function, neurogenic inflammatory response, and general health in young women. Ninety-three women aged 18-29 participated in the study and were categorized by SCL-90-R depression score into low-mood (n=21) and normal-mood (n=72) groups. All subjects were below the threshold for possible clinical depression. Low mood was associated with decreased tactile sensitivity, reduced response to topical capsaicin, and increased complaints of back, joint, muscle, and visceral pain, but not headache, when compared to normal mood controls. Low mood was also associated with reported poorer health and physical functioning, increased psychopathology, and family history of mood problems. These data show that even subclinical low mood is associated with marked alterations in health and psychophysiological function. Copyright © 2011 Elsevier Inc. All rights reserved.

Trends in overweight among women differ by occupational class: Results from 33 low and middle income countries in the period 1992–2009

PubMed Central

Lopez-Arana, Sandra; Avendano, Mauricio; van Lenthe, Frank J; Burdorf, Alex

2013-01-01

Objective There has been an increase in overweight among women in low- and middle-income countries, but whether these trends differ for women in different occupations is unknown. We examined trends by occupational class among women from 33 low- and middle-income countries in four regions. Design Cross-national study with repeated cross-sectional demographic health surveys (DHS). Subjects Height and weight were assessed at least twice between 1992 and 2009 in 248,925 women aged 25–49 years. Interviews were conducted to assess occupational class, age, place of residence, educational level, household wealth index, parity, and age at first birth and breastfeeding. We used logistic and linear regression analyses to assess the annual percent change (APC) in overweight (BMI > 25 kg/m2) by occupational class. Results The prevalence of overweight ranged from 2.2% in Nepal in 1992–1997 to 75% in Egypt in 2004–2009. In all four regions, women working in agriculture had consistently lower prevalence of overweight, while women from professional, technical, managerial as well as clerical occupational classes had higher prevalence. Although the prevalence of overweight increased in all occupational classes in most regions, women working in agriculture and production experienced the largest increase in overweight over the study period, while women in higher occupational classes experienced smaller increases. To illustrate, overweight increased annually by 0.5% in Latin America and the Caribbean and by 0.7% in Sub-Saharan Africa among women from professional, technical, and managerial classes, as compared to 2.8% and 3.7%, respectively, among women in agriculture. Conclusion The prevalence of overweight has increased in most low and middle income countries, but women working in agriculture and production have experienced larger increases than women in higher occupational classes. PMID:23649471

A nutrition and physical activity intervention promotes weight loss and enhances diet attitudes in low-income mothers of young children.

PubMed

Jordan, Kristine C; Freeland-Graves, Jeanne H; Klohe-Lehman, Deborah M; Cai, Guowen; Voruganti, V Saroja; Proffitt, J Michael; Nuss, Henry J; Milani, Tracey J; Bohman, Thomas M

2008-01-01

The purpose of this study was to evaluate a nutrition and physical activity program for reducing body weight and improving nutrition attitudes in mothers of young children. A convenience sample of 114 intervention mothers and 33 comparison mothers was recruited from public health clinics and community centers. Eligibility criteria included Hispanic, African American, or white ethnicity; body mass index of at least 25 kg/m(2); low income (< 200% of the federal poverty index); and youngest child aged 1 to 4 years. For intervention participants, height, weight, percentage of body fat, waist circumference, demographics, nutrition attitudes, and dietary intake were measured at weeks 0 and 8; height, weight, percentage of body fat, and waist circumference were reassessed at 6 months. Overweight mothers in the comparison group provided anthropometric and demographic data at weeks 0 and 8. Changes in anthropometrics, attitudes, and dietary intake were evaluated in intervention mothers. Anthropometric data of intervention vs comparison group mothers were examined. Differences in anthropometrics and attitude scores between weight loss responders (> or = 2.27 kg) and nonresponders (< 2.27 kg) were assessed at week 8. Intervention participants lost weight (x = -2.7 kg; P < .001), whereas comparison mothers gained a slight amount of weight (x = 0.1 kg) by week 8. Weight loss responders had healthier eating attitudes (5.6 vs 5.2; P < .01) and fewer perceived barriers (2.4 vs 2.9; P < .05) than nonresponders postintervention. In conclusion, this dietary and physical activity curriculum is a valuable resource for weight management programs serving low-income women.

"I Wish Kids Didn't Watch So Much TV": Out-of-School Time in Three Low Income Communities. School-Age Child Care Project.

ERIC Educational Resources Information Center

Miller, Beth M.; And Others

Research suggests that how children spend their out-of-school hours can significantly affect their social development and school success. The Out-of-School Time Study, conducted by the School-Age Child Care Project at the Wellesley College Center for Research on Women, investigated how young low-income children in three urban communities spent…

Home-based asthma education of young low-income children and their families.

PubMed

Brown, Josephine V; Bakeman, Roger; Celano, Marianne P; Demi, Alice S; Kobrynski, Lisa; Wilson, Sandra R

2002-12-01

To conduct a controlled trial of a home-based education program for low-income caregivers of young children with asthma. Participants were randomized to treatment-eight weekly asthma education sessions adapted from the Wee Wheezers program (n = 49)-or usual care (n = 46). Baseline and 3- and 12-month follow-up data were gathered from caregivers and from children's medical records. Treatment was associated with less bother from asthma symptoms, more symptom-free days, and better caregiver quality of life at follow-up for children 1-3, but not those 4-6, years of age. Treatment and control groups did not differ in caregiver asthma management behavior or children's acute care utilization. This home-based asthma education program was most effective with younger children; perhaps their caregivers were more motivated to learn about asthma management. Targeting psychosocial factors associated with asthma morbidity might also enhance the efficacy of asthma education for these families.

Economic disadvantage and transitional outcomes: a study of young people from low-income families in Hong Kong

PubMed Central

Ngai, Steven Sek Yum; Cheung, Jacky Chau-Kiu; To, Siu-ming; Luan, Hui; Zhao, Ruiling

2014-01-01

This study draws on data from focus groups involving 50 young people from low-income families in Hong Kong to investigate their school-to-work experiences. In line with the ecological–developmental perspective, our results show that contextual influences, including lower levels of parental involvement and lack of opportunities for further education or skill development, constrain both the formulation and pursuit of educational and career goals. In contrast, service use and supportive interactions with parents and non-family adults were found to help young people find a career direction and foster more adaptive transition. Furthermore, our results indicate a striking difference in intrapersonal agency and coping styles between youths who were attending further education or engaged in jobs with career advancement opportunities and those who were not. We discuss the implications of our findings, both for future research and for policy development to enhance the school-to-work transition of economically disadvantaged young people. PMID:25364087

Prenatal care: associations with prenatal depressive symptoms and social support in low-income urban women.

PubMed

Sidebottom, Abbey C; Hellerstedt, Wendy L; Harrison, Patricia A; Jones-Webb, Rhonda J

2017-10-01

We examined associations of depressive symptoms and social support with late and inadequate prenatal care in a low-income urban population. The sample was prenatal care patients at five community health centers. Measures of depressive symptoms, social support, and covariates were collected at prenatal care entry. Prenatal care entry and adequacy came from birth certificates. We examined outcomes of late prenatal care and less than adequate care in multivariable models. Among 2341 study participants, 16% had elevated depressive symptoms, 70% had moderate/poor social support, 21% had no/low partner support, 37% had late prenatal care, and 29% had less than adequate prenatal care. Women with both no/low partner support and elevated depressive symptoms were at highest risk of late care (AOR 1.85, CI 1.31, 2.60, p < 0.001) compared to women with both good partner support and low depressive symptoms. Those with good partner support and elevated depressive symptoms were less likely to have late care (AOR 0.74, CI 0.54, 1.10, p = 0.051). Women with moderate/high depressive symptoms were less likely to experience less than adequate care compared to women with low symptoms (AOR 0.73, CI 0.56, 0.96, p = 0.022). Social support and partner support were negatively associated with indices of prenatal care use. Partner support was identified as protective for women with depressive symptoms with regard to late care. Study findings support public health initiatives focused on promoting models of care that address preconception and reproductive life planning. Practice-based implications include possible screening for social support and depression in preconception contexts.

Stages of Change as a Correlate of Mental Health Symptoms in Abused, Low-Income African American Women

PubMed Central

Edwards, Tiffany A.; Houry, Debra; Kemball, Robin S.; Harp, Sharon E.; McNutt, Louise-Anne; Straus, Helen; Rhodes, Karin V.; Cerulli, Catherine; Kaslow, Nadine J.

2006-01-01

The current study aims to further our understanding of the applicability of the transtheoretical model (TM) to intimate partner violence (IPV), with particular focus on mental health symptoms (depression, posttraumatic stress disorder symptomatology, suicidal ideation) in a sample of low-income African American women seeking medical services at an inner city emergency department. Results revealed that of the 121 abused African American women, the majority (95%) were in the precontempla-tion and contemplation stages of the change process. Further, contrary to predictions, bivariate analyses revealed those at further stages of change endorsed more severe mental health symptoms. However, a multivariate analysis of variance examining differences in level of mental health symptoms between women high and low on stages of change was inconclusive due to the small number of women at the higher stages of the TM model. These findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to intervention design. PMID:16897735

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

PubMed

Walker, Lorraine O; Freeland-Graves, Jeanne H; Milani, Tracey; Hanss-Nuss, Henry; George, Goldy; Sterling, Bobbie Sue; Kim, Minseong; Timmerman, Gayle M; Wilkinson, Susan; Arheart, Kristopher L; Stuifbergen, Alexa

2004-01-01

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. 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. The analytic sample consisted of 382 White, African American, and Hispanic women. 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. Low-income ethnic minority women have a higher vulnerability to postpartum weight gains or plateaus. High depressive symptoms occurred in all ethnic groups examined.

Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial.

PubMed

Stockwell, Melissa S; Westhoff, Carolyn; Kharbanda, Elyse Olshen; Vargas, Celibell Y; Camargo, Stewin; Vawdrey, David K; Castaño, Paula M

2014-02-01

We evaluated the impact of influenza vaccine text message reminders in a low-income obstetric population. We conducted a randomized controlled trial that enrolled 1187 obstetric patients from 5 community-based clinics in New York City. The intervention group received 5 weekly text messages regarding influenza vaccination starting mid-September 2011 and 2 text message appointment reminders. Both groups received standard automated telephone appointment reminders. The prespecified endpoints were receipt of either pre- or postpartum influenza vaccination calculated cumulatively at the end of each month (September-December 2011). After adjusting for gestational age and number of clinic visits, women who received the intervention were 30% more likely to be vaccinated as of December 2011 (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.003, 1.69 end of September: AOR = 1.34; 95% CI = 0.98, 1.85; October: AOR = 1.35; 95% CI = 1.05, 1.75; November: AOR = 1.27; 95% CI = 0.98, 1.65). The subgroup of women early in the third trimester at randomization showed the greatest intervention effect (December 31: 61.9% intervention vs 49.0% control; AOR = 1.88; 95% CI = 1.12, 3.15). In this low-income obstetric population, text messaging was associated with increased influenza vaccination, especially in those who received messages early in their third trimester.

Critical Components of a Summer Enrichment Program for Urban Low-Income Gifted Students

ERIC Educational Resources Information Center

Kaul, Corina R.; Johnsen, Susan K.; Witte, Mary M.; Saxon, Terrill F.

2015-01-01

Effective program models are needed for low-income youth. This article describes one successful summer enrichment program, University for Young People's Project Promise, and outlines three key components of a Partnership for Promoting Potential in Low-Income Gifted Students (Partnership Model), which is based on Lee, Olszewski-Kubilius, and…

Why Take an HIV Test? Concerns, Benefits, and Strategies to Promote HIV Testing among Low-Income Heterosexual African American Young Adults

ERIC Educational Resources Information Center

Wallace, Scyatta A.; McLellan-Lemal, Eleanor; Harris, Muriel J.; Townsend, Tiffany G.; Miller, Kim S.

2011-01-01

A qualitative study examined perceptions of HIV testing and strategies to enhance HIV testing among HIV-negative African American heterosexual young adults (ages 18-25 years). Twenty-six focus groups (13 male groups, 13 female groups) were conducted in two low-income communities (urban and rural). All sessions were audio-recorded and transcribed.…

Correlates of exchange sex among a population-based sample of low-income women who have heterosexual sex in Baltimore.

PubMed

Sherman, Susan G; Hast, Marisa; Park, Ju Nyeong; Decker, Michele R; Flynn, Colin; German, Danielle

2018-03-08

Sex exchange is associated with HIV and other morbidities yet has received little research, surveillance, and programmatic attention in the U.S. This study identified correlates of exchange sex and among low-income women in Baltimore, Maryland. Participants were recruited into the National HIV Behavioral Surveillance (NHBS) system in 2013 using respondent driven sampling (RDS) and completed a survey and HIV testing. The analytic sample (n = 253) consisted of women aged ≥18 years who had recent (past year) heterosexual sex. Multivariable logistic regression identified correlates of recent exchange sex. Independently associated with recent exchange sex were history of injection drug use (adjusted odds ratio (AOR) = 3.4, 95% CI: 1.1-10.3), recent prescription painkiller use (AOR = 3.7, 95% CI: 1.4-9.9), recent crack/cocaine use (AOR = 6.6, 95% CI: 2.1-20.9), recent arrest (AOR = 4.1, 95% CI: 1.2-14.8), and recent consistent condom use (AOR 1.1; 95% CI: 1.0-1.3). Women who exchanged sex exhibited heightened social and structural vulnerability and substance use. These data demonstrate the need for further research examining the context of exchange sex among low-income women and synergies between substance use and HIV risk.

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

PubMed

Susan Marquis, M; Long, Stephen H

2002-11-01

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

Structural community factors and sub-optimal engagement in HIV care among low-income women in the Deep South of the USA.

PubMed

Walcott, Melonie; Kempf, Mirjam-Colette; Merlin, Jessica S; Turan, Janet M

2016-01-01

This study describes the ways in which poverty and other structural factors create a risk environment for sub-optimal engagement in HIV care among low-income women living with HIV in the Southern USA, contributing to existing health disparities. We conducted a qualitative study in 2012, involving in-depth interviews with 14 stakeholders (service providers and representatives of community-based organisations) and 7 focus-group discussions with 46 women living with HIV (89% African American). A thematic approach in the context of the social ecological model guided data analysis. Data were coded and analysed using NVivo qualitative software. The findings suggested that structural community factors, such as poverty, poor employment opportunities, limited access to healthcare resources, stigma, transportation challenges and access to illicit substances, may work independently and in synergy to impact women's health seeking behaviour and decision-making, thereby influencing their ability to engage in HIV care. Interventions designed to improve engagement in HIV care should address structural factors to bolster low-income women's ability to engage in care.

Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

PubMed Central

Kobayashi, Miwako; Vekemans, Johan; Baker, Carol J.; Ratner, Adam J.; Le Doare, Kirsty; Schrag, Stephanie J.

2016-01-01

Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations. PMID:27803803

Factors associated with six-year weight change in young and middle-aged adults in the Young Finns Study.

PubMed

Kaikkonen, Jari E; Mikkilä, Vera; Juonala, Markus; Keltikangas-Järvinen, Liisa; Hintsanen, Mirka; Pulkki-Råback, Laura; Viikari, Jorma S A; Kähönen, Mika; Lehtimäki, Terho; Telama, Risto; Raitakari, Olli T

2015-04-01

To examine factors associated with weight change and obesity risk in young and middle-aged adults. The Young Finns Study with its 923 women and 792 men aged 24-39 years at baseline were followed for six years. Variables associated with the weight change were investigated with regression models. The average weight change was 0.45 kg/year in women and 0.58 kg/year in men. In women, weight change was steady across all ages. In men, weight changes were more pronounced in younger age groups. In women (weight gain > 2 kg, n = 490), medication for anxiety, low occupational status, high baseline BMI (body mass index), high intake of sweet beverages, high childhood BMI, high salt (NaCl and/or KCl) use, low number of children, low childhood family income, high stature and low level of dependence (a temperament subscale) were associated with increased weight gain (in the order of importance). In men (weight gain > 2 kg, n = 455), high stature, high intake of french fries, low intake of sweet cookies, young age, recent divorce, low intake of cereals, high intake of milk, depressive symptoms, rural childhood origin, high baseline BMI and unemployment were associated with more pronounced weight gain. Sedentarity (screen-time) was associated with weight gain only in young men. Physical activity and genetic risk for high BMI (score of 31 known variants) were not consistently associated with weight change. Socio-economic factors, temperamental and physical characteristics, and some dietary factors are related with weight change in young/middle-aged adults. The weight change occurring in adulthood is also determined by childhood factors, such as high BMI and low family income.

Is Maternal Marriage Beneficial for Low-Income Adolescents?

ERIC Educational Resources Information Center

Bachman, Heather J.; Coley, Rebekah Levine; Chase-Lansdale, P. Lindsay

2009-01-01

The present study investigated the association of mothers' marriage and changes in young adolescents' cognitive and socioemotional development and changes in family processes. Analyses employed longitudinal data from the "Three-City Study" to track maternal partnerships for 860 low-income adolescents (10-14 years-old in Wave 1) across a…

A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India.

PubMed

Travasso, Sandra Mary; Rajaraman, Divya; Heymann, Sally Jody

2014-02-07

Low-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work. Through a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators. Even in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work. This qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated with negative mental health amongst

A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India

PubMed Central

2014-01-01

Background Low-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work. Methods Through a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators. Results Even in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work. Conclusion This qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated

Low socioeconomic status may increase the risk of central obesity in incoming university students in Taiwan.

PubMed

Chao, Chi-Yuan; Shih, Chi-Chen; Wang, Chi-Jen; Wu, Jin-Shang; Lu, Feng-Hwa; Chang, Chih-Jen; Yang, Yi-Ching

2014-01-01

Obesity is related to social disparity. The objective of the study was to evaluate different indicators of parental SES with the association of central obesity in young adult Taiwanese students. This study was cross-sectionally designed and a total of 4552 subjects were recruited. Each subject completed a self-administrated questionnaire and received anthropometric and laboratory measurements. The indicators of SES in study subjects included parental education, occupation, household incomes, childhood and current index of social position (ISP), measured according to the modified Hollingshead's ISP. Central obesity was defined as waist circumference ≥90 cm in men and ≥80 cm in women. The prevalence of central obesity was 10.7% in this study. When compared to subjects with normal waist circumferences, subjects with central obesity were older, had a higher BMI, both systolic and diastolic blood pressure, a higher proportion of male gender, family history of diabetes and hypertension, alcohol consumption habit, and a higher proportion of low current household income, current parental blue collar occupational level, and lower current and childhood parental ISP level. Multivariate analysis showed the current parental household income and ISP were significantly higher indicators of risk of central obesity after adjustment for possible confounding factors. The odds ratios were 1.26 and 1.30, respectively. Our results showed that low household income and current ISP were independently associated with the risk of central obesity. Therefore, young adults with low SES should be an important target group for prevention and management of central obesity in school health promotion programs. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.

Caring capacity in the management of the nutrition crisis in infants, young children and women in Nigeria.

PubMed

Igbedioh, S O

1996-01-01

Nigeria's nutrition crisis has been shown to have a considerable negative impact on infants, young children and women. Available evidence suggests that 'caring capacity' when properly planned and targeted at the most-at-risk can help. Strategies that can achieve this care are increasing women's income and control over income, increasing investment in women's education and improving access to credit facilities. Others are the aggressive promotion of gender-biased labour saving technology, increasing women's access to basic health and family planning services and implementing reforms in land ownership while instituting social security for women.

Using group model building to develop a culturally grounded model of breastfeeding for low-income African American women in the USA.

PubMed

Reno, Rebecca

2017-03-02

To identify barriers and supporting factors for breastfeeding, and the dynamic interactions between them, as identified by low-income African American women and lactation peer helpers. Stark breastfeeding disparities exist between African American mothers and their White counterparts in the USA. This pattern is often replicated across the globe, with marginalised populations demonstrating decreased breastfeeding rates. While breastfeeding research focused on sociocultural factors for different populations has been conducted, a more dynamic model of the factors impacting breastfeeding may help identify effective leverage points for change. Group model building was used as a grounded theoretical approach, to build and validate a model representing factors impacting breastfeeding and the relationships between them. Low-income African American women (n = 21) and lactation peer helpers (n = 3) were engaged in model building sessions to identify factors impacting breastfeeding. A two-cycle process was used for analysis, in vivo and axial coding. The final factors and model were validated with a subgroup of participants. The participants generated 82 factors that make breastfeeding easier, and 86 factors that make breastfeeding more challenging. These were grouped into 10 and 14 themes, respectively. A final model was constructed identifying three domains impacting breastfeeding: a mother's return to work or school, her knowledge, support and persistence, and the social acceptance of breastfeeding. This study documented the sociocultural context within which low-income African American women are situated by identifying factors impacting breastfeeding, and the dynamic interactions between them. The model also provided various leverage points from which breastfeeding women can be supported. Postpartum nurses are critical in supporting breastfeeding practices. To be most effective, they must be aware of the factors impacting breastfeeding, some of which may be unique to

The Risk of Partner Violence among Low-Income Hispanic Subgroups

ERIC Educational Resources Information Center

Frias, Sonia M.; Angel, Ronald J.

2005-01-01

Women with few social resources are at elevated risk of partner abuse. Certain evidence suggests that African American and Hispanic women, who are overrepresented in the lower socioeconomic strata, are at particularly high risk. We compare women's risk of partner violence, defined as moderate and severe, among 2,400 low-income African American,…

Associations between education and personal income with body mass index among Australian women residing in disadvantaged neighborhoods.

PubMed

Williams, Lauren K; Andrianopoulos, Nick; Cleland, Verity; Crawford, David; Ball, Kylie

2013-01-01

The aims of the current study were to (1) determine the association between personal income and body mass index (BMI) and between individual education and BMI, and (2) examine the association between education and BMI across strata of personal income among women. The design of the study was a quantitative analysis of data from self-report questionnaires. The study setting was socioeconomically disadvantaged neighborhoods in Victoria, Australia. The study included 4065 nonpregnant women (ages 18-45 years) living in socioeconomically disadvantaged areas. The study used a self-report questionnaire measuring sociodemographic characteristics known to be associated with BMI. Multiple linear regressions with imputation were used to assess the association between education level, personal income, and BMI, while controlling for covariates. Mean (SD) observed BMI was 26.0 (6.1) kg/m2. Compared with women with low education, women with medium (b = -0.81; 95% confidence interval, -1.30 to -0.27; p = .004) and high (b = -1.71; 95% confidence interval, -2.34 to -1.09; p < .001) education had statistically significantly lower BMI values. No differences in BMI were observed between income categories. Stratified analyses suggested that the education-BMI association may be stronger in low-income than higher-income women. Our data show that among women living in socioeconomically disadvantaged areas, high education level rather than personal income may be protective against overweight/obesity. High personal income, however, may buffer the effects of low education on BMI. Obesity prevention efforts should target women with amplified disadvantage.

Multiple domains of stress predict postpartum depressive symptoms in low-income Mexican American women: the moderating effect of social support.

PubMed

Coburn, Shayna S; Gonzales, N A; Luecken, L J; Crnic, K A

2016-12-01

Prenatal stress can have a lasting effect on women's mental health after childbirth. The negative effects may be particularly salient in women from low income and ethnic minority backgrounds, who are at increased risk for postpartum depression. However, social support may have the potential to attenuate the negative impact of stress. The present study evaluated 269 Mexican American women (ages 18-42; 83 % Spanish-speaking; median income $10,000-$15,000) for prenatal stress (daily hassles, family stress, partner stress, and culture-specific stress) in relation to depressive symptoms 6 weeks postpartum. Prenatal social support was examined as a buffer against the impact of prenatal stress. Partner stress, family stress, and daily hassles uniquely predicted depressive symptoms. Moderate and high levels of social support attenuated risk for depression due to family stressors. Prenatal interpersonal and daily stressors negatively impact the mental health of women after birth, but social support can mitigate some of these effects. Among Mexican American pregnant women, effective interpersonal support and stress management may be associated with reduced risk for postpartum depression.

Adverse childhood experiences of low-income urban youth.

PubMed

Wade, Roy; Shea, Judy A; Rubin, David; Wood, Joanne

2014-07-01

Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area. Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains. Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination. Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults. Copyright © 2014 by the American Academy of Pediatrics.

Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women.

PubMed

Gross, Rachel S; Mendelsohn, Alan L; Gross, Michelle B; Scheinmann, Roberta; Messito, Mary Jo

2016-07-01

To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women. We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether 4 domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered individually and also cumulatively, were associated with having a low internal locus of control over the prevention of child obesity. The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least 1 hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (adjusted odds ratio, 2.38; 95% confidence interval, 1.50-3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship with an increased odds of having a low internal locus of control. Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately affect infant feeding practices and child weight trajectories. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.

PubMed

Campos, Nicole G; Sharma, Monisha; Clark, Andrew; Lee, Kyueun; Geng, Fangli; Regan, Catherine; Kim, Jane; Resch, Stephen

2017-07-01

To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance. We used a model-based approach to synthesize population, demographic, and epidemiological data from 50 low- and lower-middle-income countries. Models were used to project the costs (US $), lifetime health impact (cervical cancer cases, deaths averted), and cost-effectiveness (US $ per disability adjusted life year [DALY] averted) of: (1) two-dose HPV-16/18 vaccination of girls aged 10 years; (2) once-in-a-lifetime screening, with treatment when needed, of women aged 35 years with either HPV DNA testing or visual inspection with acetic acid (VIA); and (3) cervical cancer treatment over a 10-year roll-out. We estimated that both HPV vaccination and screening would be very cost-effective, and a comprehensive program could avert 5.2 million cases, 3.7 million deaths, and 22.0 million DALYs over the lifetimes of the intervention cohorts for a total 10-year program cost of US $3.2 billion. Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low- and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Domestic violence and treatment seeking: a longitudinal study of low-income women and mental health/substance abuse care.

PubMed

Cheng, Tyrone C; Lo, Celia C

2014-01-01

A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.

Low-income mothers' views on breastfeeding.

PubMed

Guttman, N; Zimmerman, D R

2000-05-01

Nourishing infants presents women today with choices, desires, obligations and constraints. Despite mounting evidence about the health, psychosocial and societal benefits of breastfeeding both for women and infants, current breastfeeding rates worldwide are far from optimal, particularly among low-income women. Many mothers choose to use infant formula. Drawing from structured interviews with 154 mothers from an urban low-income multiethnic population in the United States, a typology of mothers' feelings about their infant feeding method is developed. Findings indicate that regardless of their feeding method, mothers tended to attribute higher health benefits to breastfeeding and perceived community norms as probreastfeeding. They differed in their rating and perceptions of logistics and the extent to which benefits mattered in their infant-feeding decision. Contradictions associated with the practice of breastfeeding even among mothers who breastfed, were reflected in their perceptions of social disapproval of breastfeeding in public, reports of ridicule by friends, lack of support from some health providers, and difficulties associated with working. A typology of mothers' emotional states resulting from such contradictions summarizes the findings and underscores how some mothers who did not, but would have liked to breastfeed, may be subjected to feelings of guilt and deprivation. Implications for educational interventions are to amplify prenatal infant feeding consultations and address ways to overcome logistical and apprehension barriers.

Perspectives of Low-Income African-American Women Non-adherent to Mammography Screening: the Importance of Information, Behavioral Skills, and Motivation.

PubMed

Wells, Anjanette A; Shon, En-Jung; McGowan, Kelly; James, Aimee

2017-06-01

Although information-motivation-behavioral skills (IMB) adherence model has been successfully used in many illness domains and with other populations, it has not been used in understanding mammogram screening among low-income African-American women. Thus, a qualitative examination is needed to theoretically and collectively understand the barriers to screening, given the disparities in breast cancer mortality rates among this population. Semi-structured telephone interviews were conducted with 28 low-income uninsured and underinsured African-American women, 40 to 70 years, who had not had a mammogram within the past 12 months. Women were recruited from 21 hair and nail salons and Laundromats within the five North St. Louis city zip codes with the highest breast cancer mortality rates. Transcripts were analyzed and rooted in grounded theory. This study found that the individual relevancy of information, behavioral skills-both procedural and systematic-and motivation seemed to affect screening adherence; (the results suggest the importance of reordering traditional IMB components into the following sequential order: information, behavioral skills, and motivation (IBM)). Future analyses should include a larger, more representative sample of unscreened women, in which quantitative statistical analyses could be conducted to assist in strengthening assertions about information, behavioral skills, and motivational aspects and their relationship to screening.

Does job stability mediate the relationship between intimate partner violence and mental health among low-income women?

PubMed

Adams, Adrienne E; Bybee, Deborah; Tolman, Richard M; Sullivan, Cris M; Kennedy, Angie C

2013-10-01

Intimate partner violence (IPV) has detrimental consequences for women's mental health. To effectively intervene, it is essential to understand the process through which IPV influences women's mental health. The current study used data from 5 waves of the Women's Employment Study, a prospective study of single mothers receiving Temporary Assistance for Needy Families (TANF), to empirically investigate the extent to which job stability mediates the relationship between IPV and adverse mental health outcomes. The findings indicate that IPV significantly negatively affects women's job stability and mental health. Further, job stability is at least partly responsible for the damaging mental health consequences of abuse, and the effects can last up to 3 years after the IPV ends. This study demonstrates the need for interventions that effectively address barriers to employment as a means of enhancing the mental health of low-income women with abusive partners. © 2013 American Orthopsychiatric Association.

Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): Toward a conceptual framework.

PubMed

Daoud, Nihaya; Matheson, Flora I; Pedersen, Cheryl; Hamilton-Wright, Sarah; Minh, Anita; Zhang, Janice; O'Campo, Patricia

2016-01-01

We used grounded theory to understand pathways and trajectories to housing instability (HI) and poor health among low-income women with experiences of intimate partner violence (IPV). We conducted in-depth interviews during 2010-11 with forty-one women (ages 18-45 years) living in Ontario, Canada. All women reported depressive symptoms in combination with other health problems. In addition to the direct pathway of IPV to poor health, thematic analysis revealed an indirect multi-tiered pathway with complex trajectories among IPV, HI, and poor health. These trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding, and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control), and social trajectories (financial problems, loss of employment, income, or social networks, and leaving school). These trajectories elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance) and exacerbated poor health already compromised by IPV. Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women's experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. Finally, we found that for these women, achieving stable housing was crucial for stabilizing their health.

Lives in isolation: stories and struggles of low-income African American women with panic disorder.

PubMed

Johnson, Michael; Mills, Terry L; Deleon, Jessica M; Hartzema, Abraham G; Haddad, Judella

2009-01-01

Research evidence points to the existence of racial-ethnic disparities in both access to and quality of mental health services for African Americans with panic disorder. Current panic disorder evaluation and treatment paradigms are not responsive to the needs of many African Americans. The primary individual, social, and health-care system factors that limit African Americans' access to care and response to treatment are not well understood. Low-income African American women with panic disorder participated in a series of focus-group sessions designed to elicit (1) their perspectives regarding access and treatment barriers and (2) their recommendations for designing a culturally consistent panic treatment program. Fear of confiding to others about panic symptoms, fear of social stigma, and lack of information about panic disorder were major individual barriers. Within their social networks, stigmatizing attitudes toward mental illness and the mentally ill, discouragement about the use of psychiatric medication, and perceptions that symptoms were the result of personal or spiritual weakness had all interfered with the participants' treatment seeking efforts and contributed to a common experience of severe social isolation. None of the focus-group members had developed fully effective therapeutic relationships with either medical or mental health providers. They described an unmet need for more interactive and culturally authentic relationships with treatment providers. Although the focus-group sessions were not intended to be therapeutic, the women reported that participation in the meetings had been an emotionally powerful and beneficial experience. They expressed a strong preference for the utilization of female-only, panic disorder peer-support groups as an initial step in the treatment/recovery process. Peer-support groups for low-income African American women with panic disorder could address many of the identified access and treatment barriers.

Family processes as pathways from income to young children's development.

PubMed

Linver, Miriam R; Brooks-Gunn, Jeanne; Kohen, Dafna E

2002-09-01

A variety of family processes have been hypothesized to mediate associations between income and young children's development. Maternal emotional distress, parental authoritative and authoritarian behavior (videotaped mother-child interactions), and provision of cognitively stimulating activities (Home Observation for Measurement of the Environment [HOME] scales) were examined as possible mediators in a sample of 493 White and African American low-birth-weight premature infants who were followed from birth through age 5. Cognitive ability was assessed by standardized test, and child behavior problems by maternal report, when the children were 3 and 5 years of age. As expected, family income was associated with child outcomes. The provision of stimulating experiences in the home mediated the relation between family income and both children's outcomes; maternal emotional distress and parenting practices mediated the relation between income and children's behavior problems.

Federal Income Tax Cuts and Low-Income Families.

ERIC Educational Resources Information Center

Sammartino, Frank J.

This report identifies overall tax burdens faced by low income families, explaining how those burdens would change if certain types of federal income tax cuts were enacted. Using detailed household-level data on incomes and taxes, the report shows how federal income and payroll taxes differ for low income families and how these families benefit…

Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey.

PubMed

Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

2012-01-01

To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.

Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey

PubMed Central

Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

2012-01-01

Objectives To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. Methods We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. Results In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Conclusion Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population. PMID:22952617

Influencing Self-Reported Health among Rural Low-Income Women through Health Care and Social Service Utilization: A Structural Equation Model

ERIC Educational Resources Information Center

Bice-Wigington, Tiffany; Huddleston-Casas, Catherine

2012-01-01

Using structural equation modeling, this study examined the mesosystemic processes among rural low-income women, and how these processes subsequently influenced self-reported health. Acknowledging the behavioral processes inherent in utilization of health care and formal social support services, this study moved beyond a behavioral focus by…

Intimate Partner Violence and Breastfeeding Outcomes in a Sample of Low-Income Women.

PubMed

Miller-Graff, Laura E; Ahmed, Azza H; Paulson, Julia L

2018-06-01

Intimate partner violence has been related to breastfeeding difficulties. Few studies, however, have also accounted for other biopsychosocial risk factors associated with women's breastfeeding. Research aim: This study aimed to examine how prenatal intimate partner violence affects women's breastfeeding initiation, early cessation, and exclusivity at 6 weeks postpartum, controlling for perinatal health problems, prenatal depression, childhood adverse experiences, and prenatal breastfeeding education. A longitudinal, prospective one-group study was conducted. Data were collected via interview and survey from a sample of low-income pregnant women ( N = 101) during pregnancy and at 6 weeks postpartum. The Pregnancy Risk Assessment Monitoring System was used to assess breastfeeding behaviors, prenatal breastfeeding education, and perinatal health problems. Intimate partner violence was assessed using the Conflict Tactics Scales-Revised; adverse childhood experiences and depression were assessed using the Adverse Childhood Experiences and Center for Epidemiologic Studies Depression Scale, respectively. Women's breastfeeding initiation was predicted by prenatal breastfeeding education (adjusted odds ratio [ OR] = 3.21, p < .05). Early breastfeeding cessation was predicted by prenatal exposure to intimate partner violence (adjusted OR = 0.22, p < .05), preterm labor (adjusted OR = 0.33, p < .05), and prenatal breastfeeding education (adjusted OR = 1.80, p < .05). These findings highlight the importance of addressing biopsychosocial risk factors, particularly adversity and perinatal health, in efforts to promote women's breastfeeding success. Future research should evaluate mechanisms that may explain the link between intimate partner violence and breastfeeding cessation.

Interrelationship between food security status, home availability of variety of fruits and vegetables and their dietary intake among low-income pregnant women.

PubMed

Nunnery, Danielle L; Labban, Jeffrey D; Dharod, Jigna M

2018-03-01

To (i) determine differences in the availability of variety of fruits and vegetables (F&V) at home by food security status; and (ii) examine the inter-associations between food security status, availability of variety of F&V at home and frequency of F&V intake, among low-income pregnant women. Design/Setting Participants were interviewed to collect food security status, home availability of variety of F&V and frequency of F&V intake. Bivariate analyses, multivariate regression and exploratory mediation analyses were conducted using IBM SPSS Statistics version 23.0 and the PROCESS macro. Low-income pregnant women (n 198) were interviewed if they were ≥18 years of age, in the second trimester of pregnancy, and spoke English or Spanish. Low/very low food security was found among 43 % of participants. Compared with fully food-secure participants, very low food-secure participants reported a lower variety of fruits (P=0·028) and vegetables (P=0·058) available at home. Mediation analyses indicated that through home availability of variety of fresh F&V, food security status was associated with the daily intake of F&V (indirect effect (95 % CI): fresh fruits, -0·039 (-0·074, -0·013); fresh vegetables, -0·048 (-0·083, -0·023)). As food security worsened, the available variety of fresh F&V decreased, which was associated with lower intake. The study highlights the interlink between food security, home food environment and diet quality, and the importance of nutrition education intervention to promote a healthy home food environment and improved pregnancy outcomes among low-income women.

Perpetuating the cycle of violence in South African low-income communities: attraction to violence in young men exposed to continuous threat

PubMed Central

Hinsberger, Martina; Sommer, Jessica; Kaminer, Debra; Holtzhausen, Leon; Weierstall, Roland; Seedat, Soraya; Madikane, Solomon; Elbert, Thomas

2016-01-01

Background Life in the low-income urban communities of South Africa is imprinted by a cycle of violence in which young males predominantly are in the roles of both victim and perpetrator. There is some evidence that adolescents who show an attraction to cruelty can display high levels of psychosocial functioning despite the presence of posttraumatic stress symptoms. However, the role of appetitive aggression in the context of ongoing threats and daily hassles is not yet fully understood. Objective In this study, we examine the role of attraction to violence in areas of continuous traumatic stress exposure and its effect on posttraumatic stress disorder (PTSD) severity and violence perpetration. Method A sample of 290 young males from two low-income Cape Town communities was surveyed. We assessed appetitive aggression with the Appetitive Aggression Scale (AAS), PTSD symptoms with the PTSD Symptom Scale-Interview, the number of witnessed and self-experienced traumatic event types with an adaptation of the Child Exposure to Community Violence questionnaire, and the number of perpetrated violence event types with an adapted offence checklist from the AAS. Results Appetitive aggression scores were predicted by witnessed as well as self-experienced traumatic events. Higher appetitive aggression scores resulted in higher levels of PTSD severity and perpetrated violence. Conclusions Young males living in the low-income areas of South Africa may develop an attraction to cruelty in response to exposure to violence. Their willingness to fight in turn can increase the likelihood of continued violent behaviour. In contrast to previous research from postconflict areas, appetitive aggression and engagement in violence do not prevent the development of PTSD, but are instead associated with higher levels of posttraumatic stress. PTSD symptoms such as avoidance and hyperarousal, as well as an attraction to cruelty and thus the willingness to fight, might support survival in areas of

Perpetuating the cycle of violence in South African low-income communities: attraction to violence in young men exposed to continuous threat.

PubMed

Hinsberger, Martina; Sommer, Jessica; Kaminer, Debra; Holtzhausen, Leon; Weierstall, Roland; Seedat, Soraya; Madikane, Solomon; Elbert, Thomas

2016-01-01

Life in the low-income urban communities of South Africa is imprinted by a cycle of violence in which young males predominantly are in the roles of both victim and perpetrator. There is some evidence that adolescents who show an attraction to cruelty can display high levels of psychosocial functioning despite the presence of posttraumatic stress symptoms. However, the role of appetitive aggression in the context of ongoing threats and daily hassles is not yet fully understood. In this study, we examine the role of attraction to violence in areas of continuous traumatic stress exposure and its effect on posttraumatic stress disorder (PTSD) severity and violence perpetration. A sample of 290 young males from two low-income Cape Town communities was surveyed. We assessed appetitive aggression with the Appetitive Aggression Scale (AAS), PTSD symptoms with the PTSD Symptom Scale-Interview, the number of witnessed and self-experienced traumatic event types with an adaptation of the Child Exposure to Community Violence questionnaire, and the number of perpetrated violence event types with an adapted offence checklist from the AAS. Appetitive aggression scores were predicted by witnessed as well as self-experienced traumatic events. Higher appetitive aggression scores resulted in higher levels of PTSD severity and perpetrated violence. Young males living in the low-income areas of South Africa may develop an attraction to cruelty in response to exposure to violence. Their willingness to fight in turn can increase the likelihood of continued violent behaviour. In contrast to previous research from postconflict areas, appetitive aggression and engagement in violence do not prevent the development of PTSD, but are instead associated with higher levels of posttraumatic stress. PTSD symptoms such as avoidance and hyperarousal, as well as an attraction to cruelty and thus the willingness to fight, might support survival in areas of ongoing conflict, but at the same time they

Daily calcium intake and physical activity status in urban women living on low incomes in Davao, Philippines: a primary study for osteoporosis prevention.

PubMed

Miura, Shoko; Nakamori, Masayo; Yagi, Masumi; Saavedra, Ophelia L; Ikemoto, Shinji; Yamamoto, Shigeru

2009-08-01

Low calcium intake and physical inactivity are modifiable risk factors of osteoporosis; however, little information is available about the prevalence of these risk factors among urban Filipino women living on low-incomes. The present study, therefore, investigated daily calcium intake, main calcium sources, and physical activity status in this population. The study group comprised healthy women aged in their 30 s who had participated in our previous survey using heel speed of sound (SOS) measurement in Davao, Philippines. The women were stratified into three groups based on SOS score and 20 were randomly selected from each, giving 60 in total. Calcium intake was measured by direct analysis of the food samples collected from 3-days 24 hour-food duplicate method. Physical activity was estimated based on pedometer determined walking steps over 5 days. The median [25%, 75%] calcium intake per day was 289 [225, 434] mg. Traditional foods derived from local small fish and plants were the main calcium sources. The median walking steps per day was 8750 [6920, 10836]. Although three groups did not show significantly different calcium intakes and walking steps, consumption of low-cost small fish and plant foods could be encouraged along with walking in urban Filipino women living on low-incomes.

Overweight and obesity among low-income Muslim Uyghur women in far western China: correlations of body mass index with blood lipids and implications in preventive public health.

PubMed

Cong, Li; Zhan, Jin Qiong; Yang, Lan; Zhang, Wei; Li, Shu Gang; Chen, Cheng; Zhang, Hong Yan; Ma, Zhi Ping; Hao, Xiao Ling; Simayi, Dilixia; Tao, Lin; Zhao, Jin; Amanguli, A; Mohemaiti, Meiliguli; Jing, Ming Xia; Wang, Wei; Saimaiti, Abudukeyoumu; Zou, Xiao Guang; Gu, Yan; Li, Li; Wang, Ying Hong; Li, Feng; Zhang, Wen Jie

2014-01-01

The pandemic of obesity is a global public health concern. Most studies on obesity are skewed toward high-income and urban settings and few covers low-income populations. This study focused on the prevalence of overweight and obesity and their correlations with blood lipids/metabolites/enzymes (bio-indicators) in a rural community typical of low-income in remote western China. This study was performed in a Muslim ethnic Uyghur rural community in Kashi Prefecture of Xinjiang, about 4,407 km (2,739 miles) away from Beijing. Body mass index (BMI) and major blood bio-indicators (25 total items) were measured and demographic information was collected from 1,733 eligible healthy women aged 21 to 71 yrs, of whom 1,452 had complete data for analysis. More than 92% of the women lived on US$1.00/day or less. According to the Chinese criteria, overweight and obesity were defined as BMI at 24 to <28 kg/m(2) and at ≥ 28 kg/m(2), respectively. The average BMI among these low-income women was 24.0 ± 4.0 (95% CI, 17.5-33.7) kg/m(2). The prevalence of obesity and overweight was high at 15.1% and 28.9%, respectively. Among 25 bio-indicators, BMI correlated positively with the levels of 11 bio-indicators including triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TCHOL), glucose (GLU), and uric acid (UA); but negatively with the levels of 5 bio-indicators including high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A/B (APO A/B). This is the first investigation reporting overweight and obesity being common in low-income Muslim Uyghur women, whose BMI correlates with several important blood bio-indicators which are risk factors for diabetes and cardiovascular diseases. These findings may help make preventive public health policies in Uyghur communities. To prevent diabetes and cardiovascular diseases in low-income settings, we therefore propose a cost-effective, two-step strategy first to screen for obesity and then to screen persons

Characteristics of women obtaining induced abortions in selected low- and middle-income countries

PubMed Central

Desai, Sheila; Crowell, Marjorie; Sedgh, Gilda; Singh, Susheela

2017-01-01

Background In 2010–2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions. Objectives To examine the characteristics of women obtaining induced abortions in LMICs. Methods We use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC). Results Women across all sociodemographic subgroups obtain abortions. In most countries, women aged 20–29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions. Conclusions These findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this

Consumption of Carbonated Soft Drinks Among Young Adolescents Aged 12 to 15 Years in 53 Low- and Middle-Income Countries.

PubMed

Yang, Lili; Bovet, Pascal; Liu, Yunxia; Zhao, Min; Ma, Chuanwei; Liang, Yajun; Xi, Bo

2017-07-01

To compare consumption of carbonated soft drinks among young adolescents in 53 low- and middle-income countries (LMICs). We used 2009 to 2013 Global School-based Student Health Survey data to assess 137 449 young adolescents aged 12 to 15 years with available data (via a standardized questionnaire) on frequency of carbonated soft drink consumption. Overall, young adolescents reported having consumed carbonated soft drinks 1.39 times per day (95% confidence interval [CI] = 1.26, 1.51), and 54.3% of adolescents reported consuming a carbonated soft drink at least once per day. Frequency (times per day) varied greatly across countries, ranging from 0.52 (95% CI = 0.43, 0.60) in Kiribati to 2.39 (95% CI = 2.25, 2.53) in Suriname. Our data confirm that consumption of carbonated soft drinks is frequent among young adolescents in LMICs. Our findings highlight the need for interventions in these countries to reduce adolescents' carbonated soft drink consumption.

Factors associated with women's and children's body mass indices by income status.

PubMed

Lin, B H; Huang, C L; French, S A

2004-04-01

To describe associations between eating behaviors, dietary intake, physical activity, attitudes toward diet and health, sociodemographic variables and body mass index (BMI) among women and children, and differences by household income. Data from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) and the Diet and Health Knowledge Survey (DHKS) were examined using multivariate regression to estimate the associations between BMI and behavioral and environmental variables among women and children. CSFII 1994-1996 is representative of the US population. DHKS surveyed CSFII respondents 20 y of age and over. Our samples consisted of 2419 adult women and 1651 school-age children. CSFII respondents reported 24 h recalls of all food intakes on 2 nonconsecutive days and their personal and household characteristics, including self-reported height and weight. DHKS collected data on knowledge and attitudes toward dietary guidance and health from CSFII adult respondents. Significant correlations between women's BMI and age, race, dietary patterns, TV watching, and smoking was observed among women from both low- and high-income households. Beverage consumption, eating out, the importance of maintaining healthy weight, and exercise were correlated with BMI only among women from high-income households. Among children, age, race, income, and mother's BMI were significantly correlated with child BMI. Among women, the associations between some behavioral and environmental factors and BMI differ by household income. Intervention programs need to target specific eating and physical activity behaviors to promote a healthy body weight.

Human papillomavirus vaccine use among adolescent girls and young adult women: an analysis of the 2007 California Health Interview Survey.

PubMed

Tiro, Jasmin A; Tsui, Jennifer; Bauer, Heidi M; Yamada, Eileen; Kobrin, Sarah; Breen, Nancy

2012-06-01

Administration of the human papillomavirus (HPV) vaccine is recommended for adolescent girls and young adult women. Little is known about the factors associated with vaccination. This study examined prevalence and correlates of HPV vaccine initiation (≥1 dose) among a statewide representative sample of adolescent and young adult females living in California. HPV vaccination data on 3615 parents of adolescent girls aged 12-17 and 2068 young adult women aged 18-27 from the 2007 California Health Interview Survey (CHIS) were examined by sociodemographic, healthcare access, and health behavior factors using chi-square and multivariable logistic regression models. Nineteen percent of adolescent girls and 11% of young adult women had initiated the HPV vaccine series. In both groups, lower educational attainment (parental/own) was associated with lack of vaccine initiation. For adolescents, vaccine initiation was also significantly lower among those whose parents had low incomes or no usual source of care. For young adults, initiation was lower among the older group and those who spent less time in the United States, had public insurance, had no recent provider visit, or had fewer sexual partners. In a statewide representative sample, different correlates of early initiation of HPV vaccination emerged for Californian adolescent girls and young adult women. These different patterns may be due to differential access to programs that provide free or low-cost HPV vaccines. Because several of these factors are associated with disparities in use of Pap tests, disparities will persist or even worsen unless greater effort is placed on vaccinating populations at highest risk for cervical cancer.

Impact of the National Breast and Cervical Cancer Early Detection Program on cervical cancer mortality among uninsured low-income women in the U.S., 1991-2007.

PubMed

Ekwueme, Donatus U; Uzunangelov, Vladislav J; Hoerger, Thomas J; Miller, Jacqueline W; Saraiya, Mona; Benard, Vicki B; Hall, Ingrid J; Royalty, Janet; Li, Chunyu; Myers, Evan R

2014-09-01

The benefits of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) on cervical cancer screening for participating uninsured low-income women have never been measured. To estimate the benefits in life-years (LYs) gained; quality-adjusted life-years (QALYs) gained; and deaths averted. A cervical cancer simulation model was constructed based on an existing cohort model. The model was applied to NBCCEDP participants aged 18-64 years. Screening habits for uninsured low-income women were estimated using National Health Interview Survey data from 1990 to 2005 and NBCCEDP data from 1991 to 2007. The study was conducted during 2011-2012 and covered all 68 NBCCEDP grantees in 50 states, the District of Columbia, five U.S. territories, and 12 tribal organizations. Separate simulations were performed for the following three scenarios: (1) women who received NBCCEDP (Program) screening; (2) women who received screening without the program (No Program); and (3) women who received no screening (No Screening). Among 1.8 million women screened in 1991-2007, the Program added 10,369 LYs gained compared to No Program, and 101,509 LYs gained compared to No Screening. The Program prevented 325 women from dying of cervical cancer relative to No Program, and 3,829 relative to No Screening. During this time period, the Program accounted for 15,589 QALYs gained when compared with No Program, and 121,529 QALYs gained when compared with No Screening. These estimates suggest that NBCCEDP cervical cancer screening has reduced mortality among medically underserved low-income women who participated in the program. Published by Elsevier Inc.

The associations between interpersonal violence and psychological distress among rural and urban young women in South Africa.

PubMed

Manyema, M; Norris, S A; Said-Mohamed, R; Tollman, S T; Twine, R; Kahn, K; Richter, L M

2018-05-01

Approximately 25% of the world's population consists of young people. The experience of violence peaks during adolescence and the early adult years. A link between personal experience of violence and mental health among young people has been demonstrated but rural-urban differences in these associations are less well known in low to middle income countries. The aim of this study was to investigate the associations between interpersonal violence and psychological distress among rural and urban young women. Data on experiences of violence and psychological distress were collected from a total of 926 non-pregnant young women aged between 18 and 22 years of age in rural and urban sites in South Africa. The General Health Questionnaire-28 was used to assess psychological distress as an indicator of mental health. Generalised structural equation models were employed to assess potential pathways of association between interpersonal violence and psychological distress. Thirty-four percent of the urban young women (n = 161) reported psychological distress compared to 18% of rural young women (n = 81). In unadjusted analysis, exposure to interpersonal violence doubled the odds of psychological distress in the urban adolescents and increased the odds 1.6 times in the rural adolescents. In adjusted models, the relationship remained significant in the urban area only (OR 1.84, 95% CI 1.13-3.00). Rural residence seemed protective against psychological distress (OR 0.41, 95% CI 0.24-0.69). Structural equation modelling did not reveal any direct association between exposure to interpersonal violence and psychological distress among rural young women. Stressful household events were indirectly associated with psychological distress, mediated by violence among young women in the urban area. The relationship between violence and psychological distress differs between urban and rural-residing young women in South Africa, and is influenced by individual, household and community

Income generation for women with renewable energy technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stone, L.

1996-10-01

70% of the world`s poor are women. The poverty that is especially hard hitting for rural women throughout the world has many causes. The lack of access to education, credit and new technologies make it almost impossible for women to earn an income. Yet, when women earn an income, it not only improves their lives, but also improves the lives of their children and their communities. Solar energy technologies, along with access to credit, can help rural women improve the quality of their lives through income generating enterprises. The technologies discussed are solar cooking, solar food drying, solar blenders, andmore » photovoltaics.« less

Recycling attitudes and behavior among a clinic-based sample of low-income Hispanic women in southeast Texas.

PubMed

Pearson, Heidi C; Dawson, Lauren N; Radecki Breitkopf, Carmen

2012-01-01

We examined attitudes and behavior surrounding voluntary recycling in a population of low-income Hispanic women. Participants (N = 1,512) 18-55 years of age completed a self-report survey and responded to questions regarding household recycling behavior, recycling knowledge, recycling beliefs, potential barriers to recycling (transportation mode, time), acculturation, demographic characteristics (age, income, employment, marital status, education, number of children, birth country), and social desirability. Forty-six percent of participants (n = 810) indicated that they or someone else in their household recycled. In a logistic regression model controlling for social desirability, recycling behavior was related to increased age (P<0.05), lower acculturation (P<0.01), knowing what to recycle (P<0.01), knowing that recycling saves landfill space (P<0.05), and disagreeing that recycling takes too much time (P<0.001). A Sobel test revealed that acculturation mediated the relationship between recycling knowledge and recycling behavior (P<0.05). We offer new information on recycling behavior among Hispanic women and highlight the need for educational outreach and intervention strategies to increase recycling behavior within this understudied population.

The impact of intimate partner violence on low-income women's economic well-being: the mediating role of job stability.

PubMed

Adams, Adrienne E; Tolman, Richard M; Bybee, Deborah; Sullivan, Cris M; Kennedy, Angie C

2012-12-01

This study sought to extend our understanding of the mechanisms by which intimate partner violence (IPV) harms women economically. We examined the mediating role of job instability on the IPV-economic well-being relationship among 503 welfare recipients. IPV had significant negative effects on women's job stability and economic well-being. Job stability was at least partly responsible for the deleterious economic consequences of IPV, and the effects lasted up to three years after the IPV ended. This study demonstrates the need for services and policies that address barriers to employment as a means of improving the economic well-being of low-income women with abusive partners.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

PubMed Central

Gelaye, Bizu; Rondon, Marta; Araya, Ricardo; Williams, Michelle A.

2016-01-01

Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise fi ndings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries. PMID:27650773

The Effect of Lactation Educators Implementing a Telephone-Based Intervention among Low-Income Hispanics: A Randomised Trial

ERIC Educational Resources Information Center

Efrat, Merav W.; Esparza, Salvador; Mendelson, Sherri G.; Lane, Christianne J.

2015-01-01

Objectives: To assess whether a telephone-based breastfeeding intervention delivered by lactation educators influenced exclusive breastfeeding rates among low-income Hispanic women in the USA. Design: Randomised two-group design. Setting: Pregnant low-income Hispanic women (298) were recruited from community health clinics in Los Angeles County…

Intimate partner violence against low-income women in Mexico City and associations with work-related disruptions: a latent class analysis using cross-sectional data.

PubMed

Gupta, Jhumka; Willie, Tiara C; Harris, Courtney; Campos, Paola Abril; Falb, Kathryn L; Garcia Moreno, Claudia; Diaz Olavarrieta, Claudia; Okechukwu, Cassandra A

2018-03-07

Disrupting women's employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions. Using baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions. Overall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged. IPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes. NCT01661504. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Family Structure and Income during the Stages of Childhood and Subsequent Prosocial Behavior in Young Adulthood

ERIC Educational Resources Information Center

Bandy, Robert; Ottoni-Wilhelm, Mark

2012-01-01

This study investigated whether family structure transition and low income are risk factors in the development of prosocial behavior. Models of young adults' prosocial behavior--charitable giving and volunteering--were estimated as functions of their family structure and income during the stages of childhood. Participants were a representative…

Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S

PubMed Central

Golin, Carol E.; Haley, Danielle F.; Wang, Jing; Hughes, James P.; Kuo, Irene; Justman, Jessica; Adimora, Adaora A.; Soto-Torres, Lydia; O’Leary, Ann; Hodder, Sally

2016-01-01

Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods. PMID:27180715

Recruiting and retaining low-income, multi-ethnic women into randomized controlled trials: Successful strategies and staffing

PubMed Central

Barnett, Josephine; Aguilar, Stephanie; Brittner, Mindy; Bonuck, Karen

2012-01-01

Developing effective recruitment and retention strategies in populations with traditionally high attrition rates is critical to the success of Randomized Controlled Trials (RCTs). Data on successful participation of women from low-income, minority populations in RCTs of behavioral interventions are limited. This is problematic given the multiplicity of Healthy People 2020 goals that target health disparities in these populations. This paper reports successful recruitment and retention methods from two separately funded NIH clinical trials of primary care-based prenatal interventions to increase breastfeeding among ethnically diverse, low-income women in urban medical centers in the Bronx, NY. It also presents the required staff effort necessary to conduct such a successful RCT, in terms of full-time equivalents (FTEs). Results include timely recruitment of 941 participants over 29 months, with 98.1% completing 1̄ follow-up interview. A recruitment and retention plan that maximized study staff access and availability to the participant, as well as strong study staff rapport with participants, addressed previously reported barriers in this population, optimizing follow-up rates. A qualitative assessment of the participants' study experience suggesting that high retention was due to strong rapport with participants, short interviews requiring little time commitment, and participants' perception of the study as informative, provides further evidence of our approach's effectiveness. Logistical protocol procedures and staff management strategies relating to successful recruitment/retention are provided to propose a practical, cost-effective and translational recruitment–retention plan for other researchers to adopt. PMID:22732312

Rejection Sensitivity, Perceived Power, and HIV Risk in the Relationships of Low-Income Urban Women.

PubMed

Berenson, Kathy R; Paprocki, Christine; Thomas Fishman, Marget; Bhushan, Devika; El-Bassel, Nabila; Downey, Geraldine

2015-01-01

The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and, therefore, may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women's sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001-2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and, in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention.

Perceived susceptibility to pregnancy and its association with safer sex, contraceptive adherence and subsequent pregnancy among adolescent and young adult women.

PubMed

Rahman, Mahbubur; Berenson, Abbey B; Herrera, Sandra R

2013-04-01

The study was conducted to examine the hypotheses that adolescent and young adult women who perceived they are susceptible to pregnancy when birth control is not used are less likely to practice unsafe sex, discontinue oral contraception (OC) and become pregnant during a 12-month follow-up period. We conducted secondary analyses using data collected for a randomized controlled trial on OC adherence among 1155 low-income women 16-24 years of age. Demographics, lifestyle variables, perceived susceptibility to pregnancy assessed at baseline, and data on OC and condom use and pregnancy status collected during 12 months of follow-up were used for the analyses. Overall, 62.3% of women accurately understood the risks of pregnancy without using any birth control method. However, perceived susceptibility was not associated with OC continuation [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.79-1.11], condom use at last sexual intercourse (OR 1.02, 95% CI 0.84-1.24), dual method use (OR 1.17, 95% CI 0.92-1.48) and subsequent pregnancy (hazards ratio 1.08, 95% CI 0.77-1.49) during the 12-month follow-up period. Perceived susceptibility to pregnancy, an important component of the health belief model, does not seem to have any impact on use of birth control methods, safer sex or rate of subsequent pregnancy among low-income adolescent and young adult women. Copyright © 2013 Elsevier Inc. All rights reserved.

Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

PubMed Central

Islam, Rakibul M; Billah, Baki; Hossain, Md Nassif; Oldroyd, John

2017-01-01

Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs. PMID:28749101

Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

PubMed

Islam, Rakibul M; Billah, Baki; Hossain, Md Nassif; Oldroyd, John

2017-07-27

Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs. Creative Commons Attribution License

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries.

PubMed

Engle, Patrice L; Fernald, Lia C H; Alderman, Harold; Behrman, Jere; O'Gara, Chloe; Yousafzai, Aisha; de Mello, Meena Cabral; Hidrobo, Melissa; Ulkuer, Nurper; Ertem, Ilgi; Iltus, Selim

2011-10-08

This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children's educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

PubMed

Fisher, Jane; Cabral de Mello, Meena; Patel, Vikram; Rahman, Atif; Tran, Thach; Holton, Sara; Holmes, Wendy

2012-02-01

To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

Mindfulness-Based Stress Reduction for Low-Income, Predominantly African American Women with PTSD and a History of Intimate Partner Violence

ERIC Educational Resources Information Center

Dutton, Mary Ann; Bermudez, Diana; Matas, Armely; Majid, Haseeb; Myers, Neely L.

2013-01-01

In this article, we consider the use of Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1991) as a community-based intervention for posttraumatic stress disorder (PTSD) among low-income, predominantly African American women with a history of intimate partner violence (IPV). The results of a pilot randomized clinical trial (RCT) of MBSR as an…

The Effects of Husband's Alcohol Consumption on Married Women in Three Low-Income Areas of Greater Mumbai

PubMed Central

Kremelberg, David; Dwivedi, Purva; Verma, Supriya; Schensul, Jean J.; Gupta, Kamla; Chandran, Devyani; Singh, S. K.

2010-01-01

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women's lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored. PMID:20544380

The effects of husband's alcohol consumption on married women in three low-income areas of Greater Mumbai.

PubMed

Berg, Marlene J; Kremelberg, David; Dwivedi, Purva; Verma, Supriya; Schensul, Jean J; Gupta, Kamla; Chandran, Devyani; Singh, S K

2010-08-01

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women's lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored.

Predictors of weight loss in low-income mothers of young children.

PubMed

Clarke, Kristine K; Freeland-Graves, Jeanne; Klohe-Lehman, Deborah M; Bohman, Thomas M

2007-07-01

To identify predictors of weight loss in a tri-ethnic population of low-income mothers. An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8. A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index > or = 25 (calculated as kg/m2) participated in the intervention. Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks. Anthropometry (body weight, weight loss). Analysis of variance, chi2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences. Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=-0.22), enhanced nutrition knowledge (r=-0.23), and higher scores for benefits of weight loss (r =-0.20) at baseline; and the change in healthful eating attitudes (r=-0.28) and social support (r=-0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively. Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge.

Expanding wallets and waistlines: the impact of family income on the BMI of women and men eligible for the Earned Income Tax Credit.

PubMed

Schmeiser, Maximilian D

2009-11-01

The rising rate of obesity has reached epidemic proportions and is now one of the most serious public health challenges facing the US. However, the underlying causes for this increase are unclear. This paper examines the effect of family income changes on body mass index (BMI) and obesity using data from the National Longitudinal Survey of Youth 1979 cohort. It does so by using exogenous variation in family income in a sample of low-income women and men. This exogenous variation is obtained from the correlation of their family income with the generosity of state and federal Earned Income Tax Credit (EITC) program benefits. Income is found to significantly raise the BMI and probability of being obese for women with EITC-eligible earnings, and have no appreciable effect for men with EITC-eligible earnings. The results imply that the increase in real family income from 1990 to 2002 explains between 10 and 21% of the increase in sample women's BMI and between 23 and 29% of their increased obesity prevalence. (c) 2009 John Wiley & Sons, Ltd.

Executive function associated with sexual risk in young South African women: Findings from the HPTN 068 cohort

PubMed Central

Pettifor, Audrey; Duta, Mihaela; Demeyere, Nele; Wagner, Ryan G.; Selin, Amanda; MacPhail, Catherine; Laeyendecker, Oliver; Hughes, James P.; Stein, Alan; Tollman, Stephen; Kahn, Kathleen

2018-01-01

Purpose Heightened sexual risk in adolescence and young adulthood may be partially explained by deficits in executive functioning, the set of cognitive processes used to make reasoned decisions. However, the association between executive function and sexual risk is understudied among adolescent girls and young women, particularly in low- and middle-income countries. Methods In a cohort of 853 young women age 18–25 in rural Mpumalanga province, South Africa, we evaluated executive function with three non-verbal cognitive tests: I. a rule-finding test, II. a trail-making test, and III. a figure drawing test. Using log-binomial regression models, we estimated the association between lower executive function test scores and indicators of sexual risk (unprotected sex acts, concurrent partnerships, transactional sex, and recent HSV-2 infection). Results In general, young women with lower executive function scores reported higher frequencies of sexual risk outcomes, though associations tended to be small with wide confidence intervals. Testing in the lowest quintile of Test I was associated with more unprotected sex [aPR (95% CI): 1.4 (1.0, 1.8)]. Testing in the lowest quintile of Test II was associated with more concurrent relationships and transactional sex [aPR (95% CI): 1.6 (1.1, 2.5) and 1.7 (1.3, 2.4), respectively], and testing in the lowest four quintiles of Test III was associated with more concurrent relationships [aPR (95% CI): 1.7 (1.0, 2.7)]. Conclusions These results demonstrate an association between low executive function and sexual risk in South African young women. Future work should seek to understand the nature of this association and whether there is promise in developing interventions to enhance executive function to reduce sexual risk. PMID:29608615

A descriptive study of the prevalence of psychological distress and mental disorders in the Canadian population: comparison between low-income and non-low-income populations.

PubMed

Caron, J; Liu, A

2010-06-01

This descriptive study compares rates of high psychological distress and mental disorders between low-income and non-low-income populations in Canada. Data were collected through the Canadian Community Health Survey - Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the low-income population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in low-income populations, and these differences were statistically consistent in most of the sociodemographic strata. This study helps determine the vulnerable groups in mental health for which prevention and promotion programs could be designed.

Composite measures of women's empowerment and their association with maternal mortality in low-income countries.

PubMed

Lan, Chiao-Wen; Tavrow, Paula

2017-11-08

Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women's empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women's advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants. Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures - the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) - with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive. Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = -0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = -0.04, P = 0.04). No gender measure was significant. In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women's motivation to deliver in a hospital setting. Improving gender equality and

Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries.

PubMed

Ibitoye, Mobolaji; Choi, Cecilia; Tai, Hina; Lee, Grace; Sommer, Marni

2017-01-01

Adolescent girls aged 15-19 bear a disproportionate burden of negative sexual and reproductive health outcomes in low- and middle-income countries. Research from several high-income countries suggests that early age at menarche is an important determinant of sexual and reproductive health. We conducted this systematic review to better understand whether and how early menarche is associated with various negative sexual and reproductive health outcomes in low- and middle-income countries and the implications of such associations. We systematically searched eight health and social sciences databases for peer-reviewed literature on menarche and sexual and reproductive health in low- and middle-income countries. Two reviewers independently assessed all studies for inclusion, overall quality and risk of bias, and performed data extraction on all included studies. Twenty-four articles met all inclusion criteria-nine of moderate quality and fifteen with several methodological weaknesses. Our review of the minimal existing literature showed that early menarche is associated with early sexual initiation, early pregnancy and some sexually transmitted infections in low- and middle-income countries, similar to what has been observed in high-income countries. Early menarche is also associated with early marriage-an association that may have particularly important implications for countries with high child marriage rates. Early age at menarche may be an important factor affecting the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. More research is needed to confirm the existence of the identified associations across different settings and to better understand the process through which early menarche and other markers of early pubertal development may contribute to the increased vulnerability of girls to negative sexual and reproductive health outcomes in low- and middle-income countries. Given the association of early

Multiple domains of stress predict postpartum depressive symptoms in low-income Mexican American women: The moderating effect of social support

PubMed Central

Coburn, S.C.; Gonzales, N.A.; Luecken, L.J.; Crnic, K.A.

2016-01-01

Purpose Prenatal stress can have a lasting effect on women’s mental health after childbirth. The negative effects may be particularly salient in women from low income and ethnic minority backgrounds, who are at increased risk for postpartum depression. However, social support may have the potential to attenuate the negative impact of stress. Methods The present study evaluated 269 Mexican American women (ages 18–42; 83% Spanish-speaking; median income $10,000–$15,000) for prenatal stress (daily hassles, family stress, partner stress, and culture-specific stress) in relation to depressive symptoms six weeks postpartum. Prenatal social support was examined as a buffer against the impact of prenatal stress. Results Partner stress, family stress, and daily hassles uniquely predicted depressive symptoms. Moderate and high levels of social support attenuated risk for depression due to family stressors. Conclusions Prenatal interpersonal and daily stressors negatively impact the mental health of women after birth, but social support can mitigate some of these effects. Among Mexican American pregnant women, effective interpersonal support and stress management may be associated with reduced risk for postpartum depression. PMID:27329119

Multilevel Perspectives on Female Sterilization in Low-Income Communities in Mumbai, India.

PubMed

Brault, Marie A; Schensul, Stephen L; Singh, Rajendra; Verma, Ravi K; Jadhav, Kalpita

2016-09-01

Surgical sterilization is the primary method of contraception among low-income women in India. This article, using qualitative analysis of key informant, in-depth interviews, and quantitative analyses, examines the antecedents, process, and outcomes of sterilization for women in a low-income area in Mumbai, India. Family planning policies, socioeconomic factors, and gender roles constrain women's reproductive choices. Procedures for sterilization rarely follow protocol, particularly during pre-procedure counseling and consent. Women who choose sterilization often marry early, begin conceiving soon after marriage, and reach or exceed ideal family size early due to problems in accessing reversible contraceptives. Despite these constraints, this study indicates that from the perspective of women, the decision to undergo sterilization is empowering, as they have fulfilled their reproductive duties and can effectively exercise control over their fertility and sexuality. This empowerment results in little post-sterilization regret, improved emotional health, and improved sexual relationships following sterilization. © The Author(s) 2015.

A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale.

PubMed

Chang, Mei-Wei; Nitzke, Susan; Brown, Roger; Resnicow, Ken

2014-03-25

Over 45% of American women 20-39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers 18-39 years old by promoting stress management, healthy eating, and physical activity. Peer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n=350) or comparison group (n=175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention. If MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs

The Short-Term Effects of Marital Disruption on the Labor Supply Behavior of Young Women.

ERIC Educational Resources Information Center

Moore, Sylvia F.

A research study was conducted to measure (1) the extent to which a young woman is financially disadvantaged by the loss of her husband's income, (2) the ways in which she seeks to alleviate this loss, and (3) how successful she is in doing so. Data were collected from 519 young women, both white and black, who experienced a first disruption of…

HIV Sexual Risk Behavior Among Low-Income Women Experiencing Intimate Partner Violence: The Role of Posttraumatic Stress Disorder

PubMed Central

Cavanaugh, Courtenay E.; Hansen, Nathan B.; Sullivan, Tami P.

2010-01-01

Posttraumatic stress disorder resulting from intimate partner violence (IPV-related PTSD), drug problems, and alcohol problems were tested as correlates of women’s sexual risk behavior. Participants were 136 low-income women experiencing physical violence by a male partner during the past 6 months. Sexual risk behavior was assessed by whether women had unprotected sex with a risky primary partner (i.e., HIV-positive, injection drug user, and/or nonmonogamous), unprotected sex with a risky nonprimary partner (i.e. HIV-positive or unknown status), or traded sex during the past 6 months. Nearly one in five women engaged in these recent sexual risk behaviors. Simultaneous logistic regression results revealed IPV-related PTSD, but not drug or alcohol problems, was significantly associated with sexual risk behavior while controlling for childhood abuse and demographic covariates. Women with IPV-related PTSD had four times greater odds of recent sexual risk behavior compared to women without IPV-related PTSD. Implications for HIV prevention interventions are discussed. PMID:19856093

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries.

PubMed

Gelaye, Bizu; Rondon, Marta B; Araya, Ricardo; Williams, Michelle A

2016-10-01

Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Depressed mood and self-esteem in young Asian, black, and white women in America.

PubMed

Woods, N F; Lentz, M; Mitchell, E; Oakley, L D

1994-01-01

During the last two decades, investigators have explored the relationship between women's life conditions and their mental health. Some have related women's socially disadvantaged status, or their socialization to a traditional feminine role, to depression and low self-esteem. Others have emphasized the consequences of women's roles, or the balance of social demands and resources, on their well-being. More recently, feminist scholars have proposed a developmental account of depression. We tested a model comparing the effects of personal resources, social demands and resources, socialization, and women's roles, on self-esteem and depressed mood in young adult Asian, Black, and White women in America. Women who resided in middle-income and racially mixed neighborhoods were interviewed in their homes. Personal resources were indicated by education and income and social resources by unconflicted network size as measured by Barrera's (1981) Arizona Social Support Interview Schedule. Social demands were assessed by conflicted network size as measured by the Barrera scale and by the Positive Life Events and Negative Life Events scales from Norbeck's (1984) revision of the Sarason Life Events Scale. Women's roles included employment, parenting, and partnership with an adult (e.g., marriage). Self-esteem was assessed with the Rosenberg Self Esteem Scale (Rosenberg, 1965) and depressed mood with the Center for Epidemiologic Studies Depression scale (Radloff, 1977). Although models for Asian, Black, and White women differed, social network and social demands as well as personal resources were common to each group as predictors of self-esteem and depression.

SIBSHIP SIZE AND YOUNG WOMEN'S TRANSITIONS TO ADULTHOOD IN INDIA.

PubMed

Santhya, K G; Zavier, A J Francis

2017-11-01

In India, a substantial proportion of young people are growing up in smaller families with fewer siblings than earlier generations of young people. Studies exploring the associations between declines in sibship size and young people's life experiences are limited. Drawing on data from a sub-nationally representative study conducted in 2006-08 of over 50,000 youths in India, this paper examines the associations between surviving sibship size and young women's (age 20-24) transitions to adulthood. Young women who reported no or a single surviving sibling were categorized as those with a small surviving sibship size, and those who reported two or more surviving siblings as those with a large surviving sibship size. Bivariate and multivariate regression analyses were conducted to ascertain the relationship between sibship size and outcome indicators. Analysis was also done separately for low- and high-fertility settings. Small sibship size tended to have a positive influence in many ways on young women's chances of making successful transitions to adulthood. Young women with fewer siblings were more likely than others to report secondary school completion, participation in vocational skills training programmes, experience of gender egalitarian socialization practices, adherence to gender egalitarian norms, exercise of pre-marital agency and small family size preferences. These associations were more apparent in low- than high-fertility settings.

Recycling Attitudes and Behavior among a Clinic-Based Sample of Low-Income Hispanic Women in Southeast Texas

PubMed Central

Pearson, Heidi C.; Dawson, Lauren N.; Radecki Breitkopf, Carmen

2012-01-01

We examined attitudes and behavior surrounding voluntary recycling in a population of low-income Hispanic women. Participants (N = 1,512) 18–55 years of age completed a self-report survey and responded to questions regarding household recycling behavior, recycling knowledge, recycling beliefs, potential barriers to recycling (transportation mode, time), acculturation, demographic characteristics (age, income, employment, marital status, education, number of children, birth country), and social desirability. Forty-six percent of participants (n = 810) indicated that they or someone else in their household recycled. In a logistic regression model controlling for social desirability, recycling behavior was related to increased age (P<0.05), lower acculturation (P<0.01), knowing what to recycle (P<0.01), knowing that recycling saves landfill space (P<0.05), and disagreeing that recycling takes too much time (P<0.001). A Sobel test revealed that acculturation mediated the relationship between recycling knowledge and recycling behavior (P<0.05). We offer new information on recycling behavior among Hispanic women and highlight the need for educational outreach and intervention strategies to increase recycling behavior within this understudied population. PMID:22493693

Launching Low-Income Entrepreneurs

ERIC Educational Resources Information Center

Laney, Kahliah

2013-01-01

With middle-income jobs in decline, entrepreneurship offers an increasingly promising pathway out of poverty; but few low-income New Yorkers are currently taking this route to economic self-sufficiency. This report provides the most comprehensive examination of low-income entrepreneurship in New York. The report documents current self-employment…

Social Support and Health-Related Quality of Life Among Low-Income Women: Findings from Community-Based Participatory Research.

PubMed

Salihu, Hamisu M; Adegoke, Korede; Turner, DeAnne; Al Agili, Dania; Berry, Estrellita Lo

2017-04-01

This study examined the association between social support and health-related quality of life (HRQoL) among low-income women in the southeastern region of the United States. Analysis was performed on data from a community needs assessment survey that was designed to explore social determinants of health and QoL indicators using a community-based participatory research approach. The study sample comprised 132 women aged 18 years old and older. Bivariate analysis and logistic regressions with bootstrapping were performed. Social support was predictive of physical and mental HRQoL in a contrasting fashion, suggesting a complex relation. Other social determinants of global HRQoL independent of social support status include marital and employment status, maternal age, and income. Our results also demonstrate complex interaction patterns across race, social support, and HRQoL. The linkage between social support and HRQoL may not be a simple relation, as previously assumed. Rather, it is characterized by multifaceted interactions through which social determinants of health modulate the impact of social support on HRQoL. These are new findings.

Rejection Sensitivity, Perceived Power and HIV Risk in the Relationships of Low-Income Urban Women

PubMed Central

Berenson, Kathy R.; Paprocki, Christine; Fishman, Marget Thomas; Bhushan, Devika; El-Bassel, Nabila; Downey, Geraldine

2016-01-01

The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and therefore may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women’s sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001–2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention. PMID:26086275

Parenting perceptions of low-income mothers.

PubMed

Webb, Jenny; Morris, Melanie Hall; Thomas, Sandra P; Combs-Orme, Terri

2015-01-01

The purpose of this descriptive qualitative study was to gain understanding of perceptions of low-income pregnant women and mothers about parenting. Participants were 65 low-income, primarily African American, women in their 20s and 30s who were recruited from a faith-based social service center in Memphis, Tennessee. Interviews were conducted by nursing, social work, and psychology students. The existential phenomenological method was used to analyze verbatim responses of participants to vignettes depicting parenting behaviors of hypothetical mothers. Five global themes were identified: (a) Focus on baby's development: "Because I'm the Mother, I'm the First Teacher"; (b) Focus on baby's safety/security: "The Baby Could Be Hurt"; (c) Focus on conveying love: "She Just Wants the Baby to Feel Her Love"; (d) Focus on learning the rules of good childcare: "It's Important to Know the Do's and Don'ts"; and (e) Focus on doing it differently (better) than parents did: "When You Know Better, You Do Better." Findings suggest that these mothers care deeply about providing a better life for their children than the life they have had. They desire to learn about being the best parents they can be. As nurses, we can help to provide educational opportunities for mothers through a variety of evidence-based interventions delivered across the childbearing years.

Marriage Promotion and Low-Income Communities: An Examination of Real Needs and Real Solutions. Briefing Paper.

ERIC Educational Resources Information Center

Jones-DeWeever, Avis

Much of the discussion surrounding marriage promotion policies have little basis in the reality of life in low-income communities. Research suggests that much of the income differential between low-income and middle class women is the result of differences in educational attainment, labor market experience, and access to labor supply rather than…

[Social and familial determinants of anxiety and depressive symptoms in middle to low income women].

PubMed

Illanes, Eduardo; Bustos, Luis; Vizcarra, María Beatriz; Muñoz, Sergio

2007-03-01

Among women, risk factors for mental disorders are violence, economical inequities and disadvantages and discrimination. To determine the prevalence of anxiety and depressive symptoms in women and to determine factors associated with them. A cross sectional study of a probabilistic sample of 422 women aged 34 years as a mean, living in a medium to low income neighborhood in Temuco, Chile. Mental health was assessed with the self reporting questionnaire (SRQ20), partner violence was evaluated using a 12 item scale and family conflict and violence was evaluated using the Conflicts Tactics scale. A logistic repression analysis was used to identify factors associated with mental health alterations. Forty one percent of women had anxiety or depressive symptoms. The main associated factors with these symptoms were severe physical violence against children (odds ratio (OR)=14.3), sexual violence against women (OR=9.7), self perception of health (OR=4.5), alcohol abuse (OR=4.4), psychological violence during childhood (OR=3.2) and lack of family support network (OR=2.7). Unemployment and lack of a support network of relatives had an OR 3.3 for mental health alterations. The OR for psychological violence plus sexual violence was 18.5. The figure for psychological violence plus sexual violence plus a history of parental violence during childhood was 26.5. Forty one percent of this group of women had mental health alterations. There is a strong association between these alterations, family violence and socioeconomic factors.

Social Norms and Stigma Regarding Unintended Pregnancy and Pregnancy Decisions: A Qualitative Study of Young Women in Alabama

PubMed Central

Smith, Whitney; Turan, Janet M.; White, Kari; Stringer, Kristi L.; Helova, Anna; Simpson, Tina; Cockrill, Kate

2016-01-01

CONTEXT Social norms and stigma may play an important role in reproductive health behavior and decision-making for young women in the U.S. South, who disproportionately experience unintended pregnancies. Research has yet to describe the presence and manifestations of social norms and stigmas around unintended pregnancy, parenting, adoption and abortion from the perspective of this population. METHODS Six focus groups and 12 cognitive interviews (n=46) were conducted with young (19-24), low-income women in Birmingham, Alabama from December 2013-July 2014, recruited from two public health department centers and a community college. Semi-structured interview guides were used to facilitate discussion around social perceptions of unintended pregnancy and subsequent pregnancy decisions. The sessions were audio-recorded, transcribed, and analyzed using a theme-based approach. RESULTS Respondents described community expectations for pregnancy to occur in the context of monogamous relationships, where both partners were mature, educated and financially stable. In contrast, participants reported that unintended pregnancy outside of those circumstances is common, and that the community expects young women to bear and raise their child when faced with an unintended pregnancy. Social views about women who choose to do so are more positive than those about women who choose abortion or adoption, which the participants generally perceived as unacceptable alternatives to parenting and discussed in terms of negative labels, social judgment, and non-disclosure. CONCLUSIONS Findings inform the development of interventions to reduce stigma and create the social environment in which young women are empowered to make the best reproductive decisions for themselves. PMID:27166869

Participation of low-income women in genetic cancer risk assessment and BRCA 1/2 testing: the experience of a safety-net institution.

PubMed

Komenaka, Ian K; Nodora, Jesse N; Madlensky, Lisa; Winton, Lisa M; Heberer, Meredith A; Schwab, Richard B; Weitzel, Jeffrey N; Martinez, Maria Elena

2016-07-01

Some communities and populations lack access to genetic cancer risk assessment (GCRA) and testing. This is particularly evident in safety-net institutions, which serve a large segment of low-income, uninsured individuals. We describe the experience of a safety-net clinic with limited resources in providing GCRA and BRCA1/2 testing. We compared the proportion and characteristics of high-risk women who were offered and underwent GCRA and genetic testing. We also provide a description of the mutation profile for affected women. All 125 patients who were offered GCRA accepted to undergo GCRA. Of these, 72 % had a breast cancer diagnosis, 70 % were Hispanic, 52.8 % were non-English speakers, and 66 % did not have health insurance. Eighty four (67 %) were offered genetic testing and 81 (96 %) agreed. Hispanic women, those with no medical insurance, and those with a family history of breast cancer were significantly more likely to undergo testing (p > 0.01). Twelve of 81 (15 %) patients were found to have deleterious mutations, seven BRCA1, and five BRCA2. Our experience shows that it is possible to offer GCRA and genetic testing even in the setting of limited resources for these services. This is important given that a large majority of the low-income women in our study agreed to undergo counseling and testing. Our experience could serve as a model for similar low-resource safety-net health settings.

Using interpretative phenomenology to understand the food-related experiences and beliefs of a select group of low-income UK women.

PubMed

Dibsdall, Louise Anne; Lambert, Nigel; Frewer, Lynn Jayne

2002-01-01

The purpose of this study was to provide an in-depth account of the beliefs and experiences pertaining to food and health from a specific group of low-income women in the United Kingdom. Data for this in-depth, qualitative study were collected using audiotaped semistructured interviews. Fourteen white, European women (aged 40 to 60 years) from a defined low-income group were recruited using systematic, nonprobabilistic sampling. Participants lived in a small city in a largely rural region of the United Kingdom. Interview transcripts were analyzed using an interpretative phenomenological approach. They were evaluated independently by several investigators, and, following discussions, a series of "shared themes" were agreed upon. All of the shared themes identified could be grouped into three superthemes or "drivers," which seemed to govern the women's attitudes and behaviors toward food choice and health. "Egocentric systems" related to the uniqueness of the participants and the social worlds they inhabit. "Information characteristics" described what information the participants were exposed to and how it was processed. Finally, "control issues" described how perceptions of control influenced attitudes toward food and health. The study highlights the need for health professionals to consider the different value systems of target groups in health promotion policies. The impact of "New Age" beliefs and the Human Genome Project on public health nutrition are two areas that particularly merit further research.

Socioeconomic determinants of infant mortality: a worldwide study of 152 low-, middle-, and high-income countries.

PubMed

Schell, Carl Otto; Reilly, Marie; Rosling, Hans; Peterson, Stefan; Ekström, Anna Mia

2007-01-01

To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level. National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries. In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant. The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.

The Pittsburgh STOP program: disseminating an evidence-informed intervention for low-income pregnant smokers.

PubMed

Cluss, Patricia A; Levine, Michele D; Landsittel, Douglas

2011-01-01

Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers. STOP is delivered in community health care clinics serving economically disadvantaged women. Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured. An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression. Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mother's age, nicotine dependence, and number of sessions attended. STOP is a community program with self-selected participants and no control group. Low-income pregnant smokers will engage in an evidence-informed cessation program tailored for this group, with quit rates that compare to controlled research results.

Health outcomes of unpaid care workers in low-income and middle-income countries: a protocol for a systematic review.

PubMed

Magaña, Irene; Martínez, Pablo; Loyola, María-Soledad

2018-01-23

The literature on health outcomes of unpaid care work has included studies coming from high-income countries, and has reported gender inequalities that make caregiving women more vulnerable to physical and mental health problems. The impact of unpaid care work on the health of those living in low-income and middle-income countries, where women's autonomy is more limited, is unknown. We will conduct a systematic review of observational studies on health outcomes according to unpaid caregiving status and sex of people living in low-income and middle-income countries. Cumulative Index to Nursing and Allied Health Literature, PubMed and Scientific Electronic Library Online Citation Index will be searched for reports in English or Spanish with published results from inception to 1 June 2017. We expect the studies to have recruited individuals in low-income and middle-income countries, including exposed and non-exposed groups to participation in unpaid care to members if their households or community reporting either physical and/or mental health problems, self-reported health-related quality of life, self-care skills/behaviours or use of any healthcare services in the participants. Data extraction, the assessment of risk of bias and confounding, and qualitative synthesis will be carried out by two independent reviewers with the assistance of a third party. Results are expected to be published in peer-reviewed journals from the field of health and gender, or health and inequality. CRD42017071785. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Contemporary Work and Family Issues Affecting Marriage and Cohabitation among Low-Income Single Mothers

ERIC Educational Resources Information Center

Joshi, Pamela; Quane, James M.; Cherlin, Andrew J.

2009-01-01

In this paper, we advance and test an integrative model of the effects of employment status, nonstandard work schedules, male employment, and women's perceptions of economic instability on union formation among low-income single mothers. On the basis of the longitudinal data from 1,299 low-income mothers from the Three-City Welfare Study, results…

Estimating dietary costs of low-income women in California: a comparison of 2 approaches.

PubMed

Aaron, Grant J; Keim, Nancy L; Drewnowski, Adam; Townsend, Marilyn S

2013-04-01

Currently, no simplified approach to estimating food costs exists for a large, nationally representative sample. The objective was to compare 2 approaches for estimating individual daily diet costs in a population of low-income women in California. Cost estimates based on time-intensive method 1 (three 24-h recalls and associated food prices on receipts) were compared with estimates made by using less intensive method 2 [a food-frequency questionnaire (FFQ) and store prices]. Low-income participants (n = 121) of USDA nutrition programs were recruited. Mean daily diet costs, both unadjusted and adjusted for energy, were compared by using Pearson correlation coefficients and the Bland-Altman 95% limits of agreement between methods. Energy and nutrient intakes derived by the 2 methods were comparable; where differences occurred, the FFQ (method 2) provided higher nutrient values than did the 24-h recall (method 1). The crude daily diet cost was $6.32 by the 24-h recall method and $5.93 by the FFQ method (P = 0.221). The energy-adjusted diet cost was $6.65 by the 24-h recall method and $5.98 by the FFQ method (P < 0.001). Although the agreement between methods was weaker than expected, both approaches may be useful. Additional research is needed to further refine a large national survey approach (method 2) to estimate daily dietary costs with the use of this minimal time-intensive method for the participant and moderate time-intensive method for the researcher.

How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children.

PubMed

Reifsnider, Elizabeth; Shin, Cha-Nam; Todd, Michael; Jeong, Mihyun; Gallagher, Martina; Moramarco, Michael

2016-04-01

Growth stunting is a complex phenomenon related to undernutrition that can contribute to developmental delay, cognitive deficits, and small size and obesity in adulthood. Stunted growth, defined as height for age below the 5th percentile, is primarily caused by chronic malnutrition. In this study, a community-based intervention to reduce undernutrition was tested in a quasi-experimental design with 174 low-income, Mexican-American mothers and children recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in a major southwestern city. The intervention was based on the public health nursing practice of collaborating with mothers of young children on appropriate nutrition and parenting, and was tailored by the author and community informants for mothers of children with stunted growth. Data were collected on child height and weight, dietary intake, maternal acculturation, maternal perceived stress as measured by the Perceived Stress Scale (PSS), home environment as measured by the home screening questionnaire (HSQ), and maternal-child interaction as measured by the Nursing Child Assessment Teaching Scale (NCATS). Intervention children had higher growth velocity than the children in the comparison group. These findings were especially prominent for children of women who were older and less acculturated. Results suggest that a nursing intervention delivered in collaboration with WIC can make a significant improvement in growth of low-income children with growth stunting. © 2016 Wiley Periodicals, Inc.

Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review.

PubMed

Kirk, Lucy; Terry, Samantha; Lokuge, Kamalini; Watterson, Jessica L

2017-07-04

Violence against women (VAW) is a major problem worldwide, with one in three women experiencing violence in their lifetime. While interventions to prevent violence (primary prevention) are extremely important, they can take many years. This review focuses on secondary and tertiary prevention interventions that address the needs of survivors of violence and aim to prevent recurrence. This review also focuses on studies taking place in low and low-middle income countries, where rates of VAW are highest. Searches of peer-reviewed and grey literature took place from March-June 2016 through databases (Embase, CINAHL, WHO Global Index Medicus, Medline, PsychINFO, Web of Science, Cochrane Library, Applied Social Sciences Index and Abstracts and Sociological Abstracts) and by consulting experts in the field. Only primary research was eligible for inclusion and studies had to focus on secondary or tertiary prevention for survivors of VAW in low or low-middle income countries. All study designs were eligible, as long as the study examined client-related outcome measures (e.g., incidence of violence, health outcomes or client satisfaction). Data were extracted and quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and a qualitative quality assessment tool developed by Mays and Pope. Due to the low number of results and heterogeneity of the study populations and outcomes, a narrative synthesis was conducted and evidence was summarized. One thousand two hundred fifteen studies were identified through the search strategy and 22 of these met the eligibility criteria. Overall, the evidence for interventions is weak and study limitations prevent definitive conclusions on what works. There is some evidence that interventions targeting alcohol use, both among perpetrators and survivors, may be effective at reducing VAW through secondary prevention, and that psychotherapy might be effective for

Income inequality and adolescent fertility in low-income countries.

PubMed

Castro, Ruben; Fajnzylber, Eduardo

2017-09-28

: The well-known socioeconomic gradient in health does not imply that income inequality by itself has any effect on well-being. However, there is evidence of a positive association between income inequality and adolescent fertility across countries. Nevertheless, this key finding is not focused on low-income countries. This study applies a multilevel logistic regression of country-level adolescent fertility on country-level income inequality plus individual-level income and controls to the Demographic and Health Surveys data. A negative association between income inequality and adolescent fertility was found among low-income countries, controlling for income (OR = 0.981; 95%CI: 0.963-0.999). Different measures and different subsamples of countries show the same results. Therefore, the international association between income inequality and adolescent fertility seems more complex than previously thought.

Experiences of the Single Low-Income African American Mothers in Their Maternal Protective Role

ERIC Educational Resources Information Center

Ivory, Shirley Clark

2010-01-01

This study was an IRB approved qualitative investigation of experiences of the single low-income African American mothers in their maternal protective role. In-depth interviews and a focus group were conducted with 13 single-low income women who met the criteria for participation in the study, in an effort to understand the social context in which…

Modeling parenting stress trajectories among low-income young mothers across the child's second and third years: Factors accounting for stability and change.

PubMed

Chang, Yiting; Fine, Mark A

2007-12-01

This study investigated parenting stress trajectories among low-income young mothers and the factors that are associated with change and stability of parenting stress as children aged from 14 to 36 months old. With a sample of 580 young mothers who applied to the Early Head Start Program, growth mixture modeling identified 3 trajectory classes of parenting stress: a chronically high group (7% of the sample), an increasing group (10% of the sample), and a decreasing group (83% of the sample). Maternal personal resources distinguished between the increasing and decreasing classes, whereas maternal personal resources, child characteristics, and contextual influences explained differences between the chronically high and decreasing trajectory classes. Findings suggest that for interventions to be effective, programs need to assess maternal, child, and contextual factors to better address the particular unique needs of young mothers.

77 FR 65139 - Designation of Low-Income Status; Acceptance of Secondary Capital Accounts by Low-Income...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

...-Income Status; Acceptance of Secondary Capital Accounts by Low-Income Designated Credit Unions AGENCY... amend its low-income credit unions regulation by extending the time credit unions have to accept a low- income designation. Under the current rule, an FCU that has received notification from NCUA that it...

WIC peer counselors’ perceptions of breastfeeding in African-American women with lower incomes

PubMed Central

Gross, Tyra T.; Powell, Rachel; Anderson, Alex K.; Hall, Jori; Davis, Marsha; Hilyard, Karen

2015-01-01

Background African-American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors’ perceptions of breastfeeding in African-American women. Objectives As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African-American women from the perspective of breastfeeding peer counselors (PCs). Methods Three focus groups were conducted with 23 PCs from the WIC program in a Southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner’s socio-ecological model was used to group categories into themes. Results Of the sample, 48% were African-American, 78.2% were married, 56.5% had some college education. Five main themes emerged to describe factors at multiple-levels influencing breastfeeding in PCs’ low-income African-American clients: Individual, Microsystem, Exosystem, Macrosystem, and Chronosystem. Novel findings included 1) having breast-pumps may give African-American women a “sense of security”, 2) cultural pressures to be a “strong black woman” can impede breastfeeding support, and 3) breastfeeding “generational gaps” have resulted from American “slavery” and when formula was “a sign of wealth”. Conclusions As PCs described, low-income African-American women breastfeeding decisions are impacted by numerous contextual factors. Findings from this study suggest a need to broaden public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and socio-cultural factors underlying breastfeeding practices in African-American women. PMID:25480019

Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries.

PubMed

Conklin, Annalijn I; Ponce, Ninez A; Frank, John; Nandi, Arijit; Heymann, Jody

2016-01-01

To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24-49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity.

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

PubMed Central

Cabral de Mello, Meena; Patel, Vikram; Rahman, Atif; Tran, Thach; Holton, Sara; Holmes, Wendy

2012-01-01

Abstract Objective To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Methods Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Findings Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4–15.9) antenatally and 19.8% (19.5–20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1–13.2); unintended pregnancy (1.6–8.8); being younger (2.1–5.4); being unmarried (3.4–5.8); lacking intimate partner empathy and support (2.0–9.4); having hostile in-laws (2.1–4.4); experiencing intimate partner violence (2.11–6.75); having insufficient emotional and practical support (2.8–6.1); in some settings, giving birth to a female (1.8–2.6), and having a history of mental health problems (5.1–5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4–1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1–0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3–0.9). Conclusion CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history. PMID:22423165

Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial.

PubMed

Phelan, Suzanne; Hagobian, Todd; Brannen, Anna; Hatley, Karen E; Schaffner, Andrew; Muñoz-Christian, Karen; Tate, Deborah F

2017-06-20

Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23

The influence of motherhood on neural systems for reward processing in low income, minority, young women.

PubMed

Moses-Kolko, Eydie L; Forbes, Erika E; Stepp, Stephanie; Fraser, David; Keenan, Kate E; Guyer, Amanda E; Chase, Henry W; Phillips, Mary L; Zevallos, Carlos R; Guo, Chaohui; Hipwell, Alison E

2016-04-01

Given the association between maternal caregiving behavior and heightened neural reward activity in experimental animal studies, the present study examined whether motherhood in humans positively modulates reward-processing neural circuits, even among mothers exposed to various life stressors and depression. Subjects were 77 first-time mothers and 126 nulliparous young women from the Pittsburgh Girls Study, a longitudinal study beginning in childhood. Subjects underwent a monetary reward task during functional magnetic resonance imaging in addition to assessment of current depressive symptoms. Life stress was measured by averaging data collected between ages 8-15 years. Using a region-of-interest approach, we conducted hierarchical regression to examine the relationship of psychosocial factors (life stress and current depression) and motherhood with extracted ventral striatal (VST) response to reward anticipation. Whole-brain regression analyses were performed post-hoc to explore non-striatal regions associated with reward anticipation in mothers vs nulliparous women. Anticipation of monetary reward was associated with increased neural activity in expected regions including caudate, orbitofrontal, occipital, superior and middle frontal cortices. There was no main effect of motherhood nor motherhood-by-psychosocial factor interaction effect on VST response during reward anticipation. Depressive symptoms were associated with increased VST activity across the entire sample. In exploratory whole brain analysis, motherhood was associated with increased somatosensory cortex activity to reward (FWE cluster forming threshold p<0.001). These findings indicate that motherhood is not associated with reward anticipation-related VST activity nor does motherhood modulate the impact of depression or life stress on VST activity. Future studies are needed to evaluate whether earlier postpartum assessment of reward function, inclusion of mothers with more severe depressive symptoms

What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review.

PubMed

Siron, Stéphanie; Dagenais, Christian; Ridde, Valéry

2015-11-01

This study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic. In this scoping review, a descriptive and systematic process was used to analyse, for each article retained, descriptions of research context and methods, types of knowledge transfer activities and results reported. 28 articles were analysed. They dealt with the evaluation of transfer strategies that employed multiple activities, mostly targeting health professionals and women with very young children. Most often these studies used quantitative designs and measurements of instrumental use with some methodological shortcomings. Results were positive and suggested recommendations for improving professional practices, knowledge and health-related behaviours. The review highlights the great diversity of transfer strategies used, strategies and many conditions for knowledge use. The review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization.

Low-Income Women’s Conceptualizations of Emotional- and Stress-Eating

PubMed Central

Hayman, Lenwood W.; Lee, Hannah J.; Miller, Alison L.; Lumeng, Julie C.

2014-01-01

Emotional- and stress-eating have been proposed as risk factors for obesity. However, the way that individuals conceptualize these behaviors is not well understood and no studies have employed a qualitative approach. We sought to understand how women conceptualize emotional- and stress-eating. Sixty-one low-income women from South-central Michigan with young children (ages 2–5 years) participated in either a focus group or individual semi-structured interview during which they were asked about their conceptualizations of eating behaviors among adults and children. Responses were transcribed and the constant comparative method was used to identify themes. Identified themes included that emotional- and stress-eating are viewed as uncommon, severe, pitiable behaviors that reflect a lack of self-control and are highly stigmatized; that when these behaviors occurred among children, the behaviors resulted from neglect or even abuse; and that bored-eating is viewed as distinct from emotional- or stress-eating and is a common and humorous behavior with which participants readily self-identified. Future research and interventions should seek to develop more detailed conceptualizations of these behaviors to improve measurement, destigmatize emotional- and stress-eating and potentially capitalize on the strong identification with bored-eating by targeting this behavior for interventions. PMID:25218718

Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India

PubMed Central

Thakur, Harshad; Aronsson, Annette; Bansode, Seema; Stalsby Lundborg, Cecilia; Dalvie, Suchitra; Faxelid, Elisabeth

2014-01-01

The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30–40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls. PMID:25072044

Socio-economic status and body mass index in low-income Mexican adults

PubMed Central

Fernald, Lia

2007-01-01

The study reported here explored the associations of body mass index (BMI), socio-economic status (SES), and beverage consumption in a very low income population. A house-to-house survey was conducted in 2003 of 12,873 Mexican adults. The sample was designed to be representative of the poorest communities in seven of Mexico’s thirty-one states. Greater educational attainment was significantly associated with higher BMI and a greater prevalence of overweight (25≤BMI<30) and obesity (30≤BMI) in men and women. The combined prevalence of overweight and obesity was over 70% in women over the median age of 35.4 years old with at least some primary education compared with a prevalence of 45% in women below the median age with no education. BMI was positively correlated with five of the six SES variables in both sexes: education, occupation, quality of housing conditions, household assets, and subjective social status. BMI and household income were significantly correlated in women but not in men. In the model including all SES variables, education, occupation, housing conditions and household assets all contributed independently and significantly to BMI, and household income and subjective social status did not. Increased consumption of alcoholic and carbonated sugar beverages was associated with higher SES and higher BMI in men and women. Thus, in spite of the narrow range of socio-economic variability in this population, the increased consumption of high calorie beverages may explain the positive relationship between SES and BMI. The positive associations between SES and BMI in this low-income, rural population are likely to be related to the changing patterns of food availability, food composition, consumption patterns and cultural factors. Contextually sensitive population-level interventions are critically needed to address obesity and overweight in poor populations, particularly in older women. PMID:17368895

"I'm Happy with My Mommy": Low-Income Preschoolers' Causal Attributions for Emotions.

ERIC Educational Resources Information Center

Curenton, Stephanie M.; Wilson, Melvin N.

2003-01-01

This study examined low-income African American and European American preschoolers' socioemotional causal attributions. Results indicate that younger preschoolers, particularly young African Americans, may need help articulating emotions. Adults can support children's emotional reasoning through scaffolding. (Author)

Relationship of low lean body mass with body weight increase until one year of age and current lifestyles in Japanese young women.

PubMed

Miyamoto, Shoji; Murotani, Kenta; Yanagawa, Takashi; Kato, Atsushi; Matsunaga, Satoshi

2010-06-01

To investigate factors affecting the low lean body mass (LBM) of young women, we focused on the increase in body weight until one year of age and current lifestyles. In 442 young women, the increase in body weight from birth until one year of age, breast-feeding method in infancy, current physique index and body composition, and physique and lifestyles were investigated using a questionnaire. Subjects with an LBM percentile of less than 33.3 (less than 36.8 kg) were classified as having a low LBM (n = 150), and those with a 33.3 or higher LBM percentile as the control (n = 293). Based on body weight changes from birth to days 3 and 7, the subjects were divided into a rapid weight gain group and two non-rapid weight gain groups (groups 1-3). To analyze factors involved in a low LBM, multivariate analysis using a logistic model was employed. The prevalence of a low LBM in the rapid weight gain group was 0.41 times higher than in the others. The prevalence of a low LBM with a low birth weight was 0.58 times higher, indicating that a low birth weight is likely to result in a low LBM. Regarding the lifestyles, the prevalence of a low LBM in subjects with a current breakfasting habit was 0.60 times higher than in those without one. These findings suggest that the thinness of young women characterized by a low LBM is associated with the increase in body weight until one year of age and current lifestyles.

Improving Outcomes from Breast Cancer in a Low-Income Country: Lessons from Bangladesh

PubMed Central

Story, H. L.; Love, R. R.; Salim, R.; Roberto, A. J.; Krieger, J. L.; Ginsburg, O. M.

2012-01-01

Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens' choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh. PMID:22295245

Improving outcomes from breast cancer in a low-income country: lessons from bangladesh.

PubMed

Story, H L; Love, R R; Salim, R; Roberto, A J; Krieger, J L; Ginsburg, O M

2012-01-01

Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens' choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh.

Maternal employment and the health of low-income young children.

PubMed

Gennetian, Lisa A; Hill, Heather D; London, Andrew S; Lopoo, Leonard M

2010-05-01

This study examines whether maternal employment affects the health status of low-income, elementary-school-aged children using instrumental variables estimation and experimental data from a welfare-to-work program implemented in the early 1990s. Maternal report of child health status is predicted as a function of exogenous variation in maternal employment associated with random assignment to the experimental group. IV estimates show a modest adverse effect of maternal employment on children's health. Making use of data from another welfare-to-work program we propose that any adverse effect on child health may be tempered by increased family income and access to public health insurance coverage, findings with direct relevance to a number of current policy discussions. In a secondary analysis using fixed effects techniques on longitudinal survey data collected in 1998 and 2001, we find a comparable adverse effect of maternal employment on child health that supports the external validity of our primary result.

The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries

PubMed Central

Bazzano, Alessandra N.; Potts, Kaitlin S.; Bazzano, Lydia A.; Mason, John B.

2017-01-01

The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability. PMID:28398257

The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries.

PubMed

Bazzano, Alessandra N; Potts, Kaitlin S; Bazzano, Lydia A; Mason, John B

2017-04-11

The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.

Effects of the Affordable Care Act on Young Women With Gynecologic Cancers.

PubMed

Smith, Anna Jo Bodurtha; Fader, Amanda N

2018-06-01

To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI -4.0 to 0.1, P=.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P=.03) for women aged 21-26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.