Problems with parsimony in research on socioeconomic determinants of health

Risk-reduction strategies to expand radon care planning with vulnerable groups

OBJECTIVES

Radon is the second leading cause of lung cancer in the United States and the leading cause of lung cancer among nonsmokers. Residential radon is the cause of approximately 21,000 U.S. lung cancer deaths each year. Dangerous levels of radon are just as likely to be found in low-rise apartments and townhomes as single-family homes in the same area. The preferred radon mitigation strategy can be expensive and requires structural modifications to the home. The public health nurse (PHN) needs a collection of low-cost alternatives when working with low-income families or families who rent their homes.

METHOD

A review of the literature was performed to identify evidence-based methods to reduce radon risk with vulnerable populations.

RESULTS

Fourteen recommendations for radon risk reduction were categorized into four strategies. Nine additional activities for raising awareness and increasing testing were also included.

DISCUSSION

The results pair the PHN with practical interventions and the underlying rationale to develop radon careplans with vulnerable families across housing types. The PHN has both the competence and the access to help families reduce their exposure to this potent carcinogen.

Maternal Mortality and Female Literacy Rates in Developing Countries during 1970–2000: A Latent Growth Curve Analysis

Background. The gross longitudinal relationship between female literacy and maternal mortality ratios has not been adequately investigated even though the knowledge of the relationship is crucial for designing maternal mortality reduction programs through female literacy campaigns and improvements. The objective of the study was to examine the dynamic relationship between female literacy and mortality ratios. A longitudinal study design spanning three decades, 1970–2000, was used. Country level data on 143 nations belonging to six geographical regions for the duration 1970–2000 were secured from websites hosted by global agencies such as World Bank and the United Nations were utilized. Maternal mortality ratios (1970–2000) ranged from 147 to 271 across the six regions. The longitudinal relationship between female literacy rates and maternal mortality ratios was examined using a latent growth curve approach. The study found that rates of change in female literacy and maternal mortality ratios are negatively related. Steady rates of increase in female literacy were associated with declining maternal mortality ratios as well. We find that female literacy programs are of immense value in reducing maternal mortality ratios given their ability to yield sustained reductions in mortality levels in developing countries.

Putting the world as classroom: an application of the inequalities imagination model in nursing and health education

This article focuses on the description of an educational initiative, the Interdisciplinary Population Health Project (IPHP) conducted in the academic year of 2006-2007 with a group of nursing and health care students. Inspired by population health, community development, critical pedagogy, and the inequalities imagination model, students participated in diverse educational activities to become immersed in the everyday life of an underserved urban neighborhood. A sample of convenience composed of 158 students was recruited from 4 health disciplines in a Western Canadian university. Data were collected using a modified version of the Parsell and Bligh's Readiness of Health Care Students for Interprofessional Learning Scale. A one group pretest-posttest design was used to assess the outcomes of the IPHP. Paired t tests and one-way analyses of variance were used to compare the responses of students from different academic programs to determine if there were differences across disciplines. Findings suggest that students' readiness to work in interprofessional teams did not significantly change over the course of their participation in the IPHP. However, the inequalities imagination model may be useful to enhance the quality and the effectiveness of fieldwork learning activities as a means of educating culturally and socially conscious nurses and other health care professionals of the future.

Integrating intersectionality and biomedicine in health disparities research

Persisting health disparities have lead to calls for an increase in health research to address them. Biomedical scientists call for research that stratifies individual indicators associated with health disparities, for example, ethnicity. Feminist social scientists recommend feminist intersectionality research. Intersectionality is the multiplicative effect of inequalities experienced by nondominant marginalized groups, for example, ethnic minorities, women, and the poor. The elimination of health disparities necessitates integration of both paradigms in health research. This study provides a practical application of the integration of biomedical and feminist intersectionality paradigms in nursing research, using a psychiatric intervention study with battered Latino women as an example.

Analysis of social epidemiology research on infectious diseases: historical patterns and future opportunities

BACKGROUND

Despite the many triumphs of biomedical research over infectious diseases, human pathogens continue to impact profoundly populations deprived of social resources. Correspondingly, health researchers have advocated a social determinants approach to the study and prevention of infectious diseases. However, it is unknown whether this call has resulted in an increase in the number of studies examining social determinants of infectious outcomes.

METHODS

Research on social determinants of infectious diseases was systematically quantified by assessing temporal trends in the published literature using MEDLINE, PsycINFO and ISI Web of Science.

RESULTS

Results of the literature review spanning 1966-2005 show that socially related citations increased an annual average of 180.3 for neuropsychiatric conditions, 81.9 for chronic conditions, 44.7 for sexually transmitted diseases and 18.9 for non-sexually transmitted infectious diseases (p<0.0001). Of the 279 publications found to employ the term "social epidemiology", 15 (5.4%) investigated infectious outcomes.

CONCLUSIONS

The results of the literature review suggest a paucity of social research on infectious diseases. There is a need for increased dialogue and collaboration between infectious disease epidemiologists and social epidemiologists.

Social justice: added metaparadigm concept for urban health nursing

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.

Low-income mothers, nutrition and health: a systematic review of qualitative evidence

Diet is a key issue for UK health policies, particularly in relation to poorer socio-economic groups. From a public health perspective, the government's role is to help low-income families to make healthy food choices, and to create the conditions to enable them to make healthy decisions. Arguably, however, current policy on nutrition and health is influenced by individualist and behavioural perspectives, which fail to take into account the full impact of structural factors on food choices. This paper draws on a systematic review of qualitative studies that prioritize low-income mothers' accounts of 'managing' in poverty, synthesizing a subset of studies that focus on diet, nutrition and health in poor families. Synthesis findings are explored in the context of dominant discourses concerning individual responsibility for health and gendered societal values concerning 'good' mothering. The paper concludes that a shift in emphasis in health policies, affording a higher priority to enabling measures that tackle the underlying determinants of health, would be advantageous in reducing nutritional inequities for low-income mothers and their children.

Mutual moral caring actions: a framework for community nursing practice

A community practice framework is presented as the synthesis of research findings from the analysis of a critical ethnonursing study of women in recovery from chemical dependence. Critical Social Theory is used to examine the paradoxical experiences of women from their lifeworld and system within the community. The framework focuses on the mutual moral caring actions of the community nurse and the women in the recovery. It is supported by the concepts of transcultural nursing ethics. The utility of the framework is to promote clarity of speech and parity of community membership for women in recovery from chemical dependence and their return to the community.

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

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

Transcendent pluralism and the influence of nursing testimony on environmental justice legislation

Environmental justice is an important issue affecting health disparities. Using the framework of transcendent pluralism, this article describes nursing actions and research in a legislative coalition for an environmental justice bill. Two descriptive studies are conducted: a focus group with six legislative aides and an evaluation of a nursing presentation given to 10 Massachusetts state legislators. Pretest and posttest results showed a small but significant increase in the legislators' disposition toward the bill; the mean score increased from 5.4 to 5.9 (p = .037). Legislators perceived nurses as lobbying more for nursing profession issues than general health issues (score of 6.3 vs. 4.6; p = .009). Guidelines for lobbying that emerged from the data are included. The author argues that nursing knowledge should play a vital role in public policy and that nurses need to broaden their efforts beyond professional issues to the larger issues that influence a healthy human society.

Is health promotion relevant across cultures and the socioeconomic spectrum?

Is health promotion a White middle-class phenomenon that people from other cultures and classes do not regard as important? When implementing health-promotion initiatives, are healthcare providers making assumptions that are not valid for other cultural or socioeconomic groups? How do people of various cultures and classes perceive health and health promotion? To explore these questions, this article reviews some of the relevant literature on culture and class in relation to health promotion, exploring issues foundational to the effectiveness of health-promotion programs and pertinent to delivering health-promotion interventions to ethnic, racial, and cultural minorities and poor populations. Health promoters are encouraged to consider the social determinants of their patients' health and tailor programs on the basis of their patients' motivations and resources.

Allostatic load and health disparities: a theoretical orientation

Eliminating racial and ethnic health disparities requires restructuring the biomedical models that have focused on the individual as the level of analysis and emphasized the parts rather than the whole. A recently developed understanding of human physiology and adaptive regulation, constructs of allostasis and allostatic load, provides a theoretical orientation that needs to be explored. Thus, the purpose of this article is to present an orientation of allostasis and allostatic load as a theoretical framework for exploring health disparities. This article will (a) present a general background on the evolution of relevant physiologic theories, (b) offer the general theoretical definitions and explanations of allostasis, allostatic load, and mediation processes, (c) examine empirical evidence for the constructs, and (d) discuss the implications of this orientation for health disparities research.

A theoretical model of social consciousness

The article presents a theoretical model of social consciousness developed from nurses' life histories. A 3-position dialectical framework--acquired, awakened, and expanded social consciousness--makes visible the way people respond to social injustice in their lives and in the lives of others. The positions coexist, are not hierarchical, and are contextually situated. A person's location influences her or his availability for social action. Nurses who could most contribute to challenging social injustices that underpin health disparities are relegated to the margins of mainstream nursing by internal processes of discrimination. More inclusive definitions of "a nurse" would open up possibilities for social change.

Advancing nursing theory through theory-guided practice: the emergence of a critical caring perspective

Critical caring is proposed as a hybrid, midrange theory that builds on nursing science and critical feminist theories. As such, it has the potential to root public health nursing practice in an expanded nursing caring science that reincorporates the social justice agenda characteristic of early public health nursing practice but not featured prominently in contemporary nursing theories. Critical caring transforms the carative processes of Watson's theory into 7 carative health-promoting processes that form the "core" of public health nursing practice and reflect the legacy and reality of public health nursing practice.