1
|
Rodrigo CH, Singal K, Mackie P, Paranjothy S. Effectiveness of financial support interventions to reduce adverse health outcomes among households in fuel poverty in the United Kingdom. PUBLIC HEALTH IN PRACTICE 2024; 7:100503. [PMID: 38817637 PMCID: PMC11137583 DOI: 10.1016/j.puhip.2024.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/25/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objectives This systematic review intended to assess the effectiveness of financial support interventions for household fuel poverty in the UK in terms of reducing adverse impacts on the health and wellbeing of recipients. Methods Bibliographic databases and grey literature sources were searched from the UK for studies that evaluated the health and wellbeing of participants following financial support to optimize indoor heating. Two independent reviewers carried out screening, data extraction and quality assessment of the articles. The outcomes included direct health-related outcomes such as Excess Winter Mortality (EWM), physical/mental health, health services utilization, well-being, and quality of life. Indirect health related outcomes included temperature, condensation/mould/dampness (CMD), fuel efficiency/expenditure and satisfaction with warmth. Due to the heterogeneity of interventions and outcomes, a narrative synthesis of the data was carried out. Results Twenty studies were included in the review: randomized controlled trials (n = 1), before and after evaluation of interventions (n = 14), ecological studies (n = 1) and modelling studies (n = 4). Sixteen studies assessed impacts of home energy efficiency improvements (HEEI) only, three studies assessed impacts of Winter Fuel Payment (WFP) only while one study assessed impacts of both HEEI and WFP. HEEI studies reported improved indoor temperatures (n = 4), reduced CMD (n = 6), reduced fuel expenditure (n = 4), improved thermal comfort (n = 7), improvements in general health (n = 4), increased wellbeing (n = 4), improved physical health (n = 2), improved mental health (n = 3), reduced new health events (n = 1) and improved existing medical conditions (n = 2). Two HEEI were reported cost effective with added years to life. During modelling studies WFP was found to significantly reduce EWM (n = 2) and fibrinogen levels (n = 1). Conclusions Most financial support interventions included in this review demonstrated positive impacts on health and wellbeing of recipients supporting their implementation with robust evaluations to better understand the cost effectiveness and long-term impacts in the future. Implementation of these interventions will require cross-sector collaborations, with consideration of which populations are most likely to benefit.
Collapse
|
2
|
Kroese L, Lobo K, Meyer M, Tate J, Mays M, Adye R, Qureshi H, Al-Shammaa B, Brito A, Seo-Mayer P, Moyer K, Port C. Improving food insecurity screening across a health system throughout the COVID-19 pandemic. BMJ Open Qual 2024; 13:e002462. [PMID: 38296603 PMCID: PMC10831437 DOI: 10.1136/bmjoq-2023-002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year. METHODS This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles. RESULTS The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic's food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month. DISCUSSION Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.
Collapse
Affiliation(s)
- Lani Kroese
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Kenia Lobo
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mary Meyer
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Jordan Tate
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mitra Mays
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Rebecca Adye
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Henna Qureshi
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Bann Al-Shammaa
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Albert Brito
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Patty Seo-Mayer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Katherine Moyer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Courtney Port
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| |
Collapse
|
3
|
Msw RET, Warner L, Shy BD, Manikowski C, Roosevelt GE. A descriptive study of screening and navigation on health-related social needs in a safety-net hospital emergency department. Am J Emerg Med 2023; 74:65-72. [PMID: 37778164 DOI: 10.1016/j.ajem.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Health-related social needs (HRSN) have been associated with worse clinical outcomes, increased Emergency Department (ED) utilization and higher healthcare costs. The ED is uniquely positioned to bring HRSN screening to the bedside and develop effective interventions. We evaluated whether navigation services for high-risk patients led to the resolution of HRSN. METHODS Navigators screened a convenience sample of patients for HRSN with the Accountable Health Communities Screening Tool from October 2019 to January 2022. Patients with HRSN were considered high-risk if they had at least two ED visits in the previous 12 months. Patients who were high-risk were eligible for navigation including community referrals and one-on-one close follow-up. The HRSN status (resolved, in-progress, unable to resolve) was queried from the Centers for Medicare and Medicaid database. The state hospital association provided data on ED visits and inpatient hospitalizations within 6 months of the screening visit. RESULTS Of 185,470 ED visits, HRSN screening occurred in 4050 (2%). HRSN were self-reported in 48% (1944) of patient visits, with 71% of these (1379) considered high-risk. 15% of high-risk patients with HRSN opted out of navigation. Food insecurity was the most identified HRSN (35%) followed by housing instability (26%), transportation needs (24%) and utility assistance (15%). Food insecurity was the most resolved HRSN (39%, in-progress 32%) followed by utility assistance (37%, in-progress 26%), transportation needs (35%, in-progress 35%) and housing instability (28%, in-progress 36%). High-risk visits in which the patient or guardian accepted navigation were less likely to be associated with an ED visit within 6 months of the screening visit (51%) compared to high-risk patients in which the patient or guardian opted out of navigation (61%, p < 0.001), but there was no difference in inpatient hospitalizations (p = 0.427). CONCLUSIONS During the study period, one-third of HRSN were successfully resolved with another one-third in-progress. Navigation in high-risk patients was associated with fewer subsequent ED visits.
Collapse
Affiliation(s)
- Ruth Ellen Tubbs Msw
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Leah Warner
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Bradley D Shy
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Christine Manikowski
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Genie E Roosevelt
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| |
Collapse
|
4
|
Bangham C, Zack RM, Nelson E, Liu X, Codner A, Hicks JM, Greece JA. Assessing the effect of adverse economic events on severity of hunger among food pantry clients. Front Public Health 2023; 11:1286094. [PMID: 38026276 PMCID: PMC10644360 DOI: 10.3389/fpubh.2023.1286094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.
Collapse
Affiliation(s)
- Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Rachel M. Zack
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Eva Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Xinyang Liu
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Alyson Codner
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jacqueline Milton Hicks
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Jacey A. Greece
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| |
Collapse
|
5
|
Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona K. Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Natl Cancer Inst 2023; 115:1179-1187. [PMID: 37261858 PMCID: PMC10560600 DOI: 10.1093/jnci/djad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Parent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001. METHODS This was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status. RESULTS Among 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1. CONCLUSIONS Despite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents-compared with unexposed parents-experienced statistically significantly increased odds of severe psychological distress at the time of their child's leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.
Collapse
Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Victoria B Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia, University Medical Center, New York, NY, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, RI, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
6
|
Evans EM, Lin J, Sanchez-Alvarez J, Agrawal AK, Winestone LE. Disparities in household material hardship, financial toxicity, and income loss in pediatric cancer. Pediatr Blood Cancer 2023:e30496. [PMID: 37394628 DOI: 10.1002/pbc.30496] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. METHODS Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change. RESULTS Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity. CONCLUSION HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH.
Collapse
Affiliation(s)
- Erica M Evans
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Jackie Lin
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jacklyn Sanchez-Alvarez
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| |
Collapse
|
7
|
Simes M, Rahman T, Hernández D. Vigilant Conservation: How Energy Insecure Households Navigate Cumulative and Administrative Burdens. ENERGY RESEARCH & SOCIAL SCIENCE 2023; 101:103092. [PMID: 38680547 PMCID: PMC11052585 DOI: 10.1016/j.erss.2023.103092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Energy insecurity research has described the prevalence and circumstances of household energy unaffordability, as well as its outcomes for health. Previous studies have also noted coping strategies that result from energy insecurity. We provide evidence advancing our understanding of the nature and extent of these coping strategies. In 2020, we conducted in-depth interviews with 30 energy insecure household members enrolled in one or more energy assistance programs in Washington D.C. We asked about their home conditions, utility usage, cost-reducing strategies, understanding of environmental concerns, and main sources of expenses and income. Qualitative analysis revealed two key themes that characterize how individuals experience energy insecurity and navigate energy assistance services: 1) vigilant conservation refers to the duty to conserve utility resources and strictly manage the household's financial affairs by saving across various categories, and 2) administrative burden includes the hardships attached to seeking help and managing the bureaucratic processes of formal support. Our study connects energy insecurity to broader questions on sustainability and clarifies a need to relieve households of administrative burdens.
Collapse
Affiliation(s)
- Miranda Simes
- Columbia University, 722 West 168th Street, New York, NY 10032, United States
| | - Tasfia Rahman
- Columbia University, 722 West 168th Street, New York, NY 10032, United States
| | - Diana Hernández
- Columbia University, 722 West 168th Street, New York, NY 10032, United States
| |
Collapse
|
8
|
Cordova-Ramos EG, Brochier A, Tripodis Y, Garg A, Parker MG. Beyond income: material hardship and the health and healthcare of premature children. J Perinatol 2023; 43:357-363. [PMID: 36396743 PMCID: PMC9998339 DOI: 10.1038/s41372-022-01560-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To estimate national prevalence of household hardships (food insufficiency, financial hardship, and difficulty paying medical bills) among children born term and preterm; and examine associations of household hardships with preterm children's outcomes (health status, emergency room visits, and unmet healthcare needs). METHODS We studied 24,026 children aged 0-3 years born term, preterm with moderately low birth weight (1501-2499 grams) and preterm with very low birth weight (VLBW; ≤1500 grams). Using propensity score matching to control for correlates of poverty, we examined associations of hardships and child outcomes. RESULTS Compared with term, households with preterm VLBW children had >2-fold higher odds of financial hardship (aOR:2.63; 95% CI: 1.26-5.46) and >5-fold higher odds of difficulty paying bills (aOR:5.60; 95% CI: 2.35-10.35). Matching for sociodemographics, special healthcare needs, income and receipt of public benefits, hardships were independently associated with adverse preterm children's outcomes. CONCLUSIONS Addressing household hardships is needed to optimize preterm child outcomes.
Collapse
Affiliation(s)
- Erika G Cordova-Ramos
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, University of Massachusetts Chan Medical School, UMass Memorial Children's Medical Center, Worcester, MA, USA
| | - Margaret G Parker
- Child Health Equity Center, Department of Pediatrics, University of Massachusetts Chan Medical School, UMass Memorial Children's Medical Center, Worcester, MA, USA
| |
Collapse
|
9
|
Varela EG, McVay MA, Shelnutt KP, Mobley AR. The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review. Adv Nutr 2023; 14:190-210. [PMID: 36811589 PMCID: PMC10103006 DOI: 10.1016/j.advnut.2022.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
Collapse
Affiliation(s)
- Elder Garcia Varela
- Graduate Research and Teaching Assistant, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
10
|
Pay (for it) as you go: Prepaid energy meters and the heat-or-eat dilemma. Soc Sci Med 2022; 315:115498. [PMID: 36371931 DOI: 10.1016/j.socscimed.2022.115498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The "heat-or-eat" dilemma, a trade-off typically between food consumption and heating, may elevate public health concerns during the 2022 energy-price crisis. Our paper contributes to the literature by exploring the role of domestic energy prepayment meters (PPMs) in the heat-or-eat dilemma, focusing on the association between PPM use and fruit and vegetable consumption. Using a representative sample of 24,811 individuals residing in Great Britain (January 2019-May 2021), we find robust evidence of lower fruit and vegetable consumption amongst individuals using PPMs, compared to those using post-payment energy bill payment methods. On average, our point estimates suggest that individuals using a PPM consume 2.7 fewer portions of fruit and vegetables per week. Our findings hold when bounding analysis is employed to account for omitted variable bias. Using a suite of IV approaches to further alleviate endogeneity concerns we found that our ordinary least squares results are consistent as opposed to IV models. Further robustness analyses highlight the deleterious impact of PPMs on people's healthy eating habits relevant to the consumption of enough fruit and vegetables. Our results suggest that targeted support for PPM users may have beneficial effects on people's fruit and vegetable consumption patterns.
Collapse
|
11
|
Rosenberg J, Rosenthal A, Castillo S, Edwards E, Erickson C, Nogelo P, Fenick AM. Medical Certification for Utility Shut-Off Protection and Health-Related Social Needs. Pediatrics 2022; 150:e2022057571. [PMID: 36226533 PMCID: PMC9647589 DOI: 10.1542/peds.2022-057571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition. METHODS After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021). RESULTS Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively. CONCLUSIONS Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.
Collapse
Affiliation(s)
| | - Alice Rosenthal
- Yale School of Medicine, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
- Center for Children’s Advocacy, Hartford, Connecticut
| | | | - Emily Edwards
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut
| | | | | | | |
Collapse
|
12
|
Holben DH, Marshall MB. Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States. J Acad Nutr Diet 2022; 122:S55-S66. [PMID: 36122960 DOI: 10.1016/j.jand.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.
Collapse
|
13
|
Insolera N, Cohen A, Wolfson JA. SNAP and WIC Participation During Childhood and Food Security in Adulthood, 1984-2019. Am J Public Health 2022; 112:1498-1506. [PMID: 35981276 PMCID: PMC9480484 DOI: 10.2105/ajph.2022.306967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the effects of childhood participation in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on adult food security in the United States. Methods. We used data from the 1984 to 2019 waves of the Panel Study of Income Dynamics to follow a balanced panel of 1406 individuals from birth through ages 20 to 36 years. We measured food insecurity from 1999 to 2003 and 2015 to 2019 among those who resided in low-income households during childhood. Results. Twenty-eight percent of individuals who resided in low-income households during childhood exhibited improved food security status from childhood to adulthood. Those who participated in SNAP and WIC during childhood had 4.16-fold higher odds (95% confidence interval [CI] = 1.91, 9.03) of being more food secure than those who were eligible for but did not receive SNAP or WIC, and those who participated in SNAP alone had 3.28-fold higher odds (95% CI = 1.56, 6.88). Conclusions. Participation in social safety net programs such as SNAP and WIC during childhood helps to improve food security across the life course. Our findings add evidence regarding the long-term benefits of participation in SNAP and WIC during childhood. (Am J Public Health. 2022;112(10):1498-1506. https://doi.org/10.2105/AJPH.2022.306967).
Collapse
Affiliation(s)
- Noura Insolera
- Noura Insolera is with the Institute for Social Research, University of Michigan, Ann Arbor. Alicia Cohen is with the Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Family Medicine, Alpert Medical School of Brown University; and Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI. Julia A. Wolfson is with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Alicia Cohen
- Noura Insolera is with the Institute for Social Research, University of Michigan, Ann Arbor. Alicia Cohen is with the Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Family Medicine, Alpert Medical School of Brown University; and Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI. Julia A. Wolfson is with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Julia A Wolfson
- Noura Insolera is with the Institute for Social Research, University of Michigan, Ann Arbor. Alicia Cohen is with the Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Family Medicine, Alpert Medical School of Brown University; and Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI. Julia A. Wolfson is with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| |
Collapse
|
14
|
Laroche HH, Park-Mroch J, O'Shea A, Rice S, Cintron Y, Engebretsen B. Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study. SAGE Open Med 2022; 10:20503121221102706. [PMID: 35707344 PMCID: PMC9189556 DOI: 10.1177/20503121221102706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This non-randomized pilot trial examined the feasibility and acceptability of an intervention for low-income families with one parent with obesity, glucose intolerance and/or diabetes. Methods: The 12-month intervention combined health coaching using motivational interviewing to promote lifestyle behavior change and community resource mobilization to assist with basic needs plus diet quality and physical activity. Outcome measures included process measures, open-ended questions, and the Family Nutrition and Physical Activity scale. Results: Forty-five families completed an average of 2.1 health coach in-person visits, including 15 families lost to follow-up. Parents who stayed in the intervention reported the intervention was helpful. Some families and the health coach had difficulties contacting one another, and some of these families reported they would have liked more sessions with the coach. The Family Nutrition and Physical Activity scores improved significantly for all children (6 months: 2.9; p < .01; 12 months: 3.2; p < .05) and at 6 months for index children (6 months: 3.5; p < .01; 12 months: 2.9; p = .09). There was variation in the FNPA and other outcome changes between families. Conclusion: This intervention was feasible in terms of recruitment and delivery of family sessions and community referrals and acceptable to participants, but maintaining contact with participants was difficult. Findings warrant improvements to help retention and logistical aspects of communication between families and coaches and testing in a randomized, controlled trial.
Collapse
Affiliation(s)
- Helena H Laroche
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Children's Mercy Hospital and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jennifer Park-Mroch
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Health & Well-Being, University of Wisconsin-Extension, Madison, WI, USA
| | - Amy O'Shea
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Sarai Rice
- Des Moines Area Religious Council (DMARC), Des Moines, IA, USA
| | - Yolanda Cintron
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | | |
Collapse
|
15
|
Carrere J, Belvis F, Peralta A, Marí-Dell'Olmo M, López MJ, Benach J, Novoa AM. Effectiveness of an Energy-Counseling Intervention in Reducing Energy Poverty: Evidence from a Quasi-Experimental Study in a Southern European City. J Urban Health 2022; 99:549-561. [PMID: 35622196 PMCID: PMC9187783 DOI: 10.1007/s11524-022-00642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Energy poverty is a serious social problem with well-known adverse health consequences. This problem has been addressed mainly through improvements in the energy efficiency of housing. Still, little is known about the effects of information-based measures on energy poverty and their impacts on health. A quasi-experimental study was implemented to assess the effectiveness of an energy-counseling home visit intervention targeting the vulnerable population in a southern European city, Barcelona, in alleviating energy poverty and improving health. The intervention had beneficial impacts on keeping homes at an adequate indoor temperature and reducing primary care visits. No effects were found on self-perceived health or self-reported anxiety and depression. After the intervention, participants reported a decrease in arrears on utility bills, but less pronounced than in the comparison group. In conclusion, the study showed that information-based measures lead to psychosocial gains and reduced healthcare use. Nevertheless, the impact of these measures could be enhanced by combining them with policies and programmes that address the structural determinants of energy poverty.
Collapse
Affiliation(s)
- Juli Carrere
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Francesc Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain
| | - Andrés Peralta
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain.,UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
16
|
Liese AD, Davis RE, Diaz D, Stucker J, Reid LA, Jindal M, Stancil M, Jones SJ. Experiences of Food Insecurity and Type 2 Diabetes Management in Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2020.1826380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rachel E. Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diana Diaz
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica Stucker
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren A. Reid
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Meenu Jindal
- Department of Internal Medicine, Prisma Health Upstate, Greenville, SC, USA
| | - Michelle Stancil
- Department of Diabetes Management, Prisma Health Upstate, Greenville
| | - Sonya J. Jones
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
17
|
Jin AS, Sanders KT. Analyzing changes to U.S. municipal heat response plans during the COVID-19 pandemic. ENVIRONMENTAL SCIENCE & POLICY 2022; 128:347-358. [PMID: 34867081 PMCID: PMC8629748 DOI: 10.1016/j.envsci.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 05/10/2023]
Abstract
Extreme heat events are the deadliest weather-related event in the United States. Cities throughout the United States have worked to develop heat adaptation strategies to limit the impact of extreme heat on vulnerable populations. However, the COVID-19 pandemic presented unprecedented challenges to local governments. This paper provides a preliminary review of strategies and interventions used to manage compound COVID-19-extreme heat events in the 25 most populous cities of the United States. Heat adaptation strategies employed prior to the COVID-19 pandemic were not adequate to meet during the co-occurring compound hazard of COVID-19-EHE. Long-term climate-adaptation strategies will require leveraging physical, financial, and community resources across multiple city departments to meet the needs of compound hazards, such as COVID-19 and extreme heat.
Collapse
Affiliation(s)
- Andrew Shida Jin
- Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, CA, United States
- Environmental Laboratory, US Army Engineer Research and Development Center, Vicksburg, MS, United States
| | - Kelly T Sanders
- Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
18
|
Noerper TE, Elmore MR, Hickman RB, Shea MT. Food Insecurity: Child Care Programs' Perspectives. Matern Child Health J 2022; 26:309-318. [PMID: 34997439 PMCID: PMC8813683 DOI: 10.1007/s10995-021-03320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/04/2022]
Abstract
Background Households experiencing "food insecurity" have limited access to food due to a lack of money or resources. Poor nutrition, from food insecurity, can impact physical and cognitive development of children. Study objectives were to document the prevalence of Tennessee child care programs screening for food insecurity, explore differences between programs receiving child and adult care food program (CACFP) funding and those screening for food insecurity, and understand possible burdens food insecurity places on child care families as perceived by child care program directors. Methods In this cross-sectional study of licensed Tennessee child care programs, a 10-question survey and four-question follow-up survey were electronically distributed. Analysis included descriptive statistics, a chi-square of programs receiving CACFP funds and screening for food insecurity, and themes analysis of open-ended responses. Results The average child care program enrollment (N = 272) was 80.16 with programs serving mostly preschoolers (98.53%) and toddlers (91.91%). Over half (56.99%) of programs reported they received CACFP funding, yet only 9.19% screen for food insecurity. Chi-square analysis found that programs receiving CACFP funds differ significantly on whether they screen households for food insecurity \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\chi$$\end{document}χ2 (1, n = 237) = 16.93, p ≤ 0.001. Themes analysis (n = 41) revealed that many child care program directors do not view food insecurity as a burden for families. Conclusions Child care programs receiving CACFP funds are more likely to screen families for food insecurity than programs who do not. Programs indicate a willingness to include food insecurity screening questions on child care paperwork.
Collapse
Affiliation(s)
- Tracy E Noerper
- Department of Nutrition, Lipscomb University, One University Park Drive, Nashville, TN, 37204, USA.
| | - Morgan R Elmore
- Department of Nutrition, Lipscomb University, One University Park Drive, Nashville, TN, 37204, USA
| | - Rachel B Hickman
- Texas Tech University, 2500 Broadway Avenue, Lubbock, TX, 79409, USA
| | - Madison T Shea
- East Tennessee State University, 1276 Gilbreath Drive, Johnson City, TN, 37614, USA
| |
Collapse
|
19
|
A randomized controlled trial of a community-based obesity intervention utilizing motivational interviewing and community resource mobilization for low-income families: Study protocol and baseline characteristics. Contemp Clin Trials 2022; 112:106626. [PMID: 34801731 PMCID: PMC8805455 DOI: 10.1016/j.cct.2021.106626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023]
Abstract
Low-income, racially diverse families with one parent with obesity are at high risk for child obesity. Effective approaches to promote healthy behaviors and prevent additional weight gain in family members are needed. Motivational interviewing (MI) may assist families to engage, identify motivations for change and establish goals. However, families with limited resources face other barriers to goal achievement that may be addressed through connection with community organizations. This paper describes a unique protocol combining MI and community connection. This randomized controlled trial includes low-income families with one parent with obesity and at least one child aged 6 to 12 years. Families in the intervention group receive an innovative, 12-month intervention combining health coaching using MI to promote lifestyle behavior change goals and community resource mobilization to assist with basic needs and resources to aid goals. The study protocol is modeled on community-based participatory research principles. Data is collected at baseline, 6 months, 12 months, and 18 months include questionnaires, body measurements, and accelerometer data. For adults, primary outcomes are Body Mass Index (BMI), minutes of moderate to vigorous physical activity (MVPA), and hours of sedentary time per day. For children, primary outcomes are sedentary time, MVPA, and the Family Nutrition and Physical Activity Score. From this hard-to-reach population, 236 diverse families were recruited. If the study is deemed effective, it has the potential to demonstrate that the combination of MI, resource mobilization, and utilization of existing community organizations is a sustainable model to assist families at risk for obesity.
Collapse
|
20
|
Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatr Rev 2021; 42:590-603. [PMID: 34725219 DOI: 10.1542/pir.2020-001883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Margot N Tang
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Soukaina Adolphe
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| |
Collapse
|
21
|
Umaretiya PJ, Revette A, Seo A, Flamand Y, Ilcisin L, Zheng DJ, Bhatia S, Wolfe J, Bona K. PediCARE: Development of a poverty-targeted intervention for pediatric cancer. Pediatr Blood Cancer 2021; 68:e29195. [PMID: 34190405 PMCID: PMC8384686 DOI: 10.1002/pbc.29195] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poverty is associated with inferior psychosocial outcomes, higher rates of relapse, and decreased overall survival in children with cancer. Despite this, there are few evidence-based, poverty-targeted interventions and none specific to pediatric oncology. To address this gap, we developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention, a household material hardship (HMH) targeted intervention providing transportation and groceries to pediatric oncology families. METHODS This was a single-arm pilot study conducted at a single, large, tertiary pediatric cancer center. Newly diagnosed patients with HMH-exposure were directly assigned to receive PediCARE for a total of three months. Quantitative and qualitative approaches were used to evaluate its acceptability and to rapidly refine the intervention. RESULTS Nine families (100% of those approached) consented to enrollment with no attrition over the three-month study period. Families were highly satisfied with the intervention and recommended participation to others. All of the families utilized the grocery delivery component of PediCARE, and seven utilized the transportation component. Qualitative participant feedback was used to rapidly refine the intervention including logistics of intervention delivery, and dose of intervention components. CONCLUSION PediCARE, a poverty-targeted intervention, was highly acceptable to pediatric oncology families. The intervention was refined in real-time utilizing quantitative and qualitative feedback. Next steps include intervention evaluation in a randomized, controlled feasibility study.
Collapse
Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Anna Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Seo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA,Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, MA
| |
Collapse
|
22
|
Between Poverty and Energy Satisfaction in Polish Households Run by People Aged 60 and Older. ENERGIES 2021. [DOI: 10.3390/en14196032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The household sector contributes significantly to a country’s energy consumption. Energy carrier expenses are the highest expenditures in Polish household budgets. Households run by individuals aged 60 and older are heavily burdened with energy expenditures. The scientific aim of the research is to present and assess housing conditions, with particular emphasis on energy poverty in households run by individuals aged 60 and older. Multivariate statistical analyses were used to conduct the research objectives (cluster methods, variance methods, regression methods). This paper identifies a new index—one that has been applied to the situation in Poland. Households that consist of elderly people are strongly diversified in terms of housing conditions (including energy conditions). There are concerns that some households are not able to access energy services that are required to satisfy basic human needs, particularly individuals with low levels of education, living on social benefits, with low disposable incomes, or living in the countryside. Households represented by men aged 60 and older have better energy supply than households run by women. The older the individual representing the household, the greater the likelihood that his/her energy service needs are not met.
Collapse
|
23
|
Girard-Buttoz C, Tkaczynski PJ, Samuni L, Fedurek P, Gomes C, Löhrich T, Manin V, Preis A, Valé PF, Deschner T, Wittig RM, Crockford C. Early maternal loss leads to short- but not long-term effects on diurnal cortisol slopes in wild chimpanzees. eLife 2021; 10:e64134. [PMID: 34133269 PMCID: PMC8208813 DOI: 10.7554/elife.64134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
The biological embedding model (BEM) suggests that fitness costs of maternal loss arise when early-life experience embeds long-term alterations to hypothalamic-pituitary-adrenal (HPA) axis activity. Alternatively, the adaptive calibration model (ACM) regards physiological changes during ontogeny as short-term adaptations. Both models have been tested in humans but rarely in wild, long-lived animals. We assessed whether, as in humans, maternal loss had short- and long-term impacts on orphan wild chimpanzee urinary cortisol levels and diurnal urinary cortisol slopes, both indicative of HPA axis functioning. Immature chimpanzees recently orphaned and/or orphaned early in life had diurnal cortisol slopes reflecting heightened activation of the HPA axis. However, these effects appeared short-term, with no consistent differences between orphan and non-orphan cortisol profiles in mature males, suggesting stronger support for the ACM than the BEM in wild chimpanzees. Compensatory mechanisms, such as adoption, may buffer against certain physiological effects of maternal loss in this species.
Collapse
Affiliation(s)
- Cédric Girard-Buttoz
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
| | - Patrick J Tkaczynski
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
| | - Liran Samuni
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
- Department of Primatology, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Department of Human Evolutionary Biology, Harvard UniversityCambridgeUnited States
| | - Pawel Fedurek
- Division of Psychology, University of StirlingStirlingUnited Kingdom
| | - Cristina Gomes
- Tropical Conservation Institute, Florida International UniversityMiamiUnited States
| | - Therese Löhrich
- World Wide Fund for Nature, Dzanga Sangha Protected AreasBanguiCentral African Republic
- Robert Koch Institute, Epidemiology of Highly Pathogenic MicroorganismsBerlinGermany
| | - Virgile Manin
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
| | - Anna Preis
- Department of Primatology, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
| | - Prince F Valé
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
- Department of Primatology, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Centre Suisse de Recherches Scientifiques en Côte d'IvoireAbidjanCôte d'Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët BoignyAbidjanCôte d'Ivoire
| | - Tobias Deschner
- Interim Group Primatology, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
| | - Roman M Wittig
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
| | - Catherine Crockford
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary AnthropologyLeipzigGermany
- Taï Chimpanzee Project, Centre Suisse de Recherches ScientifiquesAbidjanCôte d'Ivoire
- Institut des Sciences Cognitives, CNRSLyonFrance
| |
Collapse
|
24
|
Determinants of the Energy Poverty of Polish Students during the COVID-19 Pandemic. ENERGIES 2021. [DOI: 10.3390/en14113233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to define the factors influencing the level of energy poverty among students. The analysis of these factors is based on the results of a survey conducted among a group of 937 students at the Cracow University of Economics. The study takes into consideration the changes in the attitudes and behavior of students resulting from the introduction of distance learning during the COVID-19 pandemic. The switch to distance learning resulted in a significant increase in the number of responses related to feeling ill or sick due to inadequate temperature (from 24% before a lockdown to 32% after the introduction of a lockdown). Students experienced temporary surges in their overall living costs due to the pandemic, especially during the first wave. The respondents who experienced inappropriate temperatures (inadequate heating) due to excessive costs felt ill or became sick more often than others. The study demonstrated that those who pay more for energy (defined as a surplus payment in excess of 10%) tended to be, on average, less energy-aware than others. The following indicators of energy poverty among the students were distinguished: high living costs, small degree of influence over the choice of living quarters, as well as concerns over energy efficiency and environment. The conclusions drawn from the conducted studies may be utilized to design public policies aimed at curtailing the phenomenon of energy poverty among students. This issue is particularly prominent in large urban agglomerations where the costs of living are high and result in the feeling of pressure regarding the need to save money on thermal energy consumption.
Collapse
|
25
|
Abstract
Latino children face barriers to high-quality healthcare. Because children with medical complexity (CMC) have higher healthcare needs, Latino CMC are likely to experience greater effects of these barriers. These vulnerabilities are exacerbated when Latino CMC endure adverse social conditions, such as food insecurity and housing instability. The study objective was to describe the challenges faced by caregivers of Latino CMC in meeting the practical needs of their children when caring for them at home. In this qualitative study, 70 Latino CMC enrolled in a complex care program of a tertiary care children's hospital were followed for a median duration of 45 months. We collected care coordination notes from encounter logs and interviewed bilingual care coordinators regarding their experiences with each child. Using thematic content analysis and an iterative process, we identified recurrent themes related to practical needs. Four themes emerged. Caregivers: 1) faced financial challenges due to many reasons that were exacerbated by children's medical conditions; 2) had challenges meeting basic needs of their families, including food and shelter; 3) experienced difficulties obtaining necessary medical supplies for their children; and 4) relied on care coordinators to navigate the system. We conclude that Latino caregivers of CMC experience many challenges meeting their families' basic needs and obtaining necessary medical supplies to care for their CMC at home. Care coordinators play a major role in addressing the practical needs of Latino CMC. Future studies should determine whether addressing the practical needs of Latino CMC would improve their health outcomes.
Collapse
|
26
|
Bona K, Brazauskas R, He N, Lehmann L, Abdel-Azim H, Ahmed IA, Al-Homsi AS, Aljurf M, Arnold SD, Badawy SM, Battiwalla M, Beattie S, Bhatt NS, Dalal J, Dandoy CE, Diaz MA, Frangoul HA, Freytes CO, Ganguly S, George B, Gomez-Almaguer D, Hahn T, Kamble RT, Knight JM, LeMaistre CF, Law J, Lazarus HM, Majhail NS, Olsson RF, Preussler J, Savani BN, Schears R, Seo S, Sharma A, Srivastava A, Steinberg A, Szwajcer D, Wirk B, Yoshimi A, Khera N, Wood WA, Hashmi S, Duncan CN, Saber W. Neighborhood poverty and pediatric allogeneic hematopoietic cell transplantation outcomes: a CIBMTR analysis. Blood 2021; 137:556-568. [PMID: 33104215 PMCID: PMC7845011 DOI: 10.1182/blood.2020006252] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age ≤18 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (≥20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.
Collapse
Affiliation(s)
- Kira Bona
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Naya He
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Staci D Arnold
- Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Neel S Bhatt
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jignesh Dalal
- Rainbow Babies and Children's Hospital, Cleveland Case Western Reserve School of Medicine, Cleveland, OH
| | - Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Haydar A Frangoul
- Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN
| | | | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - David Gomez-Almaguer
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Theresa Hahn
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Jennifer M Knight
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jason Law
- Division of Pediatric Hematology/Oncology, Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Jaime Preussler
- CIBMTR, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Raquel Schears
- Department of Emergency Medicine, University of Central Florida, Orlando, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Alok Srivastava
- Centre for Stem Cell Research, Christian Medical College, Vellore, India
| | - Amir Steinberg
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY
| | - David Szwajcer
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, MN; and
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Christine N Duncan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and
| |
Collapse
|
27
|
Reames TG, Daley DM, Pierce JC. Exploring the Nexus of Energy Burden, Social Capital, and Environmental Quality in Shaping Health in US Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E620. [PMID: 33450890 PMCID: PMC7828329 DOI: 10.3390/ijerph18020620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/04/2022]
Abstract
The United States spends more on health care than any other OECD country, yet the nation's health is declining. Recent research has identified multiple sources for this decline, including one's position in social and economic structures, environmental quality, and individual and collective social capital. This paper assesses the primary hypotheses that the health effects of household energy burden, social capital and environmental quality on aggregated community health levels remain while controlling for other determinants. The analysis moves beyond prior research by integrating multiple secondary data sources to assess those effects across US counties. Three indicators of public health are analyzed (premature mortality, self-reported health, and life expectancy). The county-level energy burden is measured by the percent of household income spent on housing energy bills for low- and moderate-income households. In addition to energy burden, social capital, environmental quality and other determinants are included in the analysis. The results produced by multivariate regression models support the primary hypotheses, even while a number of control variables also have a significant effect on health. The paper concludes that public health is associated with a complex nexus of factors, including environmental quality and social capital, and that energy burden needs to be among the considerations.
Collapse
Affiliation(s)
- Tony G. Reames
- School for Environment & Sustainability, University of Michigan, 440 Church St., Ann Arbor, MI 48109, USA
| | - Dorothy M. Daley
- School of Public Affairs & Administration and Environmental Studies Program, University of Kansas, Lawrence, KS 66045, USA;
| | - John C. Pierce
- School of Public Affairs & Administration, University of Kansas, Lawrence, KS 66045, USA;
| |
Collapse
|
28
|
Marcil LE, Hole MK, Jackson J, Markowitz MA, Rosen L, Sude L, Rosenthal A, Bennett MB, Sarkar S, Jones N, Topel K, Chamberlain LJ, Zuckerman B, Kemper AR, Solomon BS, Bair-Merritt MH, Schickedanz A, Vinci RJ. Anti-Poverty Medicine Through Medical-Financial Partnerships: A New Approach to Child Poverty. Acad Pediatr 2021; 21:S169-S176. [PMID: 34740425 PMCID: PMC9053836 DOI: 10.1016/j.acap.2021.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/30/2022]
Abstract
Poverty threatens child health. In the United States, financial strain, which encompasses income and asset poverty, is common with many complex etiologies. Even relatively successful antipoverty programs and policies fall short of serving all families in need, endangering health. We describe a new approach to address this pervasive health problem: antipoverty medicine. Historically, medicine has viewed poverty as a social problem outside of its scope. Increasingly, health care has addressed poverty's downstream effects, such as food and housing insecurity. However, strong evidence now shows that poverty affects biology, and thus, merits treatment as a medical problem. A new approach uses Medical-Financial Partnerships (MFPs), in which healthcare systems and financial service organizations collaborate to improve health by reducing family financial strain. MFPs help families grow assets by increasing savings, decreasing debt, and improving credit and economic opportunity while building a solid foundation for lifelong financial, physical, and mental health. We review evidence-based approaches to poverty alleviation, including conditional and unconditional cash transfers, savings vehicles, debt relief, credit repair, financial coaching, and employment assistance. We describe current national MFPs and highlight different applications of these evidence-based clinical financial interventions. Current MFP models reveal implementation opportunities and challenges, including time and space constraints, time-sensitive processes, lack of familiarity among patients and communities served, and sustainability in traditional medical settings. We conclude that pediatric health care practices can intervene upon poverty and should consider embracing antipoverty medicine as an essential part of the future of pediatric care.
Collapse
Affiliation(s)
- Lucy E Marcil
- Department of Pediatrics, Boston University School of Medicine (LE Marcil, B Zuckerman, RJ Vinci), Boston, Mass.
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin (ML Hole, L Rosen, MB Bennett), Austin, Tex
| | - Jasmyne Jackson
- Boston Combined Residency Program, Boston Medical Center and Boston Children's Hospital (J Jackson). Boston, Mass
| | - Molly A Markowitz
- Yale Pediatrics Residency Program, Yale University School of Medicine (MA Markowitz, L Sude), New Haven, Conn
| | - Laura Rosen
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin (ML Hole, L Rosen, MB Bennett), Austin, Tex
| | - Leslie Sude
- Yale Pediatrics Residency Program, Yale University School of Medicine (MA Markowitz, L Sude), New Haven, Conn
| | - Alice Rosenthal
- Center for Children's Advocacy (A Rosenthal), New Haven, Conn
| | - Mary Beth Bennett
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin (ML Hole, L Rosen, MB Bennett), Austin, Tex
| | - Sonia Sarkar
- P3 Lab, SNF Agora Institute, Johns Hopkins University (S Sarkar), Baltimore, Md
| | - Nicholas Jones
- Nationwide Children's Hospital (N Jones, AR Kemper), Columbus, Ohio
| | - Kristin Topel
- Division of General Pediatrics, Johns Hopkins University School of Medicine (K Topel, BS Solomon), Baltimore, Md
| | - Lisa J Chamberlain
- Division of General Pediatrics, Stanford University School of Medicine (LJ Chamberlain), Stanford, Calif
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine (LE Marcil, B Zuckerman, RJ Vinci), Boston, Mass
| | - Alex R Kemper
- Nationwide Children's Hospital (N Jones, AR Kemper), Columbus, Ohio
| | - Barry S Solomon
- Division of General Pediatrics, Johns Hopkins University School of Medicine (K Topel, BS Solomon), Baltimore, Md
| | - Megan H Bair-Merritt
- Division of Academic General Pediatrics, Boston Medical Center (MH Bair-Merritt), Boston, Mass
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz), Los Angeles, Calif
| | - Robert J Vinci
- Department of Pediatrics, Boston University School of Medicine (LE Marcil, B Zuckerman, RJ Vinci), Boston, Mass
| |
Collapse
|
29
|
Marcil LE, Beck AF. A National Prescription for Health: Tax Credits. Pediatrics 2020; 146:peds.2019-3386. [PMID: 33008844 DOI: 10.1542/peds.2019-3386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lucy E Marcil
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; .,Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts; and
| | | |
Collapse
|
30
|
Lichtin RD, Merz EC, He X, Desai PM, Simon KR, Melvin SA, Maskus EA, Noble KG. Material hardship, prefrontal cortex-amygdala structure, and internalizing symptoms in children. Dev Psychobiol 2020; 63:364-377. [PMID: 32754912 DOI: 10.1002/dev.22020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Material hardship, or difficulty affording basic resources such as food, housing, utilities, and health care, increases children's risk for internalizing problems. The uncinate fasciculus (UNC) and two of the gray matter regions it connects-the orbitofrontal cortex (OFC) and amygdala-may play important roles in the neural mechanisms underlying these associations. We investigated associations among material hardship, UNC microstructure, OFC and amygdala structure, and internalizing symptoms in children. Participants were 5-9-year-old children (N = 94, 61% female) from socioeconomically diverse families. Parents completed questionnaires assessing material hardship and children's internalizing symptoms. High-resolution, T1-weighted magnetic resonance imaging (n = 51), and diffusion tensor imaging (n = 58) data were acquired. UNC fractional anisotropy (FA), medial OFC surface area, and amygdala gray matter volume were extracted. Greater material hardship was significantly associated with lower UNC FA, smaller amygdala volume, and higher internalizing symptoms in children, after controlling for age, sex, and family income-to-needs ratio. Lower UNC FA significantly mediated the association between material hardship and internalizing symptoms in girls but not boys. These findings are consistent with the notion that material hardship may lead to altered white matter microstructure and gray matter structure in neural networks critical to emotion processing and regulation.
Collapse
Affiliation(s)
- Rebecca D Lichtin
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily C Merz
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Xiaofu He
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, and the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Pooja M Desai
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Katrina R Simon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Samantha A Melvin
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Elaine A Maskus
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Kimberly G Noble
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
31
|
Atkins M, Castro I, Sharifi M, Perkins M, O'Connor G, Sandel M, Taveras EM, Fiechtner L. Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019. Am J Public Health 2020; 110:S251-S257. [PMID: 32663093 DOI: 10.2105/ajph.2020.305772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.
Collapse
Affiliation(s)
- Micaela Atkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Ines Castro
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Mona Sharifi
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Meghan Perkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Giselle O'Connor
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Megan Sandel
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Elsie M Taveras
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Lauren Fiechtner
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| |
Collapse
|
32
|
Climate Change Mitigation Policies Targeting Households and Addressing Energy Poverty in European Union. ENERGIES 2020. [DOI: 10.3390/en13133389] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change mitigation measures linked to households’ energy consumption have huge greenhouse gases (GHG) emission reduction potential and positive impact on energy poverty reduction. However, measures such as renovation of residential buildings or installation of micro generation technologies based on renewable energy sources have not realized their full energy saving and GHG emission reduction potentials, due to the energy efficiency paradox and other barriers. These climate change mitigation policies targeting the households’ sector can deliver extra benefits such as energy poverty reduction and implementation of the energy justice principle; therefore, they require more attention of scholars and policy makers. The aim of this paper is to analyze the energy poverty and climate change mitigation issues in EU households based on a systematic literature review, and to provide future research paths and policy recommendations. Based on the systematic literature review, this paper develops an integrated framework for addressing energy poverty, just carbon free energy transition and climate change mitigation issues in the EU. Additionally, we argue that more targeted climate change policies and measures are necessary in the light of the shortcomings of current measures to reduce energy poverty and realize climate change mitigation potential linked to energy consumption in households.
Collapse
|
33
|
Kahn PA, Daggula KR, Teng W, Hintz RC, Berland G. Medical Exemption From Disconnection of Utilities in Connecticut. JAMA 2020; 323:1189-1190. [PMID: 32207786 PMCID: PMC7093762 DOI: 10.1001/jama.2020.0542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the Connecticut Public Utilities Regulatory Authority to describe trends in medical exemptions from utility disconnection and characteristics and health care use of adults applying for such exemptions at a Yale New Haven Hospital care practice between 2011 and 2017.
Collapse
Affiliation(s)
- Peter A. Kahn
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Krishna R. Daggula
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Wei Teng
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Richard C. Hintz
- Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut
| | - Gretchen Berland
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
34
|
Fuller AE, Garg A, Brown NM, Tripodis Y, Oyeku SO, Gross RS. Relationships Between Material Hardship, Resilience, and Health Care Use. Pediatrics 2020; 145:peds.2019-1975. [PMID: 31949000 PMCID: PMC6993324 DOI: 10.1542/peds.2019-1975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Material hardship has been associated with adverse health care use patterns for children with special health care needs (CSHCN). In this study, we assessed if resilience factors were associated with lower emergency department (ED) visits and unmet health care needs and if they buffered associations between material hardship and health care use for CSHCN and children without special health care needs. METHODS A cross-sectional study using the 2016 National Survey of Children's Health, restricted to low-income participants (<200% federal poverty level). Separately, for CSHCN and children without special health care needs, weighted logistic regression was used to measure associations between material hardship, 2 resilience factors (family resilience and neighborhood cohesion), and 2 measures of use. Moderation was assessed using interaction terms. Mediation was assessed using structural equation models. RESULTS The sample consisted of 11 543 children (weighted: n = 28 465 581); 26% were CSHCN. Material hardship was associated with higher odds of ED visits and unmet health care needs for all children. Resilience factors were associated with lower odds of unmet health care needs for CSHCN (family resilience adjusted odds ratio: 0.58; 95% confidence interval: 0.36-0.94; neighborhood cohesion adjusted odds ratio: 0.53; 95% confidence interval: 0.32-0.88). For CSHCN, lower material hardship mediated associations between resilience factors and unmet health care needs. Neighborhood cohesion moderated the association between material hardship and ED visits (interaction term: P = .02). CONCLUSIONS Among low-income CSHCN, resilience factors may buffer the effects of material hardship on health care use. Future research should evaluate how resilience factors can be incorporated into programs to support CSHCN.
Collapse
Affiliation(s)
- Anne E. Fuller
- Division of Paediatric Medicine, Department of
Paediatrics, Hospital for Sick Children, University of Toronto, Toronto,
Ontario, Canada;,Division of Academic General Pediatrics, Department
of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital
at Montefiore, Bronx, New York
| | - Arvin Garg
- Division of General Pediatrics, Department of
Pediatrics, Boston Medical Center and Boston University School of Medicine,
Boston, Massachusetts
| | - Nicole M. Brown
- Division of Academic General Pediatrics, Department
of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital
at Montefiore, Bronx, New York
| | - Yorghos Tripodis
- Department of Biostatistics, School of Public Health,
Boston University, Boston, Massachusetts
| | - Suzette O. Oyeku
- Division of Academic General Pediatrics, Department
of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital
at Montefiore, Bronx, New York
| | - Rachel S. Gross
- Division of General Pediatrics, Department of
Pediatrics, School of Medicine, New York University and New York City Health and
Hospitals/Bellevue, New York, New York; and,Department of Population Health, School of Medicine,
New York University, New York, New York
| |
Collapse
|
35
|
Jessel S, Sawyer S, Hernández D. Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature. Front Public Health 2019; 7:357. [PMID: 31921733 PMCID: PMC6920209 DOI: 10.3389/fpubh.2019.00357] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022] Open
Abstract
Household energy is increasingly vital for maintaining good health. Unaffordable and inadequate household energy presents adverse consequences that are amplified by poverty and a changing climate. To date, the connections between energy, socioeconomic disadvantage, and well-being are generally underappreciated, and household energy connection with climate change is under-researched. Building on the energy insecurity framework, this review explores literature related to household energy, poverty, and health in order to highlight the disproportionate burdens borne by vulnerable populations in adequately meeting household energy needs. This paper is based on a comprehensive review of books, peer-reviewed articles, and reports published between 1990 and 2019, identified via databases including JSTOR and PubMed. A total of 406 publications were selected as having potential for full review, 203 received full review, and 162 were included in this paper on the basis of set inclusion criteria. From the literature review, we created an original heuristic model that describes energy insecurity as either acute or chronic, and we further explore the mediators and pathways that link energy insecurity to health. In the discussion, we posit that the extant literature does not sufficiently consider that vulnerable communities often experience energy insecurity bundled with other hardships. We also discuss energy, poverty, and health through the lens of climate change, making the criticism that most research on household energy does not consider climate change. This evidence is important for enhancing research in this field and developing programmatic and policy interventions as they pertain to energy access, affordability, and health, with special emphasis on vulnerable populations, climate change, and social inequality.
Collapse
Affiliation(s)
- Sonal Jessel
- Helibrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Samantha Sawyer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Diana Hernández
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| |
Collapse
|
36
|
Dopp AR, Lantz PM. Moving Upstream to Improve Children’s Mental Health Through Community and Policy Change. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:779-787. [DOI: 10.1007/s10488-019-01001-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Material Hardships and Health Care Utilization Among Low-Income Children with Special Health Care Needs. Acad Pediatr 2019; 19:733-739. [PMID: 30853575 DOI: 10.1016/j.acap.2019.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Material hardships, defined as difficulty meeting basic needs, are associated with adverse child health outcomes, including suboptimal health care utilization. Children with special health care needs (CSHCN) may be more vulnerable to the effects of hardships. Our objective was to determine associations between material hardships and health care utilization among CSHCN. METHODS We conducted a cross-sectional study surveying caregivers of 2- to 12-year-old CSHCN in a low-income, urban area. Independent variables were parent-reported material hardships: difficulty paying bills, food insecurity, housing insecurity, and health care hardship. Dependent variables were parent-reported number of emergency department (ED) visits, any hospital admission, and any unmet health care need. We used negative binomial and logistic regression to assess for associations between each hardship and each outcome. RESULTS We surveyed 205 caregivers between July 2017 and May 2018 and analyzed the data in 2018. After adjustment, difficulty paying bills (incidence rate ratio [IRR], 1.51; 95% confidence interval [CI], 1.08-2.12) and health care hardship (IRR, 1.72; 95% CI, 1.08-2.75) were associated with higher rates of ED visits. There were no associations between hardships and hospital admission. Difficulty paying bills (adjusted odds ratio [AOR], 2.13; 95% CI, 1.14-3.98), food insecurity (AOR, 1.95; 95% CI, 1.02-3.71), and housing insecurity (AOR, 2.71; 95% CI, 1.36-5.40) were associated with higher odds of unmet health care need. CONCLUSIONS Material hardships were associated with higher rates of ED visits and greater unmet health care need among low-income CSHCN. Future examination of the mechanisms of these associations is needed to enhance support for families of CSHCN.
Collapse
|
38
|
Lazow MA, DeBlasio D, Ollberding NJ, Real FJ, Klein MD. Online Simulated Cases Assess Retention of Virtual Neighborhood Tour Curriculum. Matern Child Health J 2019; 23:1159-1166. [PMID: 31267340 DOI: 10.1007/s10995-019-02790-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Learning to identify and address social determinants of health (SDH) is a crucial component of pediatric residency training. A virtual tour of an impoverished neighborhood previously demonstrated efficacy in increasing residents' self-assessed knowledge and competence, but its impact on performance has not yet been reported. Online simulated cases are emerging as feasible assessment tools to measure trainees' skills across various healthcare settings. We developed online simulated cases to evaluate residents' retention of the virtual tour's key SDH-related learning objectives 1 month after completing this curriculum. Methods Three online simulated cases with interpolated open-ended questions were created to assess residents' ability to identify SDH, recommend appropriate resources, and display empathy. Scoring rubrics to objectively evaluate responses were developed and borderline scores were decided by a team of educators. Results 19 residents participated. Mean scores for all cases exceeded pre-established borderline scores (statistically significant in two of the three cases). More than 90% of residents identified relevant SDH in the primary care and emergency department cases. Ninety-five percent of residents recommended appropriate resources in all cases, and 89% displayed empathy. Discussion Residents' performance in online simulated cases demonstrated retention and application of the virtual tour's learning objectives, including recognizing SDH, offering appropriate resources, and displaying empathy, which supports the long-term effectiveness of the virtual tour curriculum to train pediatricians about SDH. Online simulated cases provided a standardized and cost-effective way to measure residents' skills related to curricular uptake, suggesting that this assessment approach may be adapted to evaluate other educational interventions.
Collapse
Affiliation(s)
- Margot A Lazow
- Division of Pediatric Hematology/Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Dominick DeBlasio
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| |
Collapse
|
39
|
Hernández D, Siegel E. Energy insecurity and its ill health effects: A community perspective on the energy-health nexus in New York City. ENERGY RESEARCH & SOCIAL SCIENCE 2019; 47:78-83. [PMID: 32280598 PMCID: PMC7147484 DOI: 10.1016/j.erss.2018.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study examines the effects of a novel construct - energy insecurity - on adverse health in a community-based sample in New York City. Using a 2015 cross-sectional study of 2,494 households in Washington Heights, we described the socio-demographic characteristics of energy insecure households and examined the association between energy insecurity and health outcomes using logistic regression models. Twenty-seven percent of participants were energy insecure. Racial/ethnic minorities, households with children, long-term neighborhood residents, and those with poor housing conditions were more likely to be energy insecure; meanwhile, middle income households were not fully protect against energy insecurity. Energy insecurity was significantly associated with poor respiratory, mental health, and sleep outcomes; it was not associated with metabolic disorders, accidents, or neighborhood violence and cohesion. This study indicates that energy insecurity may explain some existing respiratory and mental health-related disparities in vulnerable populations. More research on energy insecurity is needed along with refinement of its measurement.
Collapse
Affiliation(s)
- Diana Hernández
- Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
- Corresponding author. (D. Hernández), (E. Siegel)
| | - Eva Siegel
- Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| |
Collapse
|
40
|
Zheng DJ, Shyr D, Ma C, Muriel A, Wolfe J, Bona K. Feasibility of systematic poverty screening in a pediatric oncology referral center. Pediatr Blood Cancer 2018; 65:e27380. [PMID: 30069999 PMCID: PMC6193823 DOI: 10.1002/pbc.27380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Based on the strong link between poverty and child health outcomes, both the American Academy of Pediatrics (AAP) and national pediatric oncology associations have advocated for routine clinical poverty screening. Systematic implementation of this recommendation in pediatric oncology is not yet standard, and feasibility data are needed. We report the feasibility of routine poverty screening in a pediatric oncology referral center and baseline poverty characteristics of this population. METHODS From 2013 to 2017, 448 families with newly diagnosed pediatric cancer at Dana-Farber/Boston Children's Cancer and Blood Disorders Center were offered the Psychosocial Assessment Tool 2.0 (PAT) as part of routine care. The PAT includes a two-item screen for household material hardship (HMH). All families were asked about annual household income by a resource specialist. Data were abstracted with sociodemographic and child/disease characteristics. Descriptive statistics are reported. RESULTS Four hundred and thirteen families completed the PAT (response rate 92%), of whom 394 (95%) completed specific questions assessing for HMH. Ninety-four percent of families who met with a resource specialist disclosed their annual household income. One quarter (27%) of families was ≤200% federal poverty level at diagnosis, and 44% of families endorsed at least one domain of HMH. The most frequent domains of HMH included housing (24%), utilities (20%), and transportation (20%). CONCLUSIONS Systematic poverty screening per AAP and pediatric oncology psychosocial standards of care is feasible in routine cancer care. There is a high baseline incidence (44%) of HMH in at least one domain in families with newly diagnosed pediatric cancer who may benefit from early identification and resource intervention.
Collapse
Affiliation(s)
- Daniel J. Zheng
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Derek Shyr
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Clement Ma
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Anna Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Joanne Wolfe
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Kira Bona
- Department of Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
41
|
Shim JE, Kim SJ, Kim K, Hwang JY. Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults. Nutrients 2018; 10:nu10101514. [PMID: 30332760 PMCID: PMC6213001 DOI: 10.3390/nu10101514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022] Open
Abstract
Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook’s physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.
Collapse
Affiliation(s)
- Jae Eun Shim
- Department of Food and Nutrition, Daejeon University, Daejeon 34520, Korea.
| | - Seo-Jin Kim
- Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.
| | - Kirang Kim
- Department of Food Science and Nutrition, Dankook University, Cheonan 31116, Korea.
| | - Ji-Yun Hwang
- Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.
| |
Collapse
|
42
|
Affordability and access in focus: Metrics and tools of relative energy vulnerability. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.tej.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
43
|
Bradley EH, Canavan M, Rogan E, Talbert-Slagle K, Ndumele C, Taylor L, Curry LA. Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09. Health Aff (Millwood) 2018; 35:760-8. [PMID: 27140980 DOI: 10.1377/hlthaff.2015.0814] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted.
Collapse
Affiliation(s)
- Elizabeth H Bradley
- Elizabeth H. Bradley is the Brady-Johnson Professor of Grand Strategy and a professor of public health at the Yale School of Public Health, in New Haven, Connecticut
| | - Maureen Canavan
- Maureen Canavan is an associate research scientist in health policy and management at the Yale School of Public Health
| | - Erika Rogan
- Erika Rogan is a doctoral candidate in health policy and management at the Yale School of Public Health
| | - Kristina Talbert-Slagle
- Kristina Talbert-Slagle is a senior scientific officer and lecturer of health policy and management at the Yale School of Public Health
| | - Chima Ndumele
- Chima Ndumele is an assistant professor of health policy and management at the Yale School of Public Health
| | - Lauren Taylor
- Lauren Taylor is a doctoral student at the Harvard Business School, in Boston, Massachusetts
| | - Leslie A Curry
- Leslie A. Curry is a senior research scientist at the Yale School of Public Health
| |
Collapse
|
44
|
Jones SJ, Draper CL, Bell BA, Burke MP, Martini L, Younginer N, Blake CE, Probst J, Freedman D, Liese AD. Child hunger from a family resilience perspective. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2017.1364189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sonya J. Jones
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Carrie L. Draper
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
| | - Bethany A. Bell
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- College of Social Work, University of South Carolina
| | - Michael P. Burke
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- U.S. Department of Agriculture, Food and Nutrition Service
| | - Lauren Martini
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Nicholas Younginer
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Christine E. Blake
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Jan Probst
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Health Services Policy and Management and Director, Arnold School of Public Health, University of South Carolina
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina
| | - Darcy Freedman
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Epidemiology and Biostatistics, Case Western Reserve University
| | - Angela D. Liese
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| |
Collapse
|
45
|
Dual Food and Energy Hardship and Associated Child Behavior Problems. Acad Pediatr 2018; 18:889-896. [PMID: 30006124 PMCID: PMC9366998 DOI: 10.1016/j.acap.2018.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine dual food and energy hardship and internalizing and externalizing behavior problems in 9-year-old children. METHODS We conducted a cross-sectional analysis of the Fragile Families and Child Wellbeing Study, a prospective national urban birth cohort, when the children were 9 years old. Maternal-reported "food hardship" (ever hungry and/or ever received free food) and "energy hardship" (ever unable to pay utility bill and/or utility shutoff) within the past year, and child behavior using the Child Behavior Checklist for Ages 6-18 were assessed. Multiple logistic regression analyses estimated associations between individual and dual food and energy hardship and child behavior problems, adjusting for a priori covariates (ie, child sex, health insurance, maternal sociodemographic characteristics, poverty, reported health, attention deficit hyperactivity disorder, depressive symptoms, smoking, and substance and alcohol abuse). RESULTS Approximately 10% of households reported dual food and energy hardship. Children experiencing dual food and energy hardship had 3 times greater odds of withdrawn/depressed behaviors (adjusted odds ratio [AOR], 2.8; 95% confidence interval [CI], 1.4-5.5), threefold greater odds of somatic complaints (AOR, 3.2; 95% CI, 1.5-6.9), and 4 times greater odds of rule-breaking behavior (AOR, 3.7; 95% CI, 1.5-9.2) in the borderline/clinical range than children with no hardship, and had fourfold greater odds of borderline/clinical range somatic complaints (AOR, 4.2; 95% CI, 1.7-10.3) than children with only energy hardship. CONCLUSIONS Children experiencing dual food and energy hardship have greater odds of coexisting internalizing and externalizing behaviors after controlling for possible confounders. Providers can consider screening and resource referrals for these addressable hardships alongside behavior assessments in the clinical setting.
Collapse
|
46
|
Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States. J Acad Nutr Diet 2017; 117:1991-2002. [PMID: 29173349 DOI: 10.1016/j.jand.2017.09.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Indexed: 02/03/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.
Collapse
|
47
|
Hospital Leadership Recognizes Need to Create Partnerships to Treat Consequences of Poverty. Curr Probl Pediatr Adolesc Health Care 2017; 47:229-232. [PMID: 28803826 DOI: 10.1016/j.cppeds.2017.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this paper, two senior administrative leaders at a tertiary care children's hospital explain why they decided to partner with a community organization in order to better fulfill the hospital mission.
Collapse
|
48
|
Ohnishi M, Leshabari S, Ambikile JS, Oishi K, Nakao Y, Nishihara M. Associations among anthropometric measures, food consumption, and quality of life in school-age children in Tanzania. J Rural Med 2017; 12:38-45. [PMID: 28593016 PMCID: PMC5458351 DOI: 10.2185/jrm.2924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/20/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives: The factors associated with quality of life (QOL) and
anthropometric measurements as outcomes of food consumption were examined among school-age
children in Tanzania. Methods: A cross-sectional study was undertaken in September 2013 in
Tanzania. Anonymous self-administered questionnaire surveys were conducted in the
Kiswahili language among primary school children in the fifth and/or sixth grade aged
10–14 years. The survey probed sociodemographic characteristics such as age, gender,
living with family members, number of meals/snacks per day, food consumption in the
previous 24 hours, and QOL, as well as anthropometric measurements (height and weight).
The Rohrer index was calculated based on height and weight. After presenting the mean and
standard deviation (SD) of height, weight, and the Rohrer index score by age and gender,
the Rohrer index score was categorized into three groups (low weight, normal weight, and
overweight) and analyzed according to sociodemographic characteristics and food
consumption using the chi-square test. Furthermore, the QOL score was analyzed using the
t test. Multivariate linear regression analysis was used to analyze the
associations between the QOL score and sociodemographic characteristics and food
consumption. Results: A total of 694 children (male: 312; female: 382) participated in
this study. According to the Rohrer index, 273 (39.3%) children were classified as low
weight, 353 (50.9%) were normal weight, and 68 (9.8%) were overweight. A total of 459
(66.1%) children reported having had three or more meals and/or snacks on the day before
the study. In addition, 127 (18.3%) children had not eaten any protein-rich food on the
day before the study, although almost all had eaten at least one carbohydrate-rich food
per day. Regardless of region, location, gender, and age, living without parents was
associated with short stature (P = 0.010). A high QOL score was
associated with having three or more meals and/or snacks per day (P <
0.001). Conclusions: The security of physiological needs such as a guarantee of
three meals per day could contribute to higher QOL among underserved children.
Collapse
Affiliation(s)
- Mayumi Ohnishi
- Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Sebalada Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Joel Seme Ambikile
- School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Kazuyo Oishi
- Unit of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yuko Nakao
- Unit of Nursing, Kagoshima University Graduate School of Health Sciences, Japan
| | - Mika Nishihara
- Unit of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
49
|
Francisco PW, Jacobs DE, Targos L, Dixon SL, Breysse J, Rose W, Cali S. Ventilation, indoor air quality, and health in homes undergoing weatherization. INDOOR AIR 2017; 27:463-477. [PMID: 27490066 DOI: 10.1111/ina.12325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health.
Collapse
Affiliation(s)
- P W Francisco
- University of Illinois at Urbana-Champaign Illinois, Champaign, IL, USA
| | - D E Jacobs
- University of Illinois at Chicago School of Public Health EOHS, Chicago, IL, USA
- National Center for Healthy Housing, Columbia, MD, USA
| | - L Targos
- University of Illinois at Chicago School of Public Health EOHS, Chicago, IL, USA
| | - S L Dixon
- National Center for Healthy Housing, Columbia, MD, USA
| | - J Breysse
- National Center for Healthy Housing, Columbia, MD, USA
| | - W Rose
- University of Illinois at Urbana-Champaign Illinois, Champaign, IL, USA
| | - S Cali
- University of Illinois at Chicago School of Public Health EOHS, Chicago, IL, USA
| |
Collapse
|
50
|
O'Sullivan KC, Howden-Chapman P, Sim D, Stanley J, Rowan RL, Harris Clark IK, Morrison LLA. Cool? Young people investigate living in cold housing and fuel poverty. A mixed methods action research study. SSM Popul Health 2016; 3:66-74. [PMID: 29349205 PMCID: PMC5769017 DOI: 10.1016/j.ssmph.2016.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background Living in cold housing conditions and risk of fuel poverty presents a range of physiological and psychosocial health risks. Limited research has specifically investigated the effects of fuel poverty on children and young people, and even less has been conducted with youth input into the research process. Methods The Cool? Study used mixed methods, participatory action research carried out with youth researchers involved at all stages through questionnaire design, analysis, qualitative design, e-interviewing and dissemination of results. This article reports on results of an online survey of 656 adolescents aged 14–16 years completed at 17 schools in New Zealand. Sampling was based on selecting schools for invitation, with the probability of selection weighted proportional to school size, within strata defined by climate zone. Results from a small e-mail interview study of survey respondents who consented to follow-up are also reported. Results The study found that almost half of the survey respondents (47%) felt their home was sometimes cold during the winter; a further 40% felt their home was often or always cold. More than two thirds of respondents (70%) had shivered inside at least once during winter. Respondents were more likely to report key indicators of fuel poverty depending on their self-reported ethnicity, with Māori at increased risk. Living in private rental housing or state-owned housing also increased risk of fuel poverty compared to those in owner-occupied dwellings. Participants of email interviews expressed concern about the widespread problem of cold housing for youth and a desire for Government intervention. Conclusion The integrated results confirm that cold housing and risk of fuel poverty are important problems for young people in New Zealand. Results contribute to the evidence-base for policy targeting of schemes such as the Government-sponsored retrofitting of insulation to households with dependent children. Mixed methods action research investigated cold housing among New Zealand youth. Participatory approach included youth throughout the research process. Online school-based survey found cold housing is a significant problem among youth. Risk of fuel poverty is higher among those in rental tenure and of Māori ethnicity. Young people support policy intervention to improve housing conditions for youth.
Collapse
Affiliation(s)
- Kimberley C O'Sullivan
- He Kainga Oranga/Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dalice Sim
- The Biostatistical Consulting Group, The Dean's Department, University of Otago, Wellington, New Zealand
| | - James Stanley
- The Biostatistical Consulting Group, The Dean's Department, University of Otago, Wellington, New Zealand
| | | | | | | | | |
Collapse
|