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Palascha A, Chang BPI. Which messages about healthy and sustainable eating resonate best with consumers with low socio-economic status? Appetite 2024; 198:107350. [PMID: 38609012 DOI: 10.1016/j.appet.2024.107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Consumers with low socioeconomic status (SES) eat less healthy and sustainable diets than consumers with higher status. This is attributed, at least in part, to inequalities in health communication. An online survey with 134 socioeconomically disadvantaged consumers in Italy was conducted to test the effectiveness of tailor-made communication material (infographics) about healthy and sustainable eating (HSE). Participants were recruited at two social supermarkets by a social service organisation as well as via a crowdsourcing platform. Participants found information about HSE delivered through infographics moderately effective in increasing motivation, capability, and opportunity for HSE, and moderately useful and likely to impact their behaviour. Certain messages were more effective than others for native consumers, while migrants showed more indifferent responses to the various messages and manifested lower motivation to shift towards HSE, limited access to and seeking of nutrition-related information, and lower trust in information sources. Selecting which messages to deliver strategically, while also considering differences between segments of the target audience and their preferred sources and channels for communication, is promising; yet, structural changes related to food's affordability and availability are also needed to facilitate an effective communication.
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Affiliation(s)
| | - Betty P I Chang
- European Food Information Council, Rue Belliard 2A, 1040 Brussels, Belgium
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Nayak-Rao S. Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam. Int Urol Nephrol 2024; 56:1103-1108. [PMID: 37642796 DOI: 10.1007/s11255-023-03736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
Chronic kidney disease (CKD) is a worldwide health problem affecting at least 10% of the world's population. CKD represents especially a large burden in low- to middle-income countries that are ill equipped to deal with its consequences. The burden of CKD is increasing in India as well. Although diabetes and hypertension account for much of this burden of CKD, there are regions where a surprisingly high rate of CKD of undetermined etiology (CKD-U) has been described in certain areas of the country. In our observational cross-sectional study, we attempted to look at burden and etiology of CKD in a predominantly rural referral center. Out of 334 patients with diagnosed CKD, of whom 70% were male, included from Oct 2021 to July 2022, CKD-U was the single largest cause of CKD in 154 (46.1%) followed by diabetic nephropathy in 148 (44.3%). 80% of CKD patients presented initially with advanced CKD (stages 4 and 5). Approximately, 2/3rd of CKD patients reported a family income of less than 10,000 Rs/month (< 130USD). Hypertension was seen in 89% of patients in total (73% in CKD-U vs. 100% in other cause CKD). Our initial study brings to focus another new and as yet unrecognized hotspot for CKD-U in the Indian subcontinent. Given the vast diversity in the population in this region and variable delivery health care resources, we believe that concerted efforts should be made by governmental and other agencies to better understand the nature of this undiagnosed CKD epidemic so that adequate preventative strategies can be envisaged.
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Kim HW, Lee YJ, Ha YJ, Lee EB, Lee YJ, Kang EH. Impact of socioeconomic status on biologics utilization in rheumatoid arthritis: revealing inequalities and healthcare efficiency. Korean J Intern Med 2024:kjim.2023.276. [PMID: 38419335 DOI: 10.3904/kjim.2023.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 03/02/2024] Open
Abstract
Background/Aims This cross-sectional study aimed to investigate biologics treatment disparities in rheumatoid arthritis (RA) patients based on socioeconomic status (SES). Methods Data from the KOrean Observational Study Network for Arthritis (KORONA) database were analyzed to assess various factors associated with SES, health behaviors, and biologics use. Logistic regression and structured equation modeling (SEM) were utilized for data analysis. Results Among 5,077 RA patients included, 393 (7.7%) patients were identified as biologics users. Within the entire cohort, 31.8% of the participants were in the low-income and low-education groups, and 39.3% of the participants were in the high-income and high-education groups. Despite the patients with low income or low education experienced higher disease activity at diagnosis, had more comorbidities, exhibited higher medication compliance, underwent more check-ups, and had more hospital admissions than their counterparts, the odds of patients with low-income receiving biologics were 34% lower (adjusted odds ratio = 0.76, 95% confidence interval: 0.60-0.96, p = 0.021) after adjustment for demographics and comorbidities. SEM and pathway analyses confirmed the negative impact of low SES on biologics use. Conclusions The findings suggest that SES plays a significant role in biologics use among RA patients, indicating potential healthcare inefficiencies for low SES patients. Moreover, adverse healthcare habits negatively affect biologics use in RA patients. The study highlights the importance of considering socioeconomic factors while discussing biologics use and promoting equitable access to biologics for optimal RA management.
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Affiliation(s)
- Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Ju Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You-Jung Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Srivastava VK, Kumar A, Gupta P, Bhati V. Visually impaired population from low socioeconomic strata and their oral health status: an observational study. J Clin Pediatr Dent 2024; 48:138-143. [PMID: 38239166 DOI: 10.22514/jocpd.2024.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/23/2023] [Indexed: 01/23/2024] Open
Abstract
A significant portion of the world's population suffers from blindness. Despite being a vital part of systemic health, oral health is neglected in such a population. The present study aimed to determine the oral health status of blind individuals in north India and to identify the factors affecting it. Sixty-nine blind students from a local school for the visually impaired were included in the study. A questionnaire was used to record the basic demographic details and oral habits, followed by an oral examination by a single trained dentist to record dental caries, periodontal status and dental trauma. The prevalence of Dental caries was 63.8% (mean 1.43 ± 1.61). Gingival bleeding on probing (BOP) was found in 60.9% of individuals. Dental trauma prevalence was 23.2%, and harmful oral habits were found in 31.9% of individuals. Individuals experiencing a toothache in the last year had a 1.784 times higher risk of dental caries than those who didn't experience a toothache. Individuals having acquired blindness are 2.411 times more prone to dental trauma in comparison to those suffering from congenital blindness. Blind individuals have poor oral health. Toothache in the last one year is an important risk factor for dental caries in such individuals. Acquired blindness makes a person more susceptible to dental trauma than congenital blindness.
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Affiliation(s)
- Vinay Kumar Srivastava
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Aman Kumar
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Pooja Gupta
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Vaishali Bhati
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
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Mann O, Bracegirdle T, Shantikumar S. The relationship between Quality and Outcomes Framework scores and socioeconomic deprivation: a longitudinal study. BJGP Open 2023; 7:BJGPO.2023.0024. [PMID: 37562823 DOI: 10.3399/bjgpo.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/01/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The Quality Outcomes Framework (QOF) is a pay incentive scheme in England designed to improve and standardise general practice. QOF attainment has been used as a proxy for primary care quality in previous research. AIM To investigate whether there is a relationship between socioeconomic deprivation and QOF attainment in primary care in England. DESIGN & SETTING Retrospective longitudinal study of primary care providers in England. METHOD QOF scores were obtained for individual general practices in England from between 2007-2019 and linked to practice-level Indices of Multiple Deprivation (IMD) scores derived from census data. Beta regression analyses were used to analyse the relationship with either percentage of total QOF attainment or of domain-specific attainment with multivariate analyses, adjusting for additional practice-level demographics. QOF attainment in the most affluent quintile was used as the reference group. RESULTS General practices in less deprived areas have consistently outperformed those in more deprived areas in terms of QOF achievement. Initially, the gap between least and most deprived practices decreased, however since 2015 there has been relatively little change in comparative performance. The magnitude of inequality was reduced after adjusting for demographic factors. Of the independent variables analysed, the proportion of patients aged >65 years ('over 65s') had the strongest relationship with QOF attainment. CONCLUSION There remains an inequality in primary care quality by socioeconomic deprivation in England, even after accounting for demographic differences.
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Affiliation(s)
- Oliver Mann
- Warwick Medical School, University of Warwick, Coventry, UK
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A S, S L, K AO, R S, A HJ. Resilient communities? A qualitative interview study on sustaining a community project for health promotion among socially disadvantaged women during the first two years of the COVID-19 pandemic. BMC Public Health 2023; 23:1654. [PMID: 37644521 PMCID: PMC10463586 DOI: 10.1186/s12889-023-16593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES With the emergence of SARS-CoV-2 a global pandemic impacted on health promotion, overlapping and hindering efforts to overcome the worldwide pandemic of lacking physical activity (PA). Nationwide lockdowns, the closure of public facilities and sports venues, made it significantly more difficult to sustain community-run PA projects. In our case study, we explore (a) under which circumstances a community-basedhealth promotion project can be maintained during crisis and (b) what resilience capacities are important for community project coordinators to deal with those aggravating circumstances. METHODS Our case study looks at a community-based project called BIG, an exercise promotion project for women in difficult life circumstances. The case study was conducted between July 2021 and January 2022 with six municipalities implementing the project. Following a triangulation approach, we used minutes from short exchanges (n=17) with community project coordinators, information brochures about current exercise classes (n=6) and semi-structured qualitative interviews with project coordinators (n=6). All data were analyzed using the framework approach. RESULTS All sites showed a high level of willingness to adapt to the pandemic situation and to maintain the project as best as possible. Findings highlight that coordinators whose work routine was characterized by intense relationship management with participants and trainers demonstrated higher levels of adaptive and absorptive capacities on an individual level than coordinators of those communities with less social cohesion. At a community level, important resources for strengthening adaptive and absorptive resilience capacities were job security of the coordinators, sufficient financial resources to adapt classes to changing circumstances, and a supportive organizational climate in the coordinators' working environment to allow them to react flexibly according to current pandemic regulations. CONCLUSION Despite high resilience capacities especially on an individual level, the low-threshold nature of the project could not be maintained at a pre-pandemic level. For many women, participation in the project was no longer possible at times. Awareness should be raised in communities that PA promotion programs are crucial to strengthening physical and mental health, even in times of crisis. It seems necessary to find permanent funding options for such programs, to integrate them permanently into municipal structures.
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Affiliation(s)
- Sauter A
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
| | - Linder S
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - Abu-Omar K
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - Sommer R
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - Herrmann-Johns A
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
- School of Medicine and Public Health, HMRI Building, Level 4, West Wing, University of Newcastle, Callaghan, NSW, 2308, Australia
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Poole NL, van den Brand FA, Willemsen MC, Nagelhout GE. Challenges and successes in the sustainment of Dutch community-level smoking cessation interventions for residents with a low socioeconomic position. BMC Public Health 2023; 23:1605. [PMID: 37612663 PMCID: PMC10464105 DOI: 10.1186/s12889-023-16529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND When health promotion interventions are implemented, the gains are often short-lived, as interventions are seldom successfully sustained. The current study explores how and under what conditions community-level smoking cessation interventions for people with a lower socioeconomic position can be sustained, drawing upon interventions delivered in Dutch neighbourhoods with a predominantly low socioeconomic position. METHODS We conducted 15 semi-structured interviews with key stakeholders from three Dutch community-level smoking cessation interventions implemented at least three years prior. The topic guide was developed based on the Determinants of Innovation framework and transcripts were analysed thematically. RESULTS We identified several factors that promote the sustainment of smoking cessation community-level interventions: 1) structural, long-term funding through the commitment of health insurers and policy makers; 2) continued stakeholder enthusiasm and involvement; 3) training and time for professionals to discuss smoking cessation, thereby also increasing the visibility of the intervention for professionals and residents; 4) integrating the intervention with existing initiatives and adapting it to be compatible with current working practices of executive staff; and 5) planning for sustainment as a team from the outset. CONCLUSIONS The current study highlights challenges and successes in intervention sustainment for people with a lower socioeconomic position. Lack of structural funding was one of the most challenging aspects for intervention sustainment in which health insurers and policy makers can play an important role. Planning for sustainment from the outset would enable intervention coordinators to consider the abovementioned factors early on. This need not be done alone but can best be discussed within a team of stakeholders.
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Affiliation(s)
- Nikita L Poole
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
- IVO Research Institute, The Hague, the Netherlands.
| | - Floor A van den Brand
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Dutch Expert Centre for Tobacco Control (NET), Trimbos Institute, Utrecht, the Netherlands
| | - Gera E Nagelhout
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- IVO Research Institute, The Hague, the Netherlands
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Lee J. Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01632-3. [PMID: 37160575 PMCID: PMC10169131 DOI: 10.1007/s40615-023-01632-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To investigate barriers and disparities in prenatal visits across population subgroups. METHODS This pooled cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System for 2020 through 2021. Women who reported their experiences of cancellation or delay in prenatal visits were included. A multivariable regression analysis estimated adjusted prevalence ratios (aPR) for cancellations or delays in prenatal care. RESULTS Of a total of 11,427, one-third had cancelled or delayed care. Hispanics, compared to their white counterparts, were 22% likelier to have cancelled or delayed care. Women covered by Medicaid and those with depression had 17% and 34% greater likelihoods of cancellation or delay, respectively. Cancellations or delays were comparable for the years 2020 and 2021 across reasons, except for facility closures, which were more common in 2020 than in 2021. Hispanics tended to cancel or delay prenatal visits more often than whites for reasons, such as facility closures, COVID-19-related reasons, a lack of transportation, and loss of insurance, while transportation and insurance issues were greater barriers for blacks. Women with less than a high school diploma were more likely to report cancellations or delays due to transportation issues (aPR 2.86, 95%CI 1.47-5.57; p = 0.002) and loss of insurance (aPR 4.82, 95%CI 1.64-14.23; P = 0.004). CONCLUSIONS While a large proportion of women experienced disruptions in prenatal care, subsets of the population, including racial/ethnic minorities and the low socioeconomically disadvantaged, faced disproportionate challenges. The current findings provide practical implications for a tailored approach to reducing barriers and disparities in prenatal care.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
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Chen EM, Chan BKK, Lee ATC. Meaning in Life and Depression in Low-Income Families in Hong Kong during the COVID-19 Pandemic. East Asian Arch Psychiatry 2023; 33:15-20. [PMID: 36991551 DOI: 10.12809/eaap2244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To determine whether meaning in life (MIL) was associated with a lower risk of depression in people from low-income families during the COVID-19 pandemic. METHODS Individuals from low-income families were recruited at a community centre during the fourth wave of the COVID-19 pandemic in Hong Kong. Levels of MIL were assessed using the Meaning in Life Questionnaire (MLQ). Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9). Scores of ≥24 on the Presence of Meaning subscale (MLQ-P) and Search for Meaning subscale (MLQ-S) were considered high. A score of ≥10 on the PHQ-9 was indicative of clinical depression. Correlations between MLQ and PHQ-9 scores were examined, along with associations between presence of/search for meaning and risk of clinical depression. RESULTS Among 102 participants, 64 (62.7%) had clinical depression; 14 (13.7%) had both high presence of meaning and high search for meaning. The MLQ score was correlated with the PHQ-9 score (r = -0.56, p < 0.001). The adjusted risk ratio for depression was 0.31 (p = 0.006) in participants with both high presence of meaning and high search for meaning. CONCLUSION Among people with lower socioeconomic status, MIL may be important for protecting against depression during the COVID-19 pandemic.
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Affiliation(s)
- E M Chen
- The Mental Health Association, Hong Kong SAR, China
| | - B K K Chan
- The Mental Health Association, Hong Kong SAR, China
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
PURPOSE OF THE REVIEW Despite marked progress in cardiovascular disease management in the last several decades, there remain significant, persistent disparities in cardiovascular health in historically marginalized racial and ethnic groups. Here, we outline current state of health disparities in cardiovascular disease, discuss the interplay between social determinants of health, structural racism, and cardiovascular outcomes, and highlight strategies to address these issues. RECENT FINDINGS Across the continuum of atherosclerotic cardiovascular disease (ASCVD) prevention, there remain significant disparities in outcomes including morbidity and mortality by race, ethnicity, and socioeconomic status (SES). These disparities begin early in childhood (primordial prevention) and continue with a higher prevalence of cardiovascular risk factors (primary prevention), and in the uptake of evidence-based therapies (secondary prevention). These disparities are driven by social determinants of health and structural racism that disproportionately disadvantage historically marginalized populations. Structural racism and social determinants of health contribute to significant disparities in cardiovascular morbidity and mortality.
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Affiliation(s)
- Ankita Devareddy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashish Sarraju
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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Mulderij LS, Verkooijen KT, Groenewoud S, Koelen MA, Wagemakers A. The positive impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life and societal participation: a mixed-methods study. BMC Public Health 2022; 22:1522. [PMID: 35948969 PMCID: PMC9363851 DOI: 10.1186/s12889-022-13936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care–physical activity (care–PA) initiatives may improve participants’ lifestyles and thereby lower overweight and obesity rates. A two-year care–PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation using a mixed-methods design. Methods Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), one year (t2) and two to three years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t0, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis. Results Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t2. Body Mass Index, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants’ self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems. Conclusions X-Fittt 2.0 improved the health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results. More complete data are needed to confirm the findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13936-w.
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Affiliation(s)
- Lisanne Sofie Mulderij
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
| | - Kirsten T Verkooijen
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands.
| | - Stef Groenewoud
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare, IQ healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Maria A Koelen
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Health and Society Group, Wageningen University & Research, P.O. Box 8130, 6700, EW, Wageningen, the Netherlands
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Chiem A, Olaoye F, Quinn R, Saini V. Reasons and suggestions for improving low immunization uptake among children living in low socioeconomic status communities in Northern Alberta, Canada - A qualitative study. Vaccine 2022; 40:4464-4472. [PMID: 35701329 DOI: 10.1016/j.vaccine.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Under-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. METHODS Fourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. RESULTS Busy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. CONCLUSION Implementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents.
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Affiliation(s)
- Alexander Chiem
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Funmilayo Olaoye
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada
| | - Renee Quinn
- Population and Public Health, North Zone, Alberta Health Services, 4720 55 Street, Cold Lake, Alberta T9M 1V8, Canada
| | - Vineet Saini
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
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Wittels P, Kay T, Mansfield L. Adopting and maintaining a healthy lifestyle in low SES families: How the experience of motherhood shapes responses to dietary and physical activity public health guidance. BMC Public Health 2022; 22:1092. [PMID: 35650565 PMCID: PMC9157027 DOI: 10.1186/s12889-022-13502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health guidance and associated interventions seek to bring about change in diet and physical activity behaviours to improve life expectancy and healthy life expectancy in the population. Low socioeconomic status (SES) groups suffer from reduced life/healthy life expectancy compared with the population as a whole. This in-depth qualitative study, investigates the lives and experiences of mothers with young children living in a low SES area in a London (UK) borough, to understand the context in which current public health guidance on diet and physical activity is received and viewed, and how this understanding could be used to inform the development of public health guidance and interventions for this group. METHODS The mothers (n = 20), were recruited from a Surestart Centre, Children's Centres and through the local branch of a national charity. The mothers took part in a series of three in depth interviews over two years (2016-2017). Thematic analysis was used to generate an iterative set of codes informing an understanding of motherhood, diet and physical activity. RESULTS Motherhood was found to be a major factor for understanding and interpreting how women in low SES areas respond to public health guidance on diet and physical activity. The mothers were well informed about dietary guidance, considered that provision of healthy food was critical to the mothering role, but found it difficult to implement the guidance in their own lives. In contrast, physical activity was not seen as integral to the mothering role, although it was acknowledged that it played a part in ensuring that the mothers remained healthy enough to fulfil all their duties. Constrained by the ethic of care, and a lack of material and time resources, the mothers prioritised their family's health above their own. This study, enabled the mothers to articulate ideas for interventions that would be supportive of a healthy lifestyle and of practical application in their busy lives. CONCLUSIONS Mothers from this low SES area responded differently to the public health guidance on diet and on physical activity. Whilst providing and modelling a healthy diet was seen as an essential part of the mother's role, participating in leisure based physical activity was problematic, and unless carefully framed, could be perceived as selfish behaviour, inappropriate for the "good" mother.
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Affiliation(s)
- P Wittels
- Brunel University London, Uxbridge, UK
| | - T Kay
- Independent Researcher, Loughborough, UK
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Mehrabi F, Ahmaripour N, Jalali-Farahani S, Amiri P. Barriers to weight management in pregnant mothers with obesity: a qualitative study on mothers with low socioeconomic background. BMC Pregnancy Childbirth 2021; 21:779. [PMID: 34789171 PMCID: PMC8597093 DOI: 10.1186/s12884-021-04243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal obesity is a public health issue that could affect both women's and children's health. This qualitative study aimed to identify barriers to weight management of pregnant women with obesity and low socioeconomic backgrounds. METHODS The current qualitative study has been conducted using a grounded theory approach by analyzing data collected from in-depth interviews with clients of Tehran's public health care centers for prenatal care. The criteria for selecting participants were excessive weight gain during the first two trimesters of pregnancy, low socioeconomic status, and willingness to share their experiences. A semi-structured guide consisting of open-ended questions was asked in a private room. Open, axial, and selective coding were applied to the data. FINDINGS Four main themes emerged from data, each of which has some subcategories: 1) personal factors (unpleasant emotions and feelings, personal tastes/hobbies, workload and responsibilities, and history of diseases), 2) pregnancy status (unintended and high-risk pregnancy), 3) interpersonal relationships and support (lack of a spouse's support and unhealthy role modeling of relatives), 4) socio-cultural factors/influences (social norms and values, lack of access to health services, and unreliable information channels). CONCLUSIONS This study provides an overview of the barriers to the weight management of pregnant women from low socioeconomic backgrounds. The results could help develop appropriate health strategies for low socioeconomic women with obesity. Also, health care providers for this group of women could use these findings as a guide to consider their conditions and background.
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Affiliation(s)
- Fahimeh Mehrabi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Najva Ahmaripour
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Sara Jalali-Farahani
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.
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De Mello A, Chavez A, Mukarram M, Buras MR, Kling JM. Menopausal symptoms in the Southwest United States: A cross-sectional survey of women from areas with different socioeconomic resources. Maturitas 2021; 154:7-12. [PMID: 34736580 DOI: 10.1016/j.maturitas.2021.08.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Menopausal symptoms may differ by geography and ethnicity, but the impact of socioeconomic factors is less clear. The purpose of this study was to compare menopausal symptoms in women from areas of Arizona with different socioeconomic resources. STUDY DESIGN Women aged 40-65 years in two cohorts were surveyed: (1) Phoenix women attending either a clinic for patients who are uninsured or a clinic for people experiencing homelessness; and (2) Scottsdale women living in zip codes with higher average income and neighborhood advantage (surveyed by mail). Surveys included the Greene Climacteric Scale (GCS) and demographic questions. MAIN OUTCOME MEASURES GCS score by domain and subdomain, corrected for age, race, menopause stage and menopausal hormone therapy (HT). RESULTS Phoenix participants (N = 104) were 51.2 years old (SD 6.45), Hispanic (54.4%), White (28.2%) or African American (8.7%), and uninsured (53.0%). Scottsdale participants (N = 151) were 52.6 years old (SD 5.52), mostly White (94.7%) and insured (100%). Three percent of Phoenix women were on HT vs. 23.3% in Scottsdale (p < 0.001). Multivariate analysis revealed higher total GCS scores in the Phoenix vs. Scottsdale cohort (39.13 vs 30.14, p < 0.001), which was also seen in the psychological and somatic domains, as well as the anxiety and depression subdomains. No statistically significant differences were seen in the vasomotor or sexual dysfunction domains. CONCLUSION In a group of women living in Arizona from distinct socioeconomic areas, significant differences were demonstrated in menopausal symptom bother specifically with higher psychological and somatic symptoms in women who were uninsured or experiencing homelessness independent of age, race, menopause stage and HT use. Future studies controlling for co-morbidities associated with lower socioeconomic status such as depression would provide further insight into this population of midlife women.
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Golubinski V, Wild EM. Factors associated with patient activation in a socially deprived population: Evidence from Germany. Patient Educ Couns 2021; 104:2791-2802. [PMID: 33863586 DOI: 10.1016/j.pec.2021.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population. METHODS We conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis. RESULTS Our results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation. CONCLUSIONS Age, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation. PRACTICE IMPLICATIONS Our results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.
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Affiliation(s)
- Veronika Golubinski
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Eva-Maria Wild
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
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McNamara R, Quinn R, Murrin C, Bel-Serrat S. Teachers' perspectives on the barriers to healthy lifestyle behaviors among adolescent girls of disadvantaged backgrounds in Ireland: A qualitative study. Appetite 2021; 167:105585. [PMID: 34246715 DOI: 10.1016/j.appet.2021.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Though adolescence is a particularly sensitive period regarding the development of long-lasting health-related attitudes and behaviors, little research has examined the factors which influence their engagement in such behaviors. Adolescent females are particularly sensitive to suffer from overweight and obesity. It is also a time that can impact the health patterns of future generations due to the influence of preconception maternal factors on the health of their offspring. Furthermore, much research has identified a strong socioeconomic gradient in obesity in Ireland, with individuals from low socioeconomic backgrounds being particularly likely to develop unhealthy habits. The current study aimed to develop an understanding of the factors which influence the health-related behaviors of adolescent girls of low-socioeconomic status in Ireland, an underrepresented yet particularly sensitive cohort. Semi-structured interviews were conducted with nine teachers from disadvantaged schools in Dublin and were examined using a thematic analytic approach. Nine themes were identified: lack of interest and knowledge, lack of self-confidence, the dual role of modern technology, behaviors of significant others, need for good role models, availability of convenience foods, inadequate existing approaches and initiatives, lack of resources to promote a healthy lifestyle, and living difficulties at home and in the community. Findings suggested ways for intervening at personal, interpersonal, organizational and community levels. In conclusion, a range of practical changes are required in the home, school, and community environments in order to improve the health of these individuals, and ultimately to improve the health of future generations.
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Affiliation(s)
- Roisin McNamara
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Roisin Quinn
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Celine Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
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18
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Sowa LE, Thomas JMN, Hundertmark AC, Baroody FM, Suskind DL. Leveraging the universal newborn hearing screen to impact parental knowledge of childhood speech development in low socioeconomic populations: A randomized clinical trial. Int J Pediatr Otorhinolaryngol 2021; 146:110763. [PMID: 34000494 DOI: 10.1016/j.ijporl.2021.110763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/23/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the impact of a video intervention administered at the time of the universal newborn hearing screen on caregiver knowledge of infant cognitive and language development in low socioeconomic status English-speaking parents. METHODS A parallel-group, single-blind randomized clinical trial was conducted from April to August 2016. Eligible participants were at least 18 years, delivered a singleton neonate, English speaking, and designated as low socioeconomic status based on household income and level of education. A total of 112 patients, 54 treatment and 58 control, completed the study and were included in the analysis. The Baby Survey of Parent/Provider Expectations and Knowledge, a validated 24-item questionnaire assessing child development knowledge, was the primary study outcome. The survey was conducted at baseline, 1 day after intervention, and 4-6 weeks later. A one-way, repeated measures analysis of variance (ANOVA) was employed to evaluate for differences in the three time points. RESULTS The average age of participants was 25.6 years and 85% identified as African-American. There was no significant difference in scores prior to and following the intervention for the control group (N = 58, F = 1.67, p = 0.19); however, a significant difference in scores was found in the treatment group (N = 54, F = 7.95, p < 0.001). Post-hoc analysis showed a significant improvement in scores 1 day after intervention, but no difference 4-6 weeks later. CONCLUSION Educational video intervention for low socioeconomic mothers at the time of the universal newborn hearing screen can positively increase knowledge related to hearing and language development in the short term. TRIAL REGISTRATION Pilot Study of Novel Postpartum Educational Video Intervention NCT02267265 https://clinicaltrials.gov/ct2/show/NCT02267265.
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Affiliation(s)
- Lauren E Sowa
- University of Chicago Medicine, Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, 5841 S. Maryland Ave MC1035, Chicago, IL, 60637, United States.
| | - Julia M N Thomas
- University of Chicago Medicine, Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, 5841 S. Maryland Ave MC1035, Chicago, IL, 60637, United States; University of Chicago Medicine, TMW Center for Early Learning and Public Health, 5841 S. Maryland Avenue MC1035, Chicago, IL, 60637, United States.
| | - Alison C Hundertmark
- University of Chicago Medicine, TMW Center for Early Learning and Public Health, 5841 S. Maryland Avenue MC1035, Chicago, IL, 60637, United States.
| | - Fuad M Baroody
- University of Chicago Medicine, Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, 5841 S. Maryland Ave MC1035, Chicago, IL, 60637, United States.
| | - Dana L Suskind
- University of Chicago Medicine, Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, 5841 S. Maryland Ave MC1035, Chicago, IL, 60637, United States; University of Chicago Medicine, TMW Center for Early Learning and Public Health, 5841 S. Maryland Avenue MC1035, Chicago, IL, 60637, United States.
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Dickson C, Ramsay J, VandeBurgh J. Barriers for Ethnic Minorities and Low Socioeconomic Status Pediatric Patients for Behavioral Health Services and Benefits of an Integrated Behavioral Health Model. Pediatr Clin North Am 2021; 68:651-658. [PMID: 34044991 DOI: 10.1016/j.pcl.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.
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Affiliation(s)
- Cheryl Dickson
- Associate Dean Health Equity and Community Affairs, 1000 Oakland Drive, Kalamazoo, MI 49009, USA.
| | - Jessica Ramsay
- Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49009, USA
| | - Joshua VandeBurgh
- Department of Neurology, University of Minnesota Medical Center, 516 Delaware Street, SE 12-100 Phillips Wangensteen Building, Minneapolis, MN 55455, USA
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Moya EM, Zamore C, Perez LM, Tellez K, Avila A, Aragones A. COVID-19 Imperils Access to Health and Human Services in El Paso, Texas and New York City: Perspectives from Hispanic Parents. J Racial Ethn Health Disparities 2021. [PMID: 33900584 DOI: 10.1007/s40615-021-01041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 10/28/2022]
Abstract
Low-income Hispanic communities are disproportionately impacted by the COVID-19 pandemic through exacerbated financial vulnerabilities and health challenges. The aim of this study is to assess and compare the self-reported impact and challenges caused by COVID-19 in Mexican-origin parents in New York City (NYC), NY and El Paso, TX. Data is based on routine follow-up calls used to assess uptake of the HPV vaccine and COVID-19 concerns conducted between March and August 2020. Three salient themes emerged: (1) financial insecurities; (2) emotional distress associated with COVID-19; and (3) limited access to health and human services. This study revealed increased financial insecurities and emotional distress, and disruptions to health and human services to low-income Mexican-born parents during the pandemic.
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21
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Heller NA, Shrestha H, Morrison DG, Daigle KM, Logan BA, Paul JA, Brown MS, Hayes MJ. Neonatal sleep development and early learning in infants with prenatal opioid exposure. Adv Child Dev Behav 2021; 60:199-228. [PMID: 33641794 DOI: 10.1016/bs.acdb.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this chapter is to examine the role of sleep and cognition in the context of the cumulative risk model examining samples of at-risk infants and maternal-infant dyads. The cumulative risk model posits that non-optimal developmental outcomes are the result of multiple factors in a child's life including, but not limited to, prenatal teratogenic exposures, premature birth, family socioeconomic status, parenting style and cognitions as well as the focus of this volume, sleep. We highlight poor neonatal sleep as both an outcome of perinatal risk as well as a risk factor to developing attentional and cognitive capabilities during early childhood. Outcomes associated with and contributing to poor sleep and cognition during infancy are examined in relation to other known risks in our clinical population. Implications of this research and recommendations for interventions for this population are provided.
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Affiliation(s)
- Nicole A Heller
- Department of Psychology, Siena College, Loudonville, NY, United States
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Deborah G Morrison
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Katrina M Daigle
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Beth A Logan
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States
| | - Jonathan A Paul
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, United States
| | - Mark S Brown
- Department of Pediatrics, Northern Light Eastern Maine Medical Center, Bangor, ME, United States
| | - Marie J Hayes
- Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, United States.
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22
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Dynia JM, Dore RA, Bates RA, Justice LM. Media exposure and language for toddlers from low-income homes. Infant Behav Dev 2021; 63:101542. [PMID: 33618211 DOI: 10.1016/j.infbeh.2021.101542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
In the current study, we examined whether the quantity of toddlers' exposure to media was related to language skills and whether meeting the American Association of Pediatrics (AAP) recommendations of limiting media exposure to one hour or less per day was related to language skills. We examined these associations in a sample of toddlers (N = 157) living in low-income homes. Toddlers were about two years of age (M = 28.44 months, SD = 1.48 months) during the first visit when parents reported on toddlers' exposure to media in the home. Toddlers were about three years of age (M = 33.61 months, SD = 1.06 months) during the second visit when direct measures of toddlers' expressive and receptive language and receptive vocabulary skills were completed. Controls were child gender, race, mothers' education, marital status, work status, and center-based child care. Results indicated that more frequent exposure to media was related to lower expressive language, but not receptive language or receptive vocabulary. The predictor of AAP recommendation was not significantly related to any child language outcomes. These results suggest that media exposure may be related to the displacement of language-enhancing activities during a critical time for toddlers' language development. However, the AAP media recommendation of one hour may not be related to language development.
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Affiliation(s)
- Jaclyn M Dynia
- Crane Center for Early Childhood Research and Policy, The Ohio State University, United States.
| | - Rebecca A Dore
- Crane Center for Early Childhood Research and Policy, The Ohio State University, United States
| | - Randi A Bates
- Crane Center for Early Childhood Research and Policy, The Ohio State University, United States
| | - Laura M Justice
- Crane Center for Early Childhood Research and Policy, The Ohio State University, United States
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Scott HC, Craddock C, Craig L. What features of a nutrition resource are important to adolescents of a low socioeconomic status? Public Health Nutr 2020; 23:1716-25. [PMID: 32338237 DOI: 10.1017/S1368980019004476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify the key features of a nutrition resource that are important to adolescents of a low socioeconomic status (SES). DESIGN Structured interviews were conducted to explore participants' preferences relating to the features of a nutrition resource. Thematic framework analysis was used to determine key themes, subthemes and concepts from the data. SETTING Streetsport activity sessions, north-east of Scotland. PARTICIPANTS Eighteen adolescents aged 12-17 years from a low socioeconomic background. RESULTS The overarching themes identified were barriers and facilitators to engagement with a nutrition resource. Adolescents expressed a preference for an app, and this was mainly attributed to convenience and low cost. There was also an emphasis on the integral role social media has in their lives. Aesthetics was a facilitator for both male and female participants, with a particular focus on weight loss. Behaviour change support, including reminders, access to simple recipes and adopting a 'small change approach', were identified as possible facilitators, whereas cost, environmental influences, and existing eating habits were identified as possible barriers to engaging with a nutrition resource. CONCLUSIONS A number of subthemes, including aesthetics, cost and convenience, which have previously been reported in adolescents with a higher SES, were prominent in our research. The present study contributes to insights relating to behaviour change tools that should be considered when developing a nutrition resource targeting disadvantaged adolescents. Further research focusing on how mobile phone technology and social media can be utilised to support dietary behaviour change in low SES adolescents is recommended.
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Côté M, Harrison S, Lapointe A, Laramée C, Desroches S, Lemieux S, Lamarche B, Bélanger-Gravel A. A cross-sectional survey examining motivation and beliefs to participating in a web-based prospective cohort study on nutrition and health among individuals with a low socioeconomic status. BMC Public Health 2020; 20:348. [PMID: 32183781 PMCID: PMC7079419 DOI: 10.1186/s12889-020-08467-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Prospective cohort studies may support public health efforts in reducing health inequalities. However, individuals with a low socioeconomic status (SES) are generally underrepresented in health research. This study aimed to examine the intention and determinants of intention of individuals with a low SES towards participation in a Web-based prospective project on nutrition and health (NutriQuébec) in order to develop recruitment and retention strategies. Methods A cross-sectional survey based on the Theory of planned behaviour was conducted in the Province of Québec, Canada. Low SES individuals (high school or less and annual household income < $55,000 CAN) were recruited through a Web panel of a polling firm to assess intention, attitude, subjective norm and perceived behavioural control (PBC) towards participation in the NutriQuébec project. Linear regression and logistic regression analyses were conducted. Results Mean age of respondents (184 women, 141 men) was 57.6 y (SD = 13.6). Attitude (ß = 0.54, 95%CI: 0.41–0.68) and PBC (ß = 0.50, 95%CI: 0.37–0.63) were significantly associated with intention. Participants who agreed that participating in the study would contribute to an improvement in 1) collective health (odds ratio [OR] = 2.15, 95%CI: 1.27–3.64) and in 2) one’s lifestyle habits (OR = 1.70, 95%CI: 1.04–2.78) were more likely to express positive intention compared to participants who did not agree with these statements. Participants who agreed to participate in the study even 1) in the absence of a financial incentive (OR = 1.43, 95%CI: 1.04–1.99) and even 2) if the completion of questionnaires took up to two hours (OR = 1.78, 95%CI: 1.27–2.48) were also more likely to express high intention. Receiving a personalized brief health assessment (OR = 1.61, 95%CI: 1.13–2.30) and the use of simple questions in the questionnaires (OR = 1.54, 95%CI: 1.05–2.25) were facilitating factors associated with high intention. Participants believing that participation would be too time-consuming were less likely to have positive intention (OR = 0.57, 95%CI: 0.43–0.75). Conclusions The development of a positive attitude and a high PBC towards participation in the NutriQuébec project will be necessary to obtain representative data of low SES adults.
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Affiliation(s)
- Mélina Côté
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Stéphanie Harrison
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Annie Lapointe
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Catherine Laramée
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Sophie Desroches
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Simone Lemieux
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Québec, Canada
| | - Ariane Bélanger-Gravel
- Department of Information and Communication, Université Laval, Quebec City, Québec, Canada. .,Research Centre of the Quebec Heart and Lung Institute, Quebec City, Québec, Canada.
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25
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Abu-Saad K, Kaufman-Shriqui V, Freedman LS, Belmaker I, Fraser D. Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country. Eur J Nutr 2020; 60:65-77. [PMID: 32185478 DOI: 10.1007/s00394-020-02221-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/04/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country. METHODS In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age. RESULTS Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28-6.86) of an adverse birth outcome than a woman at the 90th percentile. CONCLUSION Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.
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Affiliation(s)
- Kathleen Abu-Saad
- Department of Public Health, Faculty of Health Sciences, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel. .,Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat Gan, Israel.
| | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, 52621, Ramat Gan, Israel
| | - Ilana Belmaker
- Division of Community Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Drora Fraser
- Department of Public Health, Faculty of Health Sciences, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
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Mulderij LS, Wolters F, Verkooijen KT, Koelen MA, Groenewoud S, Wagemakers A. Effective elements of care-physical activity initiatives for adults with a low socioeconomic status: A concept mapping study with health promotion experts. Eval Program Plann 2020; 80:101813. [PMID: 32179253 DOI: 10.1016/j.evalprogplan.2020.101813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
In care-physical activity (care-PA) initiatives, primary care and sports are combined to stimulate PA among adults at risk of lifestyle related diseases. Preliminary results from Dutch care-PA initiatives for adults with a low socioeconomic status (SES) indicate a decrease in participants' body weight and an improved quality of life, however, the elements that make these initiatives successful are yet to be identified. In total, 19 Dutch health promotion experts participated in our concept mapping (CM) of the effective elements of care-PA initiatives for adults with a low SES. The experts identified 111 effective elements of these initiatives, which were grouped into 11 clusters, focusing on: 1) approaching participants within the care-PA initiative, 2) barriers experienced throughout the initiative, 3) long-term implementation, 4) customizing the care-PA initiative to the target population, 5) social support, 6) structure and guidance, 7) the professionals within the care-PA initiative, 8) the accessibility of the care-PA initiative, 9) targeted behaviour and progression, 10) recruitment and administration, and 11) intersectoral collaboration. CM was useful for creating a valuable overview of these effective elements. Our results could be used to improve the development and implementation of future care-PA initiatives for adults with a low SES.
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Affiliation(s)
- Lisanne S Mulderij
- Health & Society, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, the Netherlands.
| | - Fieke Wolters
- Health & Society, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, the Netherlands
| | - Kirsten T Verkooijen
- Health & Society, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, the Netherlands
| | - Maria A Koelen
- Health & Society, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, the Netherlands
| | - Stef Groenewoud
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, P.O. Box 9101, 114, 6500 HB Nijmegen, the Netherlands
| | - Annemarie Wagemakers
- Health & Society, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, the Netherlands
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Fontenot B, Uwayo M, Avendano SM, Ross D. A Descriptive Analysis of Applied Behavior Analysis Research With Economically Disadvantaged Children. Behav Anal Pract 2019; 12:782-794. [PMID: 31976290 PMCID: PMC6834796 DOI: 10.1007/s40617-019-00389-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In the United States, approximately 43% of children under age 18 are considered economically disadvantaged. Research suggests that these children are at a greater risk for academic underperformance and dropping out of school than their peers who are not from economically disadvantaged backgrounds. As such, they may need effective educational interventions to improve their academic performance. The purpose of the current article is to describe the degree to which economically disadvantaged children are included in educational research in behavioral journals. Ninety-four studies were analyzed to determine the publication trends between 1968 and 2017. Studies were scored and categorized based on journal; publication year; several demographic characteristics for participants including age, income status, and disability diagnosis; and research designs, interventions, and target behaviors. Results suggest that economically disadvantaged children are increasingly included in behavior-analytic literature. However, there are opportunities for research with English language learners and children with disabilities. Implications for practice and research are discussed.
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Affiliation(s)
- Brandi Fontenot
- Department of Psychology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI 49009 USA
| | - Margaret Uwayo
- Department of Psychology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI 49009 USA
| | - Sarah M. Avendano
- Department of Counseling, Psychology, and Special Education, Michigan State University, Kalamazoo, MI USA
| | - Denise Ross
- Department of Psychology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI 49009 USA
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Elsborg P, Nielsen G, Klinker CD, Melby PS, Christensen JH, Bentsen P. Sports-based recreation as a means to address social inequity in health: why, when, where, who, what, and how. BMC Public Health 2019; 19:1084. [PMID: 31399029 PMCID: PMC6688353 DOI: 10.1186/s12889-019-7428-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.
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Affiliation(s)
- Peter Elsborg
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Glen Nielsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte D Klinker
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Paulina S Melby
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Julie H Christensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bentsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
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Abstract
Background The rapid growth of economy and increasing cost of living in Malaysia have given significant impact especially to the lowest household income population. The main objective of this study was to determine risk factors for low quality of life (QOL) and poor health status of this population. Methods This was a cross sectional study design. A total of 347 respondents from low household income groups, including persons with disability and Orang Asli were recruited from E-kasih. A semi-guided self-administered questionnaire was used. QOL measured by EQ. 5D utility value and health status measured by visual analogue score (VAS). Descriptive statistic, bivariate Chi-square analysis and binary logistic regression were conducted to determine factors influencing low QOL and poor health status. Results Majority of the respondents were Malay, female (61%), 63% were married, 60% were employed and 46% with total household income of less than 1 thousand Ringgit Malaysia. 70% of them were not having any chronic medical problems. Factors that associated with low QOL were male, single, low household income, and present chronic medical illness, while poor health status associated with female, lower education level and present chronic medical illness. Logistic regression analysis has showed that determinants of low QOL was present chronic illness [AOR 4.15 95%CI (2.42, 7.13)], while determinants for poor health status were; female [AOR 1.94 95%CI (1.09,3.44)], lower education [AOR 3.07 95%CI (1.28,7.34)] and present chronic illness [AOR 2.53 95%CI (1.39,4.61)]. Conclusion Low socioeconomic population defined as low total household income in this study. Low QOL of this population determined by present chronic illness, while poor health status determined by gender, education level and chronic medical illness.
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chamhuri Siwar
- Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Hazila Abdul Kadir
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Christensen CB, Mikkelsen BE, Toft U. The effect of introducing a free breakfast club on eating habits among students at vocational schools. BMC Public Health 2019; 19:369. [PMID: 30943941 PMCID: PMC6446271 DOI: 10.1186/s12889-019-6701-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background Unhealthy eating habits are a major problem among adolescents. The objective of the study was to assess the effect of a free breakfast club intervention on dietary habits among students at vocational schools. Methods The study included students (n = 318) from four vocational schools in Denmark. Food frequency questionnaires were used to measure eating habits at baseline, first, and second follow-up, after 7 and 14 weeks respectively, in a clustered randomized controlled intervention of four months. The effect of the intervention was evaluated through self-reported frequencies of breakfast intake, intake of whole grain products for breakfast and intake of unhealthy snacking in the morning. The outcome measures were daily breakfast intake (yes/no), daily intake of whole grain for breakfast (yes/no), and unhealthy snacking on school day mornings (yes/no). Results The proportion of students who had breakfast every school day increased significantly in the intervention schools from baseline to the first follow-up compared to the control group (OR: 3.77; P = 0.0149). The effect was attenuated at the second follow-up. The intake of whole grain products for breakfast increased significantly more among students in intervention schools compared to students in control schools both at first (OR: 4.13; P = 0.0079) and second follow-up (OR: 3.27; P = 0.0317). No significant change in unhealthy snacking was found. Conclusion Provision of free breakfast at vocational schools can improve the dietary quality of breakfast and decrease breakfast skipping. However, the sustainability of the intervention is a critical issue that needs to be further studied and addressed. Trial registration ISRCTN11265280. Registered 20 November 2018 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6701-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camilla Berg Christensen
- Department for Development and Planning, Aalborg University Copenhagen, A. C. Meyers Vænge 15, DK-2450, Copenhagen, SV, Denmark.
| | - Bent Egberg Mikkelsen
- Department for Development and Planning, Aalborg University Copenhagen, A. C. Meyers Vænge 15, DK-2450, Copenhagen, SV, Denmark.,Department of Education, Learning and Philosophy, Aalborg University, A. C. Meyers Vænge 15, DK-2450, Copenhagen, SV, Denmark
| | - Ulla Toft
- Centre for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital, Hovedvejen, Entrance 5, Nordre Fasanvej 57, DK-2000, Frederiksberg, Denmark
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Gunn HE, O'Rourke F, Dahl RE, Goldstein TR, Rofey DL, Forbes EE, Shaw DS. Young adolescent sleep is associated with parental monitoring. Sleep Health 2019; 5:58-63. [PMID: 30670167 DOI: 10.1016/j.sleh.2018.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Insufficient sleep can increase risk for adverse psychological and physical outcomes. Parental monitoring of daily activities is associated with youth health behaviors. We examined parental monitoring of waking and bedtime behaviors and sleep in a community sample of high-risk youth. METHODS One-hundred sixty-five 10- to 14-year-olds from low-socioeconomic status families participated (11.8 years ±1.16, 52% female; 78% Black/African American). Parents and youth evaluated parental monitoring of waking activities. Parent expectations about bedtime and parent knowledge about adolescent's bedtime and sleep routine were independently rated. Youth sleep was assessed via parent report and actigraphy over 7 days. RESULTS More parental knowledge about bedtime was associated with longer parent-reported sleep duration (β = .18, P < .05). Parental monitoring of waking activities (youth reported) was associated with more actigraph-assessed sleep over 7 days (B = 2.73, SE = .91), weekdays (B = 2.44, SE = .01), and weekends (B = 3.88, SE = .1.41, all Ps < .05), whereas parent reported monitoring was associated with more sleep on weekdays only (B = 2.10, SE = .87, P < .05). Parental knowledge and expectations about bedtime behaviors were not associated with actigraph-assessed sleep (P values > .05). Parental monitoring of waking and bedtime behaviors was not associated with sleep duration variability (P values > .05). CONCLUSIONS Parental monitoring of waking activities may indirectly influence adolescent sleep via increased structure and felt security in the parent-adolescent relationship. Youth perception of monitoring may be particularly relevant for youth sleep duration.
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Seng JJB, Kwan YH, Goh H, Thumboo J, Low LL. Public rental housing and its association with mortality - a retrospective, cohort study. BMC Public Health 2018; 18:665. [PMID: 29843652 PMCID: PMC5975624 DOI: 10.1186/s12889-018-5583-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is a well-established determinant of health status and home ownership is a commonly used composite indicator of SES. Patients in low-income households often stay in public rental housing. The association between public rental housing and mortality has not been examined in Singapore. METHODS A retrospective, cohort study was conducted involving all patients who utilized the healthcare facilities under SingHealth Regional Health (SHRS) Services in Year 2012. Each patient was followed up for 5 years. Patients who were non-citizens or residing in a non-SHRS area were excluded from the study. RESULTS A total of 147,004 patients were included in the study, of which 7252 (4.9%) patients died during the study period. The mean age of patients was 50.2 ± 17.2 years old and 7.1% (n = 10,400) of patients stayed in public rental housing. Patients who passed away had higher utilization of healthcare resources in the past 1 year and a higher proportion stayed in public rental housing (p < 0.001). They also had higher rates of co-morbidities such as hypertension, hyperlipidaemia and diabetes. (p < 0.001) After adjustment for demographic and clinical covariates, residence in public rental housing was associated with increased risk of all-cause mortality (Adjusted hazard ratio: 1.568, 95% CI: 1.469-1.673). CONCLUSION Public rental housing was an independent risk factor for all-cause mortality. More studies should be conducted to understand health-seeking behavior and needs of public rental housing patients, to aid policymakers in formulating better plans for improving their health outcomes.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Durand MA, Yen RW, O'Malley AJ, Politi MC, Dhage S, Rosenkranz K, Weichman K, Margenthaler J, Tosteson ANA, Crayton E, Jackson S, Bradley A, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Song J, Acosta J, Mir N, Elwyn G. What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata. BMC Public Health 2018; 18:241. [PMID: 29439691 DOI: 10.1186/s12889-018-5109-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/22/2018] [Indexed: 01/25/2023] Open
Abstract
Background Breast cancer is the most commonly diagnosed malignancy in women. Mastectomy and breast-conserving surgery (BCS) have equivalent survival for early stage breast cancer. However, each surgery has different benefits and harms that women may value differently. Women of lower socioeconomic status (SES) diagnosed with early stage breast cancer are more likely to experience poorer doctor-patient communication, lower satisfaction with surgery and decision-making, and higher decision regret compared to women of higher SES. They often play a more passive role in decision-making and are less likely to undergo BCS. Our aim is to understand how best to support women of lower SES in making decisions about early stage breast cancer treatments and to reduce disparities in decision quality across socioeconomic strata. Methods We will conduct a three-arm, multi-site randomized controlled superiority trial with stratification by SES and clinician-level randomization. At four large cancer centers in the United States, 1100 patients (half higher SES and half lower SES) will be randomized to: (1) Option Grid, (2) Picture Option Grid, or (3) usual care. Interviews, field-notes, and observations will be used to explore strategies that promote the interventions’ sustained use and dissemination. Community-Based Participatory Research will be used throughout. We will include women aged at least 18 years of age with a confirmed diagnosis of early stage breast cancer (I to IIIA) from both higher and lower SES, provided they speak English, Spanish, or Mandarin Chinese. Our primary outcome measure is the 16-item validated Decision Quality Instrument. We will use a regression framework, mediation analyses, and multiple informants analysis. Heterogeneity of treatment effects analyses for SES, age, ethnicity, race, literacy, language, and study site will be performed. Discussion Currently, women of lower SES are more likely to make treatment decisions based on incomplete or uninformed preferences, potentially leading to poorer decision quality, quality of life, and decision regret. This study hopes to identify solutions that effectively improve patient-centered care across socioeconomic strata and reduce disparities in decision and care quality. Trial registration NCT03136367 at ClinicalTrials.gov Protocol version: Manuscript based on study protocol version 2.2, 7 November 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5109-2) contains supplementary material, which is available to authorized users.
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DeBiasse MA, Bowen DJ, Quatromoni PA, Quinn E, Quintiliani LM. Feasibility and Acceptability of Dietary Intake Assessment Via 24-Hour Recall and Food Frequency Questionnaire among Women with Low Socioeconomic Status. J Acad Nutr Diet 2017; 118:301-307. [PMID: 29102422 DOI: 10.1016/j.jand.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/09/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations. OBJECTIVE This research focused on evaluating feasibility and acceptability of two self-report measures of diet. DESIGN Cross-sectional. PARTICIPANTS/SETTING Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure. MAIN OUTCOME MEASURES Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions. RESULTS During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ. CONCLUSION Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method.
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Chibwe E, Mirambo MM, Kihunrwa A, Mshana SE. Magnitude of the Cytomegalovirus infection among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania. BMC Res Notes 2017; 10:489. [PMID: 28931421 PMCID: PMC5607485 DOI: 10.1186/s13104-017-2813-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Despite, Cytomegalovirus (CMV) infection being associated with a potential risk to the fetus, there is limited data from Tanzania and many other developing countries regarding the epidemiology and the impact of CMV infections. This cross-sectional study was conducted between December 2014 and June 2015 among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania to investigate the magnitude and associated factors of CMV infection. Methods The specific CMV IgM and IgG antibodies were detected using indirect enzyme linked immunosorbent assay (ELISA). Demographic and clinical data were collected using pre-tested data collection tool. Data were analysed using STATA version 13. Results A total of 261 pregnant women with median age of 20 (IQR 19–25) years and mean gestation age of 17 ± 7.8 weeks were enrolled. The seroprevalence of CMV IgG antibodies was 193(73.9%; 95% CI 67.2–79.6) while that of CMV IgM antibodies was 0.4%. As the age increased by one unit the IgG seroprevalence was found to increase by 0.3% (95% CI 0.13–0.47, p = 0.001) whereas the risk of being IgG positive increased by 24%. On multivariable logistic regression analysis only urban residence (OR 6.329, 95% CI 2.885–13.887, p < 0.001) was found to independently predict CMV IgG seropositivity. Regarding the outcomes of previous pregnancies the history of miscarriage independently predicted IgG seropositivity (OR 5.6, 95% CI 1.29–24.178, p = 0.021). The IgM seropositive woman had fatal outcome of the term delivery of the baby with microcephaly and spinal-bifida. Conclusion Cytomegalovirus seroprevalence among pregnant women residing in urban areas of Mwanza city, Tanzania is high and is associated with poor pregnancy outcomes. There is a need to emphasize routine screening of CMV in order to establish the impact of CMV during pregnancy.
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Affiliation(s)
- Elieza Chibwe
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
| | - Albert Kihunrwa
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
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Santana DD, Barros EG, Costa RSD, da Veiga GV. Temporal changes in the prevalence of disordered eating behaviors among adolescents living in the metropolitan area of Rio de Janeiro, Brazil. Psychiatry Res 2017; 253:64-70. [PMID: 28351004 DOI: 10.1016/j.psychres.2017.03.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/26/2017] [Accepted: 03/21/2017] [Indexed: 12/15/2022]
Abstract
To investigate temporal changes in the prevalence of disordered eating behaviors among adolescents, and their association with socio demographic factors and overweight. Using probability sampling, two population-based cross-sectional surveys were conducted: one in 2005 (n=511) and the other in 2010 (n=314). The frequency of disordered eating behaviors (binge eating, strict dieting or fasting and compensatory behaviors) was investigated using a self-administered questionnaire. The presence of binge eating increased by 18.4% in the 5 years between the two surveys. In 2005, girls were 1.95 times more likely to engage in strict dieting or fasting than boys, and this difference increased to 7.02 times in 2010. Overweight adolescents were 2.29 times more likely to undertake strict dieting than non-overweight adolescents in 2005 and 3.65 times more likely to do so in 2010. No significant associations were found for compensatory behaviors. A pronounced increase in the prevalence of binge eating was observed, and girls and overweight adolescents were more likely to engage in strict dieting or fasting.
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Jafta N, Barregard L, Jeena PM, Naidoo RN. Indoor air quality of low and middle income urban households in Durban, South Africa. Environ Res 2017; 156:47-56. [PMID: 28319817 DOI: 10.1016/j.envres.2017.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Elevated levels of indoor air pollutants may cause cardiopulmonary disease such as lower respiratory infection, chronic obstructive lung disease and lung cancer, but the association with tuberculosis (TB) is unclear. So far the risk estimates of TB infection or/and disease due to indoor air pollution (IAP) exposure are based on self-reported exposures rather than direct measurements of IAP, and these exposures have not been validated. OBJECTIVE The aim of this paper was to characterize and develop predictive models for concentrations of three air pollutants (PM10, NO2 and SO2) in homes of children participating in a childhood TB study. METHODS Children younger than 15 years living within the eThekwini Municipality in South Africa were recruited for a childhood TB case control study. The homes of these children (n=246) were assessed using a walkthrough checklist, and in 114 of them monitoring of three indoor pollutants was also performed (sampling period: 24h for PM10, and 2-3 weeks for NO2 and SO2). Linear regression models were used to predict PM10 and NO2 concentrations from household characteristics, and these models were validated using leave out one cross validation (LOOCV). SO2 concentrations were not modeled as concentrations were very low. RESULTS Mean indoor concentrations of PM10 (n=105), NO2 (n=82) and SO2 (n=82) were 64μg/m3 (range 6.6-241); 19μg/m3 (range 4.5-55) and 0.6μg/m3 (range 0.005-3.4) respectively with the distributions for all three pollutants being skewed to the right. Spearman correlations showed weak positive correlations between the three pollutants. The largest contributors to the PM10 predictive model were type of housing structure (formal or informal), number of smokers in the household, and type of primary fuel used in the household. The NO2 predictive model was influenced mostly by the primary fuel type and by distance from the major roadway. The coefficients of determination (R2) for the models were 0.41 for PM10 and 0.31 for NO2. Spearman correlations were significant between measured vs. predicted PM10 and NO2 with coefficients of 0.66 and 0.55 respectively. CONCLUSION Indoor PM10 levels were relatively high in these households. Both PM10 and NO2 can be modeled with a reasonable validity and these predictive models can decrease the necessary number of direct measurements that are expensive and time consuming.
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Affiliation(s)
- Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, 321 George Campbell Building, Howard College Campus, Durban 4041, South Africa.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy at Gothenburg University, Box 414, S-405 30 Gothenburg, Sweden
| | - Prakash M Jeena
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Private Bag X1, Congella, Durban 4013, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, 321 George Campbell Building, Howard College Campus, Durban 4041, South Africa
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Abou-Zeid AA, ElAbbassy IH, Kamal AM, Somaie DA. Complete rectal prolapse in young Egyptian males: Is schistosomiasis really condemned? World J Gastrointest Surg 2016; 8:779-783. [PMID: 28070233 PMCID: PMC5183921 DOI: 10.4240/wjgs.v8.i12.779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/11/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the assumption that schistosomiasis is the main cause of rectal prolapse in young Egyptian males.
METHODS Twenty-one male patients between ages of 18 and 50 years with complete rectal prolapse were included in the study out of a total 29 patients with rectal prolapse admitted for surgery at Colorectal Surgery Unit, Ain Shams University hospitals between the period of January 2011 and April 2014. Patients were asked to fill out a specifically designed questionnaire about duration of the prolapse, different bowel symptoms and any past or present history of schistosomiasis. Patients also underwent flexible sigmoidoscopy and four quadrant mid-rectal biopsies documenting any gross or microscopic rectal pathology. Data from questionnaire and pathology results were analyzed and patients were categorized according to their socioeconomic class.
RESULTS Twelve patients (57%) never contracted schistosomiasis and were never susceptible to the disease, nine patients (43%) had history of the disease but were properly treated. None of the patients had gross rectal polyps and none of the patients had active schistosomiasis on histopathological examination. Fifteen patients (71%) had early onset prolapse that started in childhood, majority before the age of 5 years. Thirteen patients (62%) were habitual strainers, and four of them (19%) had straining dating since early childhood. Four patients (19%) stated that prolapse followed a period of straining that ranged between 8 mo and 2 years. Nine patients (43%) in the present study came from the low social class, 10 patients (48%) came from the working class and 2 patients (9%) came from the low middle social class.
CONCLUSION Schistosomiasis should not be considered the main cause of rectal prolapse among young Egyptian males. Childhood prolapse that continues through adult life is likely involved. Childhood prolapse probably results from malnutrition, recurrent parasitic infections and diarrhea that induce straining and prolapse, all are common in lower socioeconomic classes.
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Goff SL, Youssef Y, Pekow PS, White KO, Guhn-Knight H, Lagu T, Mazor KM, Lindenauer PK. Successful Strategies for Practice-Based Recruitment of Racial and Ethnic Minority Pregnant Women in a Randomized Controlled Trial: the IDEAS for a Healthy Baby Study. J Racial Ethn Health Disparities 2016; 3:731-737. [PMID: 27068662 PMCID: PMC5064805 DOI: 10.1007/s40615-015-0192-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/29/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Racial/ethnic minority patients are often underrepresented in clinical trials. Efforts to address barriers to participation may improve representation, thus enhancing our understanding of how research findings apply to more diverse populations. METHODS The IDEAS (Information, Description, Education, Assistance, and Support) for a Healthy Baby study was a randomized controlled trial (RCT) of an intervention to reduce barriers to using publicly reported quality data for low-income, racial/ethnic minority women. We used strategies grounded in a health equity framework to address barriers to recruitment and retention in three domains: preparation, process, and patient-centeredness. "Preparation" included teaching study staff about health inequities, role-playing skills to develop rapport and trust, and partnering with clinic staff. "Processes" included use of electronic registration systems to pre-screen potential candidates and determine when eligible participants were in clinic and an electronic database to track patients through the study. Use of a flexible protocol, stipends, and consideration of literacy levels promoted "patient-centeredness." RESULTS We anticipated needing to recruit 800 women over 18 months to achieve a completion goal of 650. Using the recruitment and retention strategies outlined above, we recruited 746 women in 15 months, achieving higher recruitment (87.1 %) and retention rates (97.3 %) than we had anticipated. DISCUSSION These successful recruitment and retention strategies used for a large RCT promoted inclusivity and accessibility. Researchers seeking to recruit racial and ethnic minority pregnant women in similar settings may find the preparation, process, and patient-centered strategies used in this study applicable for their own studies. TRIAL REGISTRATION ClinicalTrials.gov NCT01784575 , 1R21HS021864-01.
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Affiliation(s)
- Sarah L. Goff
- Department of Medicine, Tufts University/Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
- Center for Quality of Care Research, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
| | - Yara Youssef
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Penelope S. Pekow
- Center for Quality of Care Research, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Katharine O. White
- Department of Obstetrics and Gynecology, Boston University Medical Center, 72 East Concord St., Boston, MA 02118, USA
| | - Haley Guhn-Knight
- Department of Medicine, Tufts University/Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
- Center for Quality of Care Research, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
| | - Tara Lagu
- Department of Medicine, Tufts University/Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
- Center for Quality of Care Research, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
| | - Kathleen M. Mazor
- Meyers Primary Care Institute, 630 Plantation St., Worcester, MA, USA
- Department of Internal Medicine, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA, USA
| | - Peter K. Lindenauer
- Department of Medicine, Tufts University/Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
- Center for Quality of Care Research, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
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Ma P, Kendzor DE, Poonawalla IB, Balis DS, Businelle MS. Daily nicotine patch wear time predicts smoking abstinence in socioeconomically disadvantaged adults: An analysis of ecological momentary assessment data. Drug Alcohol Depend 2016; 169:64-67. [PMID: 27776246 DOI: 10.1016/j.drugalcdep.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Individuals who use the nicotine patch are more likely to quit smoking than those who receive placebo or no medication. However, studies have not yet examined the association between actual daily nicotine patch wear time during the early phase of a smoking cessation attempt and later smoking abstinence. The purpose of this study was to address this gap in the literature. METHODS Participants who enrolled in a safety-net hospital smoking cessation program were followed for 13 weeks (i.e., 1 week pre-quit through 12 weeks post-quit). Participants completed in-person assessments and daily ecological momentary assessments on study provided smartphones. Multivariate logistic regressions were used to determine if daily patch wear time during the first week post-quit predicted 7-day biochemically verified point prevalence smoking abstinence 4 and 12 weeks following the scheduled quit date. Demographic characteristics and smoking behaviors were adjusted as covariates. RESULTS Participants (N=74) were primarily non-White (78.7%) and most (86%) had an annual household income of <$20,000. Greater average hours of daily nicotine patch wear time during the first week post-quit was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=2.22, 95% CI:1.17-4.23; aOR=2.24, 95% CI:1.00-5.03). Furthermore, more days of wearing the patch for ≥19h was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=1.81, 95% CI:1.01-3.22; aOR=2.18, 95% CI:1.03-4.63). CONCLUSIONS Greater adherence to the nicotine patch early in a quit attempt may increase the likelihood of smoking cessation among socioeconomically disadvantaged adults.
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Affiliation(s)
- Ping Ma
- Children's Health/Children's Medical Center at Dallas, Dallas, TX, United States.
| | - Darla E Kendzor
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma, OK, United States
| | - Insiya B Poonawalla
- Department of Health Promotion and Behavioral Sciences, Dallas, TX, United States
| | - David S Balis
- University of Texas Southwestern Medical Center, Department of General Internal Medicine, Dallas, TX, United States
| | - Michael S Businelle
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma, OK, United States
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Alam S, Elwyn G, Percac-Lima S, Grande S, Durand MA. Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients. BMC Med Inform Decis Mak 2016; 16:147. [PMID: 27871271 PMCID: PMC5117693 DOI: 10.1186/s12911-016-0384-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background Women of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions. They tend to report higher decisional regret and poorer communication. Evidence suggests that well-designed encounter decision aids (DAs) could improve outcomes and potentially reduce healthcare disparities. Our goal was to evaluate the acceptability and feasibility of encounter decision aids (Option Grid, Comic Option Grid, and Picture Option Grid) adapted for a low-SES and low-literacy population. Methods We used a multi-phase, mixed-methods approach. In phase 1, we conducted a focus group with rural community stakeholders. In phase 2, we developed and administered a web-based questionnaire with patients of low and high SES. In phase 3, we interviewed patients of low SES and relevant healthcare professionals. Results Data from phase 1 (n = 5) highlighted the importance of addressing treatment costs for patients. Data from phase 2 (n = 268) and phase 3 (n = 15) indicated that using both visual displays and numbers are helpful for understanding statistical information. Data from all three phases suggested that using plain language and simple images (Picture Option Grid) was most acceptable and feasible. The Comic Option Grid was deemed least acceptable. Conclusion Option Grid and Picture Option Grid appeared acceptable and feasible in facilitating patient involvement and improving perceived understanding among patients of high and low SES. Picture Option Grid was considered most acceptable, accessible and feasible in the clinic visit. However, given the small sample sizes used, those findings need to be interpreted with caution. Further research is needed to determine the impact of pictorial and text-based encounter decision aids in underserved patients and across socioeconomic strata.
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Affiliation(s)
- Shama Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA.
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Durand MA, Alam S, Grande SW, Elwyn G. 'Much clearer with pictures': using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer. BMJ Open 2016; 6:e010008. [PMID: 26839014 PMCID: PMC4746463 DOI: 10.1136/bmjopen-2015-010008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. DESIGN Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). SETTING Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. PARTICIPANTS In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. INTERVENTION The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). OUTCOME MEASURES We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. RESULTS After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. CONCLUSIONS AND RELEVANCE Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Shama Alam
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Stuart W Grande
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
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Løyland B. The co-occurrence of chronic pain and psychological distress and its associations with salient socio-demographic characteristics among long-term social assistance recipients in Norway. Scand J Pain 2016; 11:65-72. [PMID: 28850472 DOI: 10.1016/j.sjpain.2015.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND While lower socioeconomic status increases individual's risk for chronic conditions, little is known about how long-term social assistance recipients (LTRs) with multiple chronic health problems experience chronic pain and/or psychological distress. Social assistance is the last safety net in the Norwegian welfare system and individuals have a legal right to economic assistance if they are unable to support themselves or are entitled to other types of benefits. The purposes of this study were to determine the co-occurrence of both chronic pain and psychological distress and to evaluate for differences in demographic and social characteristics, as well as health-related quality of life, among LTRs. METHODS This descriptive, cross-sectional study surveyed people receiving long-term social assistance in Norway about their health and social functioning from January-November 2005. The social welfare authority offices in each of 14 municipalities in Norway were responsible to locate the LTRs who met the study's inclusion criteria. The selected municipalities provided geographic variability including both rural and urban municipalities in different parts of the country. LTRs were included in this study if they: had received social assistance as their main source of income for at least 6 of the last 12 months; were between 18 and 60 years of age; and were able to complete the study questionnaire. In this study, 405 LTRs were divided into four groups based on the presence or absence of chronic pain and/or psychological distress. (1) Neither chronic pain nor psychological distress (32%, n=119), (2) only chronic pain (12%, n=44), (3) only psychological distress and (24%, n=87), (4) both chronic pain and psychological distress (32%, n=119). RESULTS Except for age and marital status, no differences were found between groups in demographic characteristics. Significant differences were found among the four groups on all of the items related to childhood difficulties before the age of 16, except the item on sexual abuse. LTRs with both chronic pain and psychological distress were more likely to have experienced economic problems in their childhood home; other types of abuse than sexual abuse; long-term bullying; and had more often dropped out of school than LTRs with neither chronic pain nor psychological distress. LTRs with both chronic pain and psychological distress, reported more alcohol and substance use/illicit drug use, more feelings of loneliness and a lower mental score on SF-12 than LTRs with only chronic pain. CONCLUSIONS AND IMPLICATIONS Co-occurrence of chronic pain and psychological distress is common in LTRs and problems in early life are associated with the co-occurrence of chronic pain and psychological distress in adult life. Although this study cannot assign a clear direction or causality to the association between social and demographic characteristics and chronic pain and psychological distress, the findings when examining LTRs' problems in childhood before the age of 16, indicated that incidents in early life create a probability of chronic pain and psychological distress in the adult life of the individuals. Further studies should use life course studies and longitudinal data in to investigate these important questions in LTRs.
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Affiliation(s)
- Borghild Løyland
- Oslo and Akershus University College of Applied Science, Institute of Nursing and Health Promotion, Oslo, Norway.
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Kim CO. Food choice patterns among frail older adults: The associations between social network, food choice values, and diet quality. Appetite 2015; 96:116-121. [PMID: 26385288 DOI: 10.1016/j.appet.2015.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 09/06/2015] [Accepted: 09/11/2015] [Indexed: 01/17/2023]
Abstract
Social network type might affect an individual's food choice because these decisions are often made as a group rather than individually. In this study, the associations between social network type, food choice value, and diet quality in frail older adults with low socioeconomic status were investigated. For this cross-sectional study, 87 frail older adults were recruited from the National Home Healthcare Services in Seoul, South Korea. Social network types, food choice values, and diet quality were assessed using The Practitioner Assessment of Network Type Instrument, The Food Choice Questionnaire, and mean adequacy ratio, respectively. Results showed that frail older adults with close relationships with local family and/or friends and neighbors were less likely to follow their own preferences, such as taste, price, and beliefs regarding food health values. In contrast, frail older adults with a small social network and few community contacts were more likely to be influenced by their food choice values, such as price or healthiness of food. Frail older adults who tend to choose familiar foods were associated with low-quality dietary intake, while older adults who valued healthiness or use of natural ingredients were associated with a high-quality diet. The strength and direction of these associations were dependent on social network type of frail older adults. This study explored the hypothesis that food choice values are associated with a certain type of social network and consequently affect diet quality. While additional research needs to be conducted, community-based intervention intended to improve diet quality of frail older adults must carefully consider individual food choice values as well as social network types.
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Affiliation(s)
- Chang-O Kim
- Department of Social Welfare, Seoul National University, Republic of Korea; Clinical Research Center, Yang Ji Hospital, Republic of Korea.
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Ferreira JE, de Souza PR Jr, da Costa RS, Sichieri R, da Veiga GV. Disordered eating behaviors in adolescents and adults living in the same household in metropolitan area of Rio de Janeiro, Brazil. Psychiatry Res 2013; 210:612-7. [PMID: 23838420 DOI: 10.1016/j.psychres.2013.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 06/07/2013] [Accepted: 06/15/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the prevalence of disordered eating behaviors among adolescents and adults living in the same household. METHODS We conducted a population-based cross-sectional study developed with a probabilistic sample of 511 adolescents and 1254 adults living in the metropolitan area of Rio de Janeiro, Brazil. The frequency of binge eating, purging, and strict dieting or fasting over the previous 6 months was ascertained using a self-report questionnaire. RESULTS Binge eating (20.0% vs. 8.4%), strict dieting or fasting (18.9% vs. 2.4%), and purging (3.3% vs. 2.2%) were more frequent among adolescents than adults. There was a significant association between frequency of binge eating and strict dieting or fasting in adults and in adolescents living in the same household. CONCLUSION The presence of disordered eating behaviors in adults may be a risk factor for the development of eating disorders in adolescents living in the same household. Thus, the development and implementation of eating disorder interventions should consider incorporating a family component.
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