scholarly journals Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Genny Carrillo ◽  
Taehyun Roh ◽  
Juha Baek ◽  
Betty Chong-Menard ◽  
Marcia Ory
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Low Income ◽  
The United States ◽  
South Texas ◽  
Environmental Modification ◽  
Asthma Education ◽  
Individual Level ◽  
Children With Asthma ◽  
The Impact

Abstract Background In the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families. Methods The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children’s schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9–12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test. Results The HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children’s school attendance and participation in physical activities and family social events and decreased families’ worry about their asthma management. Conclusions The RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

scholarly journals A Qualitative Study to Explore Perception of Impacts of Preemption of Tobacco Regulation on Counties in Appalachian Tennessee

2020 ◽  
Vol 17 (9) ◽  
pp. 3230
Author(s):  
Hadii M. Mamudu ◽  
Fenose Osedeme ◽  
Crystal Robertson ◽  
Mary Ann Littleton ◽  
Daniel Owusu ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Tobacco Use ◽  
Low Income ◽  
State Level ◽  
The United States ◽  
Control Measures ◽  
Health Improvement ◽  
Individual Level ◽  
Normative Factors ◽  
The Impact

Bottom-up processes, starting at the local government level, are valuable for more-stringent tobacco control measures. The existence of industry-backed state-level tobacco control preemption in states has impeded policy progress within the state and localities/communities. A national public health goal under Healthy People 2020 is to eliminate state-level preemption across the United States. This study explored individual-level perceptions of the impact of state-level preemption in Appalachian Tennessee—a high-smoking, low-income region. During 2015–2016, a community-engagement project to develop a Population Health Improvement Plan (PHIP) involving over 200 stakeholders and 90 organizations was conducted in Appalachian Tennessee to identify policies/programs to address tobacco use. Using a multifaceted framework approach that focused on prevention, protection, and cessation, interviews and meeting discussions were audio-recorded and transcribed. Content analysis using NVivo 11 was conducted to generate themes. Although the central focus of the PHIP was not preemption, the issue emerged naturally in the discussions as a major concern among participants. Cultural and normative factors in Appalachian Tennessee were identified as key rationales for participants’ aversion to state preemption. Thus, repealing preemption would facilitate culturally tailored and region-specific policies/programs to the high tobacco use among Appalachian Tennessee communities where statewide/nationwide policies/programs have not had the intended impacts.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

scholarly journals More Than Shelter: Housing for Urban Maternal and Infant Health

2021 ◽  
Vol 18 (7) ◽  
pp. 3331
Author(s):  
Jason Reece
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Outcomes ◽  
City Planning ◽  
Infant Health ◽  
The United States ◽  
Housing Quality ◽  
Housing Discrimination ◽  
Maternal Health Outcomes ◽  
The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

scholarly journals Inequality, policy polarization and the income gap in turnout

2021 ◽  
pp. 135406882110119
Author(s):  
Matthew Polacko
Keyword(s):  
Income Inequality ◽  
Low Income ◽  
Party Systems ◽  
Individual Level ◽  
Income Gap ◽  
Income Groups ◽  
Logistic Regressions ◽  
Negative Impacts ◽  
The Impact ◽  
The Relationship

Previous research into the relationship between income inequality and turnout inequality has produced mixed results, as consensus is lacking whether inequality reduces turnout for all income groups, low-income earners, or no one. Therefore, this paper builds on this literature by introducing supply-side logic, through the first individual-level test of the impact that income inequality (moderated by policy manifesto positions) has on turnout. It does so through multilevel logistic regressions utilizing mixed effects, on a sample of 30 advanced democracies in 102 elections from 1996 to 2016. It finds that higher levels of income inequality significantly reduce turnout and widen the turnout gap between rich and poor. However, it also finds that when party systems are more polarized, low-income earners are mobilized the greatest extent coupled with higher inequality, resulting in a significantly reduced income gap in turnout. The findings magnify the negative impacts income inequality can exert on political behavior and contribute to the study of policy offerings as a key moderating mechanism in the relationship.

scholarly journals Childlessness, Individual Socioeconomic Resources, and Health: Exploring Variation in 20 Countries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 515-516
Author(s):  
Nekehia Quashie ◽  
Christine Mair ◽  
Radoslaw Antczak ◽  
Bruno Arpino
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Health Indicators ◽  
Data Repository ◽  
Middle Income ◽  
Individual Level ◽  
Socioeconomic Resources ◽  
Middle Income Countries ◽  
Using Data ◽  
The Impact

Abstract Childless older adults may be at risk for poorer health cross-nationally, yet most studies on this topic analyze only a small number of countries and only 1 or 2 health outcomes. To our knowledge, two papers exist that explore associations between childlessness and multiple indicators of health using data from a large number of regionally diverse countries (e.g., 20 countries from North America, Asia, and Europe), but neither study includes an examination of socioeconomic resources. The level of health risk faced by childless older adults is likely to be distinctly shaped by older adults’ socioeconomic resources (e.g., education, income, wealth). Associations between childlessness, socioeconomic resources, and health may also differ by country context. Using harmonized, cross-national data for adults aged 50 and older across 20 high- and middle-income countries (United States (HRS), European Union (SHARE), Mexico (MHAS), and China (CHARLS) from the Gateway to Global Aging data repository), we explore if and how individual-level socioeconomic resources (income, education, wealth) moderate associations between childlessness and five health indicators (self-rated health, ADL limitations, IADL limitations, chronic conditions, and depression). Results suggest that associations between childlessness and health outcomes vary by individual socioeconomic resources in some country contexts, but not in others. We discuss these findings in light of the impact of individual-level socioeconomic resources on older adults’ support options and health outcomes cross-nationally.

scholarly journals Type 2 diabetes and tuberculosis in a dynamic bi-national border population

2006 ◽  
Vol 135 (3) ◽  
pp. 483-491 ◽  
Author(s):  
B. I. RESTREPO ◽  
S. P. FISHER-HOCH ◽  
J. G. CRESPO ◽  
E. WHITNEY ◽  
A. PEREZ ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Large Population ◽  
The United States ◽  
South Texas ◽  
Control Programmes ◽  
Mexico Border ◽  
Northeastern Mexico ◽  
The Impact ◽  
Border Population

The epidemic of type 2 diabetes in the United States prompted us to explore the association between diabetes and tuberculosis (TB) on the South Texas–Mexico border, in a large population of mostly non-hospitalized TB patients. We examined 6 years of retrospective data from all TB patients (n=5049) in South Texas and northeastern Mexico and found diabetes self-reported by 27·8% of Texan and 17·8% of Mexican TB patients, significantly exceeding national self-reported diabetes rates for both countries. Diabetes comorbidity substantially exceeded that of HIV/AIDS. Patients with TB and diabetes were older, more likely to have haemoptysis, pulmonary cavitations, be smear positive at diagnosis, and remain positive at the end of the first (Texas) or second (Mexico) month of treatment. The impact of type 2 diabetes on TB is underappreciated, and in the light of its epidemic status in many countries, it should be actively considered by TB control programmes, particularly in older patients.

An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context

2021 ◽  
pp. 027507402110493
Author(s):  
Kenicia Wright
Keyword(s):  
Health Care ◽  
Black Women ◽  
Health Outcomes ◽  
White Women ◽  
The United States ◽  
Symbolic Representation ◽  
Representative Bureaucracy ◽  
Female Physicians ◽  
Individual Level ◽  
Gender Concordance

Although the United States spends more on health care than comparable nations, many Americans suffer from poor health. Many factors are emphasized as being important for improved health outcomes, including social and economic indicators, living and working conditions, and individual-level behavior. However, I argue the overwhelming attention to male health outcomes—compared to female health outcomes—and focus on factors that are “traditionally understood” as important in shaping health are two limitations of existing health-related research. I adopt an innovative approach that combines the theory of representative bureaucracy, gender concordance, and symbolic representation to argue that increase in female physicians contribute to improved female health outcomes. Using an originally collected dataset that contains information on female physicians, health outcomes, and state and individual-level factors, I study how female physicians influence the health outcomes of non-Hispanic White women, non-Hispanic Black women, and Latinas in the United States from 2000 to 2012. The findings suggest female physicians contribute to improved health outcomes for non-Hispanic White women and non-Hispanic Black women, but not Latinas. Supplemental Analysis bolsters confidence that the findings are not the result of increased access to health care professionals. This study highlights the importance of applying the theory of representative bureaucracy and symbolic representation to health care, the promise of greater female representation in health, and the insight gleaned from incorporating intersectionality in public administration research.

scholarly journals School's Out

Elements ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 39-52
Author(s):  
Charlie Power
Keyword(s):  
United States ◽  
Low Income ◽  
Education System ◽  
The United States ◽  
Current Evidence ◽  
Learning Loss ◽  
Summer Learning ◽  
Elementary And Secondary Education ◽  
Heated Debate ◽  
The Impact

The debate over the future direction of elementary and secondary education in the United States is fractious and contentious. Many of these are rooted in concerns over disparities in financial circumstances and race. While the full extent of the gaps, in addition to the United States' mediocre education system relative to other industrialized nations, has been a subject of frequent research and heated debate, one crucial component of this divide has yet to be analyzed: summer learning loss. This paper will closely analyze published literature in order to analyze the impact of summer education loss. Additionally, this paper will argue that summer learning varies by socioeconomic status (SES), with low-income populations gradually regressing over the years. This phenomenon has ramifications on students' achievement and explains the disparities that accumulate over a student's educational career. Finally, based on current evidence, this paper will make policy recommendations on how to change the current education system to better address summer's inherent inequities. 

scholarly journals A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

2021 ◽  
Vol 53 (10) ◽  
pp. 843-856
Author(s):  
Constance Gundacker ◽  
Tyler W. Barreto ◽  
Julie P. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Health Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Traumatic Experiences ◽  
Search Term ◽  
Care Providers ◽  
Trauma Informed ◽  
The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

scholarly journals “Here in the Bible Belt, It’s Predominantly Negative”: Sexual Identity Stigma in the American South, 50 Years After Stonewall

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph J. Frey ◽  
William J. Hall ◽  
Jeremy T. Goldbach ◽  
Paul Lanier
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Disparities ◽  
Sexual Identity ◽  
Minority Stress ◽  
The United States ◽  
Mental Health Disparities ◽  
Structured Interviews ◽  
United States South ◽  
The Impact

Lesbian, gay, bisexual, and pansexual (LGB+) individuals have disproportionate rates of mental illness. Minority stress and sexual identity stigma are posited as the primary social determinants of LGB+ mental health disparities. Discussions in the literature have questioned the impact of sexual identity stigma in a world increasingly accepting of sexual minorities. Additionally, the LGB+ population in the United States South is often overlooked in American research. This article details a qualitative study exploring experiences related to sexual identity stigma among adults who identify as LGB+ in the United States South. Semi-structured interviews with 16 individuals were analyzed using content analysis. Six thematic categories of stigma emerged from participants’ experiences: (a) navigating an LGB+ identity, (b) social acceptability of an LGB+ identity, (c) expectation of LGB+ stigma, (d) interpersonal discrimination and harassment, (e) structural stigma, and (f) relationship with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Findings suggest that sexual identity stigma remains a common experience among these Southern United States participants. Further, thematic categories and subcategories primarily aligned with extant theory with one exception: Intracommunity stigma, a form of stigma emanating from the LGBTQ community, emerged as a stigma type not currently accounted for in theoretical foundations underpinning mental health disparities in this population.

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