Economic Well-Being And Health: The Role Of Income Support Programs In Promoting Health And Advancing Health Equity.

People with low incomes have poorer health outcomes, including greater risk for disease and shorter lifespans. This pattern has the least favorable outcomes for those living in poverty but is present at every level of the income ladder. Income support programs that provide a social safety net for families-including the Earned Income Tax Credit and Temporary Assistance for Needy Families-can influence health by meeting families' basic needs and supporting participation in economic development. However, families face inequitable access to income support programs. States vary in whether they offer the Earned Income Tax Credit, and this can lead to unequal access and participation across groups. Critical challenges for policy makers are identifying barriers to access to and participation in income supports as well as developing strategies to increase equitable access to income supports. This article synthesizes evidence on income and health and its relevance to income supports.

Promoting Children's Physical Activity in Low-Income Communities in Colorado: What Are the Barriers and Opportunities?

INTRODUCTION: Colorado has the highest rate of adult physical activity in the United States. However, children in Colorado have a lower rate of physical activity relative to other states, and the rate is lowest among children in low-income households. We conducted focus groups, surveys, and interviews with parents, youth, and stakeholders to understand barriers to physical activity among children in low-income households in Colorado and to identify opportunities to increase physical activity. METHODS: From April to July 2016, we recruited participants from 5 communities in Colorado with high rates of poverty, inactivity, and obesity; conducted 20 focus groups with 128 parents and 42 youth; and interviewed 8 stakeholders. All focus group participants completed intake surveys. We analyzed focus group and interviews by using constant comparison. RESULTS: We identified 12 themes that reflect barriers to children's physical activity. Within the family context, barriers included parents' work schedules, lack of interest, and competing commitments. At the community level, barriers included affordability, traffic safety, illicit activity in public spaces, access to high-quality facilities, transportation, neighborhood inequities, program availability, lack of information, and low community engagement. Survey respondents most commonly cited lack of affordable options and traffic safety as barriers. Study participants also identified recommendations for addressing these barriers. Providing subsidized transportation, improving parks and recreation centers, and making better use of existing facilities were all proposed as opportunities to improve children's physical activity levels. CONCLUSION: In this formative study of Colorado families, participants confirmed barriers to physical activity that previous research on low-income communities has documented, and these varied by geographic location. Participants proposed a set of solutions for addressing barriers and endorsed community input as an essential first step for planning community-level health initiatives.

A tool to predict suicidal ideation and behavior in bipolar disorder: The Concise Health Risk Tracking Self-Report.

BACKGROUND: Few brief, self-report measures exist that can reliably predict adverse suicidality outcomes in patients with BD. This study utilized the Concise Health Risk Tracking Self-Report (CHRT) to assess suicidality in patients with BD and examined its psychometric performance, clinical correlates, and prospective value in predicting adverse events related to suicidality. METHODS: The CHRT was administered at baseline and follow-up to 482 adult patients in Bipolar CHOICE, a 6-month randomized comparative effectiveness trial. The Columbia Suicide Severity Rating Scale (CSSRS) was used at baseline to assess lifetime history of suicide attempts and related behaviors. Clinician-rated measures of mood (Bipolar Inventory of Symptoms Scale) and bipolar symptoms (Clinical Global Impressions-Bipolar Version) were conducted at baseline and follow-up. RESULTS: The CHRT showed excellent internal consistency and construct validity and was highly correlated with clinician ratings of depression, anxiety, and overall functioning at baseline and throughout the study. Baseline CHRT scores significantly predicted risk of subsequent suicidality-related Serious Adverse Events (sSAEs), after controlling for mood and comorbidity. Specifically, the hazard of a sSAE increased by 76% for every 10-point increase in baseline CHRT score. Past history of suicide attempts and related behaviors, as assessed by the CSSRS, did not predict subsequent sSAEs. LIMITATIONS: The CSSRS was used to assess static risk factors in terms of past suicidal behaviors and may have been a more powerful predictor over longer-term follow-up. CONCLUSIONS: The CHRT offers a quick and robust self-report tool for assessing suicidal risk and has important implications for future research and clinical practice.

Obesity and food insecurity at the same table: how head start programs respond.

INTRODUCTION: Head Start is a federally funded early childhood education program that serves just over 900,000 US children, many of whom are at risk for obesity, are living in food insecure households, or both. The objective of this study was to describe Head Start practices related to assessing body mass index (BMI), addressing food insecurity, and determining portion sizes at meals. METHODS: A survey was mailed in 2008 to all eligible Head Start programs (N = 1,810) as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start. We describe program directors' responses to questions about BMI, food insecurity, and portion sizes. RESULTS: The response rate was 87% (N = 1,583). Nearly all programs (99.5%) reported obtaining height and weight data, 78% of programs calculated BMI for all children, and 50% of programs discussed height and weight measurements with all families. In 14% of programs, directors reported that staff often or very often saw children who did not seem to be getting enough to eat at home; 55% saw this sometimes, 26% rarely, and 5% never. Fifty-four percent of programs addressed perceived food insecurity by giving extra food to children and families. In 39% of programs, staff primarily decided what portion sizes children received at meals, and in 55% the children primarily decided on their own portions. CONCLUSION: Head Start programs should consider moving resources from assessing BMI to assessing household food security and providing training and technical assistance to help staff manage children's portion sizes.

Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008.

INTRODUCTION: Lowering the prevalence of childhood obesity requires a multilevel approach that targets the home, school, and community. Head Start, the largest federally funded early childhood education program in the United States, reaches nearly 1 million low-income children, and it provides an ideal opportunity for implementing such an approach. Our objective was to describe obesity prevention activities in Head Start that are directed at staff, parents, and community partners. METHODS: We mailed a survey in 2008 to all 1,810 Head Start programs in the United States. RESULTS: Among the 1,583 (87%) responding programs, 60% held workshops to train new staff about children's feeding and 63% held workshops to train new staff about children's gross motor activity. Parent workshops on preparing or shopping for healthy foods were offered by 84% of programs and on encouraging children's gross motor activity by 43% of programs. Ninety-seven percent of programs reported having at least 1 community partnership to encourage children's healthy eating, and 75% reported at least 1 to encourage children's gross motor activity. CONCLUSION: Head Start programs reported using a multilevel approach to childhood obesity prevention that included staff, parents, and community partners. More information is needed about the content and effectiveness of these efforts.

Barriers to obesity prevention in Head Start.

Head Start provides early childhood education to nearly one million low-income children, through federal grants to more than 2,000 local programs. About one-third of children who enter Head Start are overweight or obese. But program directors face difficulty in implementing policies and practices to address obesity-and in our national survey, they identified the key barriers as lack of time, money, and knowledge. Also, parents and staff sometimes shared cultural beliefs that were inconsistent with preventing obesity, such as the belief that heavier children are healthier. Minimizing those barriers will require federal resources to increase staff training and technical assistance, develop staff wellness programs, and provide healthy meals and snacks.

A national survey of obesity prevention practices in Head Start.

OBJECTIVE: To describe obesity prevention practices and environments in Head Start, the largest federally funded early childhood education program in the United States. DESIGN: Self-administered survey as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES). SETTING: Head Start, 2008. PARTICIPANTS: Directors of all 1810 Head Start programs, excluding those in US territories. OUTCOME MEASURES: Descriptive measures of reported practices and environments related to healthy eating and gross motor activity. RESULTS: The 1583 (87%) programs responding to the survey enrolled 828 707 preschool children. Of these programs, 70% reported serving only nonfat or 1% fat milk. Ninety-four percent of programs reported that each day they served children some fruit other than 100% fruit juice; 97% reported serving some vegetable other than fried potatoes; and 91% reported both of these daily practices. Sixty-six percent of programs said they celebrated special events with healthy foods or nonfood treats, and 54% did not allow vending machines for staff. Having an on-site outdoor play area at every center was reported by 89% of programs. Seventy-four percent of programs reported that children were given structured (adult-led or -guided) gross motor activity for at least 30 minutes each day; 73% reported that children were given unstructured gross motor activity for at least 30 minutes each day, and 56% reported both of these daily practices. CONCLUSION: Most Head Start programs report doing more to support healthy eating and gross motor activity than required by federal performance standards in these areas.

School food environments and policies in US public schools.

OBJECTIVE: The purpose of this study was to describe school food environments and policies in US public schools and how they vary according to school characteristics. METHODS: We analyzed cross-sectional data from the third School Nutrition and Dietary Assessment study by using a nationally representative sample of 395 US public schools in 129 school districts in 38 states. These 2005 data included school reports of foods and beverages offered in the National School Lunch Program and on-site observations, in a subsample of schools, of competitive foods and beverages (those sold in vending machines and a la carte and that are not part of the National School Lunch Program). Seventeen factors were used to characterize school lunches, competitive foods, and other food-related policies and practices. These factors were used to compute the food environment summary score (0 [least healthy] to 17 [most healthy]) of each school. RESULTS: There were vending machines in 17%, 82%, and 97% of elementary, middle, and high schools, respectively, and a la carte items were sold in 71%, 92%, and 93% of schools, respectively. Among secondary schools with vending and a la carte sales, these sources were free of low-nutrient energy-dense foods or beverages in 15% and 21% of middle and high schools, respectively. The food environment summary score was significantly higher (healthier) in the lower grade levels. The summary score was not associated with the percentage of students that was certified for free or reduced-price lunches or the percentage of students that was a racial/ethnic minority. CONCLUSIONS: As children move to higher grade levels, their school food environments become less healthy. The great majority of US secondary schools sell items a la carte in the cafeteria and through vending machines, and these 2 sources often contain low-nutrient, energy-dense foods and beverages, commonly referred to as junk food.

Reliability and validity of YRBS physical activity items among middle school students.

PURPOSE: To assess test-retest reliability and validity of the Youth Risk Behavior Survey (YRBS) items for moderate and vigorous physical activity in middle school students. METHODS: Students (N = 125; 12.7 +/- 0.6 yr) wore Actigraph accelerometers for 6.1 +/- 1.0 d and twice completed surveys that included YRBS moderate and vigorous physical activity items. Accelerometer counts were transformed into minutes of moderate (3-6 METs) and vigorous (> 6 METs) physical activity. Days per week meeting moderate and vigorous physical activity recommendations were estimated using four summary methods. Reliability was assessed using intraclass correlation coefficients (ICC) from the two surveys. Validity was assessed as percent concordance, kappa coefficients, and sensitivity and specificity using binary YRBS and Actigraph outcomes. RESULTS: Test-retest ICC for the moderate and vigorous physical activity items were 0.51 and 0.46, respectively. Twenty-two percent of students met the recommended level of moderate physical activity (>or= 30 min.d(-1), >or= 5 d.wk(-1)) according to self-reports, whereas 90.4 and 66.4% met the recommendation according to accumulated accelerometer minutes and 5-min-bout criteria, respectively. Concordance between YRBS and Actigraph moderate physical activity measures was highest using accumulated accelerometer minutes. Sensitivity of the moderate YRBS item ranged from 0.19 to 0.23 for four comparisons, and specificity was 0.74-0.92. More than two thirds of students reported vigorous physical activity at recommended levels (>or= 20 min.d(-1), >or= 3 d.wk(-1)), whereas the highest prevalence according to Actigraph monitoring was 22.4%. Sensitivity of the YRBS vigorous item was high (0.75-0.92) compared with the four Actigraph measures; specificity was low (0.23-0.26). CONCLUSION: YRBS questions underestimate the proportion of students attaining recommended levels of moderate physical activity and overestimate the proportion meeting vigorous recommendations. Use of accelerometry for physical activity surveillance seems to be indicated. At the minimum, new questions demonstrating greater validity are needed.

Socioeconomic differences in adolescent stress: the role of psychological resources.

PURPOSE: To investigate whether psychological resources influenced the association between parent education (PE), a marker of socioeconomic status (SES), and perceived stress. METHODS: Cross-sectional analyses were conducted in a sample of 1167 non-Hispanic black and white junior and senior high school students from a Midwestern public school district in 2002-2003. Hierarchical multivariable regression analyses examined relationships between PE (high school graduate or less = E1, > high school, < college = E2, college graduate = E3, and professional degree = E4), and psychological resources (optimism and coping style) on teens' perceived stress. Greater optimism and adaptive coping were hypothesized to influence (i.e., mediate or moderate) the relationship between higher PE and lower stress. RESULTS: Relative to adolescents from families with a professionally educated parent, adolescents with lower parent education had higher perceived stress (E3 beta = 1.70, p < .01, E2 beta = 1.94, p < .01, E1 beta = 3.19, p < .0001). Both psychological resources were associated with stress: higher optimism (beta = -.58, p < .0001) and engagement coping (beta = -.19, p < .0001) were associated with less stress and higher disengagement coping was associated with more stress (beta = .09, p < .01). Adding optimism to the regression model attenuated the effect of SES by nearly 30%, suggesting that optimism partially mediates the inverse SES-stress relationship. Mediation was confirmed using a Sobel test (p < .01). CONCLUSIONS: Adolescents from families with lower parent education are less optimistic than teens from more educated families. This pessimism may be a mechanism through which lower SES increases stress in adolescence.

Social status, stress, and adolescent smoking.

PURPOSE: Adolescent smoking is associated with increased perceived stress and lower social status, but past research has not explored links between lower social status, stress, and smoking risk. This study examined whether the relation between social status and perceived stress could explain the association between lower social status and increased risk of smoking. METHODS: Data were collected from 1021 non-Hispanic black and white adolescents participating in a longitudinal school-based study. Students completed a questionnaire and parents provided information on their highest level of education. Hierarchical logistic regression estimated the effects of parental education, subjective social status (SSS), and stress on smoking risk. RESULTS: At baseline, students from families without a college-educated parent were at greater risk of current smoking (odds ratio [OR] some college = 1.98, 95% confidence interval [CI] = 1.06-3.67, and OR high school degree or less = 3.34, 95% CI = 1.67-6.60). Higher school SSS decreased risk of current smoking (OR = .73, 95% CI = .62-.87), and higher stress increased smoking risk (OR = 1.05, 95% CI = 1.01-1.08). There was no evidence that the effects of parental education were mediated through stress. At one-year follow-up, both lower school SSS and higher baseline stress were significantly associated with smoking initiation in preliminary models, but only baseline stress (OR = 1.06, 95% CI = 1.02-1.11) predicted smoking initiation in multivariable models. DISCUSSION: These findings indicate that higher stress and lower social status increase risk of smoking, but that stress does not explain the association between lower social status and smoking. Therefore, stress reduction interventions may not alleviate social inequalities in teen smoking, but they do hold promise for youth smoking prevention.