Health outcomes of the Bolsa Família program among Brazilian Amazonian children.

OBJECTIVE: One of the primary objectives of Brazil's conditional cash transfer program, Bolsa Família, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Família participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelândia, Acre state, Western Brazilian Amazon. METHODS: Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Família participants (n = 325) and nonparticipants (n = 738). RESULTS: Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34-1.02) when comparing Bolsa Família participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Família participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70-0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS: Early school enrollment and consistent nutritional indicators between Bolsa Família participants and nonparticipants suggest Bolsa Família was facilitating similarities between groups over time.

Health outcomes of the bolsa família program among Brazilian Amazonian children

ABSTRACT OBJECTIVE One of the primary objectives of Brazil's conditional cash transfer program, Bolsa Família, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Família participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelândia, Acre state, Western Brazilian Amazon. METHODS Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Família participants (n = 325) and nonparticipants (n = 738). RESULTS Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34-1.02) when comparing Bolsa Família participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Família participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70-0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS Early school enrollment and consistent nutritional indicators between Bolsa Família participants and nonparticipants suggest Bolsa Família was facilitating similarities between groups over time.

Improving birth outcomes for women who are substance using or have mental illness: a Canadian cohort study comparing antenatal midwifery and physician models of care for women of low socioeconomic position.

BACKGROUND: Some observational studies have shown improved birth outcomes for women of low socioeconomic position (SEP) receiving antenatal midwifery versus physician care. To understand for whom and under what circumstances midwifery care is associated with better birth outcomes we examined whether psychosocial risk including substance use, mental illness, social assistance, residence in a neighbourhood of low/moderate SEP, and teen maternal age modified the association between model of care (midwifery versus physician) and small-for-gestational-age (SGA) or preterm birth (PTB) for women of low SEP. METHODS: For this retrospective cohort study, maternity data from the British Columbia Perinatal Data Registry were linked with Medical Services Plan billing data. We report adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for SGA birth (< the 10th percentile) and PTB (< 37 weeks' completed gestation). For tests of interaction between antenatal models of care and psychosocial risk, p-values < 0.10 were considered statistically significant. Women were eligible for inclusion if they were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, birthed between April 1, 2008 and Dec. 31, 2012, and received a health insurance subsidy (n = 33,937). RESULTS: Midwifery versus obstetrician patients had lower odds of PTB. The difference was 31% larger among substance users (aOR 0.24, 95% CI: 0.11-0.54) compared to non-substance users (aOR 0.55, 95% CI: 0.45-0.68). Additionally, there was a 34% statistically significant absolute difference in odds of PTB for midwifery versus obstetrician patients with both mental illness and substance use (aOR 0.18, 95% CI: 0.06-0.55) compared to women with neither mental illness nor substance use (aOR 0.52, 95% CI: 0.41-.66). Results demonstrated a consistent association between midwifery versus physician care and lower odds of SGA, yet effects were not statistically significantly different for women with higher or lower psychosocial risk. CONCLUSION: Among low SEP women in British Columbia, Canada, antenatal midwifery compared to obstetrician care was associated with reduced odds of PTB. Odds were lower among women with substance use, and mental illness and substance use, than among women without these risk factors.

Breastfeeding Discontinuation Not Associated with Maternal Pregravid BMI But Associated with Native Hawaiian or Other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants.

Objectives This study investigated the association between maternal pregravid body mass index (BMI) and breastfeeding discontinuation at 4-6 months postpartum in Hawaii and Puerto Rico participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods A secondary data analysis was conducted from a text message-based intervention in WIC participants in Hawaii and Puerto Rico. The analysis included 87 women from the control group who initiated breastfeeding and whose breastfeeding status was known at the end of the study when infants were 4-6 months old. Pregravid BMI and breastfeeding discontinuation were assessed using questionnaires. Results The association between pregravid BMI and breastfeeding discontinuation was not significant in the unadjusted model or in the adjusted model. Native Hawaiian or Other Pacific Islander (NHOPI) participants showed significantly increased odds of discontinuing breastfeeding (adjusted odds ratio [AOR] 7.12; 95% CI 1.34, 37.97; p = .02) compared to all the other racial/ethnic participants, as did older women ages 32-39 years versus women who were 25-31 years old (AOR 4.21; 95% CI 1.13, 15.72; p = .03). Women who took vitamins while breastfeeding had decreased odds of discontinuing breastfeeding (AOR 0.15; 95% CI 0.05, 0.46; p = .0009). Conclusions for Practice Pregravid BMI was not significantly associated with breastfeeding discontinuation at 4-6 months postpartum in women from Hawaii and Puerto Rico WIC, but NHOPIs and women who were older had higher odds of discontinuing breastfeeding. The results of this study may inform strategies for breastfeeding promotion and childhood obesity prevention but should be further investigated in larger studies. ClinicalTrials.gov Identifier: NCT02903186.

Substance use and use disorders and treatment receipt among adults in families receiving Temporary Assistance for Needy Families (TANF), 2003-2014.

BACKGROUND/PURPOSE: Legalization of marijuana for medical and/or recreational use in some U.S. states has increased attention to substance use and related problems. However, little attention has been paid to these phenomena among adults in families receiving Temporary Assistance for Needy Families (TANF) whose adverse life experiences may put them at elevated risk of substance use disorders (SUDs). METHODS: Data from the 2003-2014 National Survey on Drug Use and Health (NSDUH) were used to test trends in past-month binge drinking and past-year marijuana, other illicit drug, and any illicit drug use and to examine SUD prevalence and treatment correlates among adults in TANF families. RESULTS: While rates of binge drinking and any illicit drug use remained steady, marijuana use increased from 15.8% in 2003/2004 to 21.6% in 2013/2014, a 36.7% increase. Increased marijuana use was strongly related to changes in marijuana risk perception. Among adults in TANF families, 19.5% of men and 10.8% of women had a past-year SUD, but only one in five received treatment. Those aged 18-25, Black or Hispanic women, and those who had children at home when surveyed were less likely to have received treatment. DISCUSSION: Preventive efforts to address substance use, especially marijuana use, among adults in TANF families are needed. Moreover, given greater odds of unmet SUD treatment need among these economically disadvantaged adults, particularly racial/ethnic minority women and those who are in emerging adulthood, uninsured, and have children at home, measures to provide more inclusive services such as integrated behavioral health care are needed.

[Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014]. / Pagos por desempeño para mejorar el estado nutricional infantil: impacto de los convenios de apoyo presupuestario en tres regiones peruanas con alta prevalencia de desnutrición crónica infantil, 2010-2014.

To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. METHODS: Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. RESULTS: There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. CONCLUSIONS: The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

OBJETIVOS: Estimar el impacto de un esquema de pago por desempeño, denominado convenios de apoyo presupuestario, aplicado por el Gobierno a las tres regiones con mayores tasas de desnutrición crónica infantil (DCI) en 2008, Apurimac, Ayacucho y Huancavelica, sobre indicadores de cobertura de servicios de cuidado infantil (vacunación, controles de crecimiento y desarrollo infantil, suplemento de hierro) y del estado nutricional del niño (desnutrición, anemia, diarrea). Mediante estos convenios se transferían recursos a los presupuestos de dichas regiones condicionados al cumplimiento de compromisos de gestión y metas de cobertura con el objetivo de mejorar el estado nutricional infantil. MATERIALES Y MÉTODOS: A partir de los datos de la Encuesta Demográfica y de Salud Familiar de 2008 a 2014, se compara la evolución en los indicadores evaluados de una muestra de niños que residen en los ámbitos donde se suscribieron los convenios y una muestra de control, mientras los convenios estuvieron vigentes y en los años posteriores para reportar el estimador de diferencias en diferencias del impacto promedio de los convenios. RESULTADOS: se encuentran impactos positivos sobre el incremento de coberturas de vacunas del esquema básico y de la vacuna rotavirus y, a través de ellos, en la reducción de la ocurrencia de diarrea y desnutrición. CONCLUSIONES el esquema habría sido efectivo en activar la cadena mayor cobertura de vacunas y menor DCI, pero no parece mejorar la cobertura de otras prestaciones como las atenciones de crecimiento y desarrollo del niño y entrega de suplementos de hierro al niño y gestante.

Pagos por desempeño para mejorar el estado nutricional infantil: impacto de los convenios de apoyo presupuestario en tres regiones peruanas con alta prevalencia de desnutrición crónica infantil, 2010-2014 / Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014

RESUMEN Objetivos. Estimar el impacto de un esquema de pago por desempeño, denominado convenios de apoyo presupuestario, aplicado por el Gobierno a las tres regiones con mayores tasas de desnutrición crónica infantil (DCI) en 2008, Apurimac, Ayacucho y Huancavelica, sobre indicadores de cobertura de servicios de cuidado infantil (vacunación, controles de crecimiento y desarrollo infantil, suplemento de hierro) y del estado nutricional del niño (desnutrición, anemia, diarrea). Mediante estos convenios se transferían recursos a los presupuestos de dichas regiones condicionados al cumplimiento de compromisos de gestión y metas de cobertura con el objetivo de mejorar el estado nutricional infantil. Materiales y métodos. A partir de los datos de la Encuesta Demográfica y de Salud Familiar de 2008 a 2014, se compara la evolución en los indicadores evaluados de una muestra de niños que residen en los ámbitos donde se suscribieron los convenios y una muestra de control, mientras los convenios estuvieron vigentes y en los años posteriores para reportar el estimador de diferencias en diferencias del impacto promedio de los convenios Resultados. se encuentran impactos positivos sobre el incremento de coberturas de vacunas del esquema básico y de la vacuna rotavirus y, a través de ellos, en la reducción de la ocurrencia de diarrea y desnutrición. Conclusiones. el esquema habría sido efectivo en activar la cadena mayor cobertura de vacunas y menor DCI, pero no parece mejorar la cobertura de otras prestaciones como las atenciones de crecimiento y desarrollo del niño y entrega de suplementos de hierro al niño y gestante.

ABSTRACT To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Materials and methods. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. Results. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. Conclusions. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

Identifying Social Determinants of Health and Legal Needs for Children With Special Health Care Needs.

Children with special health care needs (CSHCN) require comprehensive care with high levels of community and government assistance. Medical-legal partnerships may be particularly suited to address needs for this population. To explore this, we conducted in-depth telephone interviews of families of CSHCN cared for in the primary care practice of our tertiary care children's hospital. The majority of the sample (N = 46) had been late on housing payments and 17% of homeowners had been threatened with foreclosure. Families frequently reported denial of public benefits. Approximately 10% had executed advance planning documents such as guardianship plans for the children or wills for the parents. A minority of families had sought help from community agencies or lawyers. Less than one third had ever discussed any of the issues with health care providers, but two thirds were likely or very likely to in the future. CSHCN may especially benefit from the social support of a medical-legal partnership.

Dynamics of cinacalcet use and biochemical control in hemodialysis patients: a retrospective New-user cohort design.

BACKGROUND: Cinacalcet is used to treat secondary hyperparathyroidism among hemodialysis patients. Large-scale epidemiologic studies describing patterns of cinacalcet use, effects on parathyroid hormone (PTH), calcium, and phosphorous levels, and predictors of discontinuation have not been previously reported. METHODS: This retrospective cohort study used a clinical database of a large U.S. dialysis provider (2007-2010) merged with administrative data from the United States Renal Data System. Among new users of cinacalcet with Medicare coverage, trends in PTH, calcium, and phosphorus were measured in 30-day intervals following cinacalcet initiation. RESULTS: Seventeen thousand seven hundred sixty-three eligible initiators contributed 111,047 30-day follow-up intervals. Of these, 56 % discontinued cinacalcet by month 4. Of those discontinuing, 76.3 % reinitiated. Mean values of PTH, calcium, and phosphorus decreased to recommended levels within 4 months following initiation. Proximal PTH levels < 150 pg/mL were associated with discontinuation: HR = 1.23 (95 % CI: 1.12, 1.36), whereas low calcium (< 7.5 mg/dL) was suggestive of an association, HR = 1.09 (95 % CI 0.91, 1.32). Being in the Part D gap period increased discontinuation risk: HR = 1.09 (95 % CI: 1.03, 1.16). Low-income subsidy status decreased discontinuation risk: HR = 0.77 (95 % CI 0.69, 0.86). Predictors of reinitiation included low-income subsidy, HR = 1.32 (95 % CI 1.22, 1.43); higher albumin level, HR = 1.23 (95 % CI 1.10, 1.36) and higher calcium level, HR = 1.26 (95 % CI 1.19, 1.33). CONCLUSIONS: Substantial and expected declines in laboratory values occurred following cinacalcet initiation. Early discontinuation and reinitiation of cinacalcet were common and may have occurred for clinical and economic reasons.

Comparison of Feeding Practices in Infants in the WIC Supplemental Nutrition Program Who Were Enrolled in Child Care as Opposed to Those with Parent Care Only.

BACKGROUND: The environment or setting to which an infant is exposed is crucial to establishing healthy eating habits and to preventing obesity. This study aimed to compare infant feeding practices and complementary food type between parent care (PC) and childcare (CC) settings among infants receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). MATERIALS AND METHODS: This study sampled 105 dyads of mothers and infants between 2 to 8 months of age from a WIC office in Central Illinois. Mothers completed a cross-sectional survey to assess their infant feeding practices and demographic characteristics. CC was defined as infants receiving 10 hours or more per week of care from a nonparental caregiver. RESULTS: Almost half of the infants (44%) were enrolled in CC. Infants in CC had an average of 29 hours of care per week compared with 0.64 hours in the PC group (p<0.01). There were no differences between the two groups in age, sex, race/ethnicity, preterm birth, and birth weight. Overall, there were no significant differences in breastfeeding initiation and duration. The average age at formula introduction was earlier for PC infants (0.90 ± 1.16 months) than for CC infants (1.66 ± 1.64 months) (p = 0.03). PC infants stopped breastfeeding at 1.96 ± 1.15 months compared with 2.31 ± 1.64 months for CC infants (p = 0.080). Among complementary foods introduced to infants, the primary food type was infant cereal, followed by baby food of fruits and vegetables, 100% fruit juice, and meat-based baby food. The timing of introduction and the types of complementary foods were similar between study groups. CONCLUSIONS: CC use is not a significant influence on breastfeeding rates, introduction of complementary foods, and types of complementary foods; however, it does influence when formula is introduced. The findings support the need for infant nutrition education and breastfeeding promotion targeting WIC mothers, regardless of their pattern of CC.

Smoking Behaviors Among Urban and Rural Pregnant Women Enrolled in the Kansas WIC Program.

Smoking during pregnancy is associated with poor birth outcomes. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a public nutritional assistance program for low-income pregnant women and their children up to age five. This study examined differences in smoking behavior among women enrolled in the Kansas WIC program. A secondary analysis was conducted using the Pregnancy Nutrition Surveillance System dataset of enrolled women between 2005 and 2011. Geographic residency status was obtained through application of the Census tract-based rural-urban commuting area codes. Chi square tests of association were used to assess differences. Multi-variable binary logistic regression was used to assess maternal characteristics and smoking 3 months prior to pregnancy. Total sample size averaged 21,650 women for years 2005 through 2011. Low-income, rural pregnant women smoked at significantly higher rates before, during, and after pregnancy. High smoking rates have remained unchanged since 2008. The following characteristics were associated with reduced odds of smoking 3 months prior to pregnancy: being 17 years old or younger, Hispanic, a high school graduate, urban location, normal body mass index, no live births prior to current pregnancy, and using multi-vitamins. Results from this study indicate that the WIC population in rural areas may have different needs regarding smoking cessation programming than the urban WIC population. Findings help inform WIC program administrators and assist in enhancing current smoking cessation services to the Kansas WIC population.

Association between food assistance program participation and overweight / Associação entre participação em programa de assistência alimentar e sobrepeso

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition. .

OBJETIVO Investigar associação entre participação no programa de assistência alimentar e sobrepeso/obesidade, segundo nível de pobreza. MÉTODOS Estudo transversal com dados sobre 46.217 mulheres não gestantes e não lactantes, de Lima, Peru, obtidos de pesquisas, com representatividade nacional, nos anos de 2003, 2004, 2006 e 2008-2010. A variável dependente foi o sobrepeso/obesidade e a independente foi a participação no programa de assistência alimentar. Utilizou-se regressão de Poisson; os modelos foram estratificados por nível socioeconômico familiar para todo o país, por área de residência (Lima versus o resto do país; urbano versus residência rural) e anos de estudo (2003-2006 versus 2008-2010). Os modelos foram ajustados por idade, nível acadêmico, urbanização e ano de estudo. RESULTADOS Participar do programa de assistência alimentar associou-se com risco aumentado de sobrepeso/obesidade para as mulheres que viviam em domicílios sem indicadores de pobreza (PR = 1,29; IC95% 1,06;1,57). Quando estratificados por área de residência, foram observadas associações similares para as mulheres que vivem em Lima e em áreas urbanas; não foram encontradas associações entre a participação no programa de assistência alimentar e sobrepeso/obesidade entre as mulheres que vivem fora de Lima ou em áreas rurais, independentemente de sua condição de pobreza. CONCLUSÕES Participar do programa de assistência alimentar associou-se com sobrepeso/obesidade para mulheres não pobres. Estudos adicionais serão necessários em países que enfrentam ambas as faces da má nutrição. .

Association between food assistance program participation and overweight.

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice.

PURPOSE: Older adults in prison present a significant health and human rights challenge for the criminal justice system. To date, there is no known study that provides a comprehensive examination or portrait of older persons in prison. The purpose of this paper is to understand individual, family, system, and community vulnerabilities that can complicate successful community reintegration for these individuals. DESIGN/METHODOLOGY/APPROACH: This study provides a cross-sectional, descriptive analysis of biopsychosocial, spiritual, and prison use characteristics associated with a sample of 677 older prisoners, aged 50+, in a state-wide prison system. FINDINGS: Results indicate the extent of diversity within this population based on demographic, clinical, social, legal profiles, prison service use patterns, and professional and personal contacts. RESEARCH LIMITATIONS/IMPLICATIONS: Due to the diversity within this population, an interdisciplinary approach is needed to address the complex social and health care needs of an aging prison population and to plan for their reentry. Practical implications - These findings suggest the need for holistic prevention, assessment, and interventions to interrupt the social-structural disparities that foster and support pathways to incarceration and recidivism. ORIGINALITY/VALUE: The human rights implications for the current treatment of older adults in prison include providing in-prison treatment that promotes safety, well-being, reconciliation, and seamless bridges between prison and community for older adults and their families. The True Grit Program is presented as an example of a humanistic and holistic approach of such an approach.

Racial/ethnic differences in dietary intake among WIC families prior to food package revisions.

OBJECTIVE: To compare the diets of African American and Hispanic families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prior to the 2009 food package revisions. METHODS: Mother-child dyads were recruited from 12 WIC sites in Chicago, IL. Individuals with 1 valid 24-hour recall were included in the analyses (n = 331 children, n = 352 mothers). RESULTS: Compared to their African American counterparts, diets of Hispanic mothers and children were lower (P < .001) in percentage of calories from fat, added sugars, sodium, and sweetened beverages, but higher (P < .001) in vitamin A, calcium, whole grains, fruit, and total dairy. However, no groups met national recommendations for percentage of calories from saturated fat, fiber, sodium, whole grains, vegetables, and total dairy. CONCLUSIONS AND IMPLICATIONS: There are racial/ethnic differences in dietary intake, and future research is needed to determine whether diets improve as a result of package revisions and whether uptake of these changes varies by race/ethnicity.

Revised WIC food package improves diets of WIC families.

OBJECTIVE: To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk. DESIGN: Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package. PARTICIPANTS: Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010. MAIN OUTCOME MEASURES: Consumption of fruit, vegetables, whole-grain food, and lower-fat milk. ANALYSIS: Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages). RESULTS: Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed. CONCLUSIONS AND IMPLICATIONS: Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

Demographic and substance abuse trends among pregnant and non-pregnant women: eleven years of treatment admission data.

The objective of this study was to identify demographic and substance abuse trends among pregnant women entering treatment over eleven years. This study compiled the publicly available Treatment Episode Datasets from the Substance Abuse Mental Health Services Administration from 1998 to 2008. Subjects included 1,724,479 women entering publicly funded substance abuse treatment for the first time, 81,818 of whom were pregnant. Compared to non-pregnant women, pregnant women were more likely to be younger, minority, never married, less educated, homeless, and on public-assistance or have no income. Referrals from health care providers (HCPs) among pregnant women entering treatment have stayed consistently low while referrals from the criminal justice system accounted for the largest portion of pregnant women entering treatment. Over the past eleven years, there has been a general decline in alcohol abuse and an increase in drug abuse among women entering treatment; this trend was more pronounced in pregnant women. Unlike their non-pregnant counterparts, pregnant women were more likely to report marijuana, not alcohol, as their primary problem substance as well as other drugs like methamphetamine and cocaine. Over the past eleven years, trends in the demographics and patterns of substance abuse among women have changed; some of these trends were unique to pregnant women. A large proportion of pregnant women entering treatment are referred by the criminal justice system. Knowledge surrounding the demographics and abuse patterns of pregnant women entering treatment can inform HCPs and community programs in their screening and outreach efforts.

Los indigentes ante la asistencia pública: una estrategia para sobrevivir en la ciudad de México, 1877-1905 / The indigents before the public assistance: a strategy to survive in Mexico city, 1877-1905

Este artículo se ocupa de un grupo escasamente estudiado en la historiografía mexicana: los pobres urbanos. Con un enfoque novedoso, los indigentes no son sólo el objeto de las políticas públicas y de las instituciones, sino que se consideran actores sociales que concretan reformas y definen prácticas de la asistencia porfiriana. Si bien los recursos de la beneficencia son limitados, el ingreso en las instituciones de auxilio público es una alternativa de subsistencia para los indigentes de la ciudad. Su determinación por ingresar en el Tecpam de Santiago y en el Hospicio de Pobres se manifiesta en las solicitudes, al presentarse como merecedores ideales de la asistencia . Esta ayuda se demanda y se defiende con reclamos ocultos y manifestaciones expresas, pues por la costumbre de recibir el socorro del Estado la beneficencia es un instrumento para ganarse la vida. (AU)