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1.
Med Care ; 57(10): 773-780, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415338

RESUMO

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde dos Veteranos/estatística & dados numéricos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos/etnologia
2.
BMC Public Health ; 19(1): 939, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300003

RESUMO

BACKGROUND: Born in Bradford (BiB) is a prospective multi-ethnic pregnancy and birth cohort study that was established to examine determinants of health and development during childhood and, subsequently, adult life in a deprived multi-ethnic population in the north of England. Between 2007 and 2010, the BiB cohort recruited 12,453 women who experienced 13,776 pregnancies and 13,858 births, along with 3353 of their partners. Forty five percent of the cohort are of Pakistani origin. Now that children are at primary school, the first full follow-up of the cohort is taking place. The aims of the follow-up are to investigate the determinants of children's pre-pubertal health and development, including through understanding parents' health and wellbeing, and to obtain data on exposures in childhood that might influence future health. METHODS: We are employing a multi-method approach across three data collection arms (community-based family visits, school based physical assessment, and whole classroom cognitive, motor function and wellbeing measures) to follow-up over 9000 BiB children aged 7-11 years and their families between 2017 and 2021. We are collecting detailed parent and child questionnaires, cognitive and sensorimotor assessments, blood pressure, anthropometry and blood samples from parents and children. Dual x-ray absorptiometry body scans, accelerometry and urine samples are collected on subsamples. Informed consent is collected for continued routine data linkage to health, social care and education records. A range of engagement activities are being used to raise the profile of BiB and to disseminate findings. DISCUSSION: Our multi-method approach to recruitment and assessment provides an efficient method of collecting rich data on all family members. Data collected will enhance BiB as a resource for the international research community to study the interplay between ethnicity, socioeconomic circumstances and biology in relation to cardiometabolic health, mental health, education, cognitive and sensorimotor development and wellbeing.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Pobreza/etnologia , Determinantes Sociais da Saúde/etnologia , Criança , Inglaterra , Feminino , Seguimentos , Humanos , Masculino , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
3.
BMC Public Health ; 19(1): 1008, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357962

RESUMO

BACKGROUND: How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh. METHODS: Our analysis draws from qualitative data collected through a range of methods (see Additional file 1). We conducted 25 in-depth interviews (IDIs) of two adivasi communities targeted by an extreme-poverty alleviation programme, 11 key informant interviews (KIIs) with project personnel (community workers, field officers, project managers), community leaders, and healthcare providers, and 9 focus group discussions (FGDs) with community members. Data triangulation was performed to further validate the data, and a thematic analysis approach was used to analyze the data. RESULTS: Health shocks were a defining characteristic of households' experiences of extreme poverty in the studied region. Care-seeking behaviours are influenced by an array of cultural and economic factors. Households adopt a range of coping strategies during the treatment or care-seeking process, which are often insufficient to allow households to maintain a stable economic status. This is largely due to the fact that healthcare costs are borne by the household, primarily through out-of-pocket payments. Households meet healthcare cost by selling their means of livelihoods, borrowing cash, and marketing livestock. This process erodes their wellbeing and hinders they attempt at achieving resilience, despite their involvement in an extreme poverty-alleviation programme. CONCLUSIONS: Livelihood supports or asset-transfers alone are insufficient to improve household resilience in this context. Therefore, we argue that extreme poor households' healthcare needs should be central to the design of poverty-alleviating intervention for them to contribute to foster resilience.


Assuntos
Adaptação Psicológica , Grupos Étnicos/psicologia , Características da Família/etnologia , Nível de Saúde , Grupos Minoritários/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Adulto , Bangladesh , Grupos Étnicos/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Pesquisa Qualitativa , Resiliência Psicológica , Adulto Jovem
4.
BMC Public Health ; 19(1): 782, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221117

RESUMO

BACKGROUND: The purpose of this study was to determine physical activity (PA) preferences associated with increases in moderate-to-vigorous physical activity (MVPA) and decrease in sedentary time in Mexican American (MA) women participating in a Promotora (community health worker)-led intervention on the U.S.-Mexico border. METHODS: Enlace ('to link' in Spanish) was a randomized clinical trial to increase PA in low-income, MA women living in South Texas on the U.S.-Mexico border. A total of 620 participants were recruited into the study. The primary outcome was increase in moderate to vigorous physical activity (MVPA) using the Actigraph GT3X 16 Mb accelerometer. A modified version of the Community Health Activities Model Program for Seniors Physical Activity (CHAMPS) instrument was used to predict MVPA. Adjusted and unadjusted logistic regression models predicted change in MVPA by change in CHAMPS activities. ANOVA analysis determined the variance explained in change in MVPA by change in time engaged in activity. Individual effect sizes were then calculated for significant activity type change on MVPA increase. RESULTS: There were significant increases in all CHAMPS activities except aerobic machines and errand walking. An increase in leisure walking (O.R. = 2.76, p = .046), errand (O.R. = 3.53, p = .051), and brisk walking (O.R. = 4.74, p = .011), dance (O.R. = 8.22, p = .003), aerobics class (O.R. = 32.7, p = .001), and light housework (O.R. = 6.75, p = .000), were associated with a decrease in sedentary time. Significant effect sizes for MVPA were observed for jogging (1.2, p = .050), general exercise (1.6, p = .024), and other exercise not specified (2.6, p = .003). Significant effect sizes for sedentary time were detected for leisure time (.031, p = .036), errands (.017, p = .022), brisk walking (.022, p = .003), dance (.042, p = .005), and aerobics class (.013, p = .009). DISCUSSION: Participants who engaged in walking and aerobic activities through this intervention significantly increased their engagement in MVPA and decreased their sedentary time. These findings are novel, since preferences have not been examined in relation to MVPA or sedentary time in MA women. CONCLUSION: PA preferences need to be considered when aiming to promote activities that reduce sedentary time and increase PA participation among marginalized groups, such as MA women. TRIAL REGISTRATION: NCT02046343 .


Assuntos
Exercício Físico/psicologia , Promoção da Saúde/organização & administração , Americanos Mexicanos/psicologia , Pobreza/etnologia , Adulto , Feminino , Humanos , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Comportamento Sedentário/etnologia , Texas
5.
Fam Community Health ; 42(3): 213-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107732

RESUMO

Low-income children of Mexican immigrants are at high risk for obesity. Drawing on a sample of 104 Mexican American children (Mage = 8.39 years; 61% female), this longitudinal study considered relations between food insecurity and chronic stress (ie, parent report and hair cortisol measurement) on body mass index (BMI) and examined whether stress moderated associations between food insecurity and BMI. Analyses revealed that undocumented status was associated with food insecurity and chronic stress but not when accounting for poverty. Food insecurity was only associated with higher BMI for children with the highest hair cortisol. Results suggest that chronic stress may impact body weight among food-insecure children.


Assuntos
Índice de Massa Corporal , Abastecimento de Alimentos/estatística & dados numéricos , Obesidade/etnologia , Pobreza/etnologia , Estresse Psicológico/psicologia , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Americanos Mexicanos
6.
Soc Psychiatry Psychiatr Epidemiol ; 54(10): 1199-1207, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31055631

RESUMO

OBJECTIVE: The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá. METHODS: Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi2 tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates. RESULTS: Within the sample surveyed, 6.2% (95% CI 3.4-10.4) reported serious psychological distress, 32.0% (95% CI 25.7-38.9) reported depression, and 22.9% (95% CI 17.4-29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60-90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27-19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13-0.78). CONCLUSION: High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.


Assuntos
Depressão/epidemiologia , Grupos Populacionais/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Ideação Suicida , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Depressão/etnologia , Depressão/psicologia , Feminino , Humanos , Renda , Masculino , Saúde Mental/etnologia , Pessoa de Meia-Idade , Panamá/epidemiologia , Pobreza/etnologia , Prevalência , Fatores de Risco , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Suicídio/etnologia , Suicídio/psicologia , Inquéritos e Questionários
7.
J Autism Dev Disord ; 49(9): 3611-3624, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31124024

RESUMO

An increased prevalence of autism spectrum disorder (ASD) among children of immigrant backgrounds has been observed but clinical profiles are rarely compared. Diagnostic data from children with ASD notified to the Western Australian Register for Autism Spectrum Disorders were analysed according to maternal-race ethnicity and country of birth. A total of 4776 children aged between 0 and 18 years diagnosed with ASD from 1999 to 2017 were included. Those born to immigrant mothers from lower income countries were younger at the time of diagnosis, had an increased risk of intellectual disability and poorer presentations in the social and communication domains. Further work is required to understand environmental influences that may affect children born to immigrant mothers and to improve monitoring and assessments.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Mães/estatística & dados numéricos , Adolescente , Transtorno do Espectro Autista/etnologia , Criança , Pré-Escolar , Grupos de Populações Continentais/etnologia , Grupos de Populações Continentais/psicologia , Emigrantes e Imigrantes/psicologia , Grupos Étnicos/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Prevalência , Sistema de Registros , Austrália Ocidental/epidemiologia
8.
Ann Intern Med ; 170(9_Suppl): S79-S86, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31060058

RESUMO

Background: Little is known about how to promote cost-of-care conversations in health care settings. Objective: To develop and evaluate community-designed messages promoting cost-of-care conversations. Design: Focus groups and point-of-care surveys. Setting: Three pediatric clinics, a family community health clinic, and a community health worker (promotora) program serving predominately low-income, Latino populations in Adams County, Colorado. Participants: Focus groups included staff (n = 22) and patients or community members (n = 15). At baseline, 107 patients and 9 providers completed surveys, and 111 patients and 11 providers did so postintervention. Intervention: Setting-specific, community-designed messages about cost-of-care conversations delivered to patients on fliers. Measurements: Qualitative themes about the frequency and nature of cost-of-care conversations, and frequencies of patient- and provider-reported cost-of-care conversations before and after the intervention. Results: Five themes emerged from the focus groups, and the groups reported more discussion of costs after distribution of the messaging interventions than before in the clinical but not the community setting. Lack of transparent pricing tools was a barrier, and consideration of incidental costs was important. In cross-sectional, point-of-care surveys, fewer patients reported talking about costs with providers at baseline (44.4%) than after the messaging intervention (73.7%). Providers reported similar frequency of talking about costs with patients before (41.0%) and after (44.9%) the intervention. Nearly one third of patient and provider reports were discordant regarding whether costs were discussed. Limitations: The response rate was low, cost-of-care conversations were self-reported, generalizability of the findings to other settings is uncertain, and the sample was small. The survey proved infeasible in the promotora setting. Conclusion: Participants reported some favorable perceptions of cost-of-care conversations after implementation of community-designed messages, suggesting promise for this approach to promoting conversations about costs of care in settings serving low-income, uninsured Latino populations. Primary Funding Source: Robert Wood Johnson Foundation.


Assuntos
Serviços de Saúde da Criança/organização & administração , Comunicação , Serviços de Saúde Comunitária/organização & administração , Hispano-Americanos , Pessoas sem Cobertura de Seguro de Saúde , Relações Médico-Paciente , Pobreza/etnologia , Criança , Serviços de Saúde da Criança/economia , Colorado , Serviços de Saúde Comunitária/economia , Efeitos Psicossociais da Doença , Grupos Focais , Pesquisas sobre Serviços de Saúde , Humanos , Estados Unidos
9.
Nat Hum Behav ; 3(3): 214-220, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30953016

RESUMO

Economic inequality can have a range of negative consequences for those in younger generations, particularly for those from lower-socioeconomic status (SES) backgrounds. Economists and psychologists, among other social scientists, have addressed this issue, but have proceeded largely in parallel. This Perspective outlines how these disciplines have proposed and provided empirical support for complementary theoretical models. Specifically, both disciplines emphasize that inequality weakens people's belief in socioeconomic opportunity, thereby reducing the likelihood that low-SES young people will engage in behaviours that would improve their chances of upward mobility (for example, persisting in school or averting teenage pregnancy). In integrating the methods and techniques of economics and psychology, we offer a cohesive framework for considering this issue. When viewed as a whole, the interdisciplinary body of evidence presents a more complete and compelling framework than does either discipline alone. We use this unification to offer policy recommendations that would advance prospects for mobility among low-SES young people.


Assuntos
Logro , Comportamento do Adolescente , Economia Comportamental , Modelos Psicológicos , Pobreza , Classe Social , Fatores Socioeconômicos , Populações Vulneráveis , Adolescente , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Humanos , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos
10.
BMC Pregnancy Childbirth ; 19(1): 111, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940107

RESUMO

BACKGROUND: Vitamin D deficiency is a growing public health problem, with pregnant women being particularly vulnerable due to its influences on maternal and neonatal outcomes. However, there are limited data published about mediators of vitamin D status in Louisiana women. We aimed to assess the vitamin D status and its determinants among low-income pregnant and non-pregnant reproductive-aged women from southeast Louisiana. METHODS: This study was conducted using data from the Gulf Resilience on Women's Health (GROWH) research consortium cohort of pregnant and non-pregnant women which contained sociodemographic and dietary variables as well as blood and salivary element concentrations. Serum 25-hydroxy vitamin D was measured using an enzyme-linked immunosorbent assay in 86 pregnant and 98 non-pregnant women with an even distribution of race in both groups. RESULTS: The prevalence of deficient vitamin D levels in the total cohort (184 women) was 67% and the mean 25(OH) vitamin D3 was 24.1 ng/mL (SD 10.7). Self-identifying as White, being pregnant, autumn season, young age and high exposure to tobacco smoke measured by cotinine were significantly associated with higher serum levels of vitamin D. Visiting Women and Infant clinics (WIC) was an important determinant in improving 25(OH) vitamin D3 levels for Black women but not for White women and concentrations varied more among Black women across seasons compared to White women. CONCLUSIONS: Serum vitamin D levels are inadequate among a high proportion of Black and White low-income pregnant and reproductive-aged women living in Southeast Louisiana who were enrolled in the GROWH study. Black women who are over 35 years old and non-WIC participants constitute the subpopulation most at risk for vitamin D deficiency, especially during the winter. As an overall higher level of deficiency exists in Black women, if even small behavioral and dietary modifications are produced by WIC, this can lead to a comparatively greater improvement in vitamin D status in women from Southeast Louisiana who self-identify as Black.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Louisiana/epidemiologia , Estado Nutricional , Pobreza/etnologia , Gravidez , Complicações na Gravidez/etnologia , Prevalência , Estações do Ano , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/etnologia , Saúde da Mulher/etnologia , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
11.
Diabetes Educ ; 45(3): 260-271, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027477

RESUMO

PURPOSE: The purpose of the study was to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-health educational tools than peer coaching alone. METHODS: The effectiveness of peer coaches who used an individually tailored, interactive, web-based tool (iDecide) was compared with peer coaches with no access to the tool. Two hundred and ninety Veterans Affairs patients with A1C ≥8.0% received a 6-month intervention with an initial session with a fellow patient trained to be a peer coach, followed by weekly phone calls to discuss behavioral goals. Participants were randomized to coaches who used iDecide or coaches who used nontailored educational materials at the initial session. Outcomes were A1C (primary), blood pressure, and diabetes social support (secondary) at 6 and 12 months. RESULTS: Two hundred and fifty-five participants (88%) completed 6-month and 237 (82%) 12-month follow-up. Ninety-eight percent were men, and 63% were African American. Participants in both groups improved A1C values (>-0.6%, P < .001) at 6 months and maintained these gains at 12-month follow-up ( >-0.5%, P < .005). Diabetes social support was improved at both 6 and 12 months ( P < .01). There were no changes in blood pressure. CONCLUSIONS: Clinical gains achieved through a volunteer peer coach program were not increased by the addition of a tailored e-health educational tool.


Assuntos
Afro-Americanos/estatística & dados numéricos , Diabetes Mellitus Tipo 2/terapia , Tutoria/métodos , Educação de Pacientes como Assunto/métodos , Pobreza/estatística & dados numéricos , Telemedicina/métodos , Afro-Americanos/psicologia , Idoso , Pressão Sanguínea , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Grupo Associado , Pobreza/etnologia , Pobreza/psicologia , Autocuidado/métodos , Autocuidado/psicologia , Apoio Social , Resultado do Tratamento
12.
J Health Care Poor Underserved ; 30(1): 59-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30827969

RESUMO

OBJECTIVES: To evaluate acceptability, feasibility, and short-term behavioral impact of an early childhood caries (ECC) intervention. METHODS: Predominantly low-income Hispanic parent/child (2-6 years) dyads attending a busy pediatric dental clinic in New York City completed a single administration of the iPad-based technology-assisted education, goal-setting, and behavior change MySmileBuddy program. Self-reported behavior change was assessed via telephone survey one month post-intervention. RESULTS: Of 113 parent/child dyads approached, 108 (95.6%) participated and all completed MySmileBuddy in its entirety. Over 96% (n = 76) of 79 parents reached for follow-up recalled MySmileBuddy; 63.3% (n = 50) recalled their diet-and/or oral hygiene-related behavioral goal; and 79.7% (n = 79) reported taking action to initiate behavior change. CONCLUSIONS: Findings suggest that MySmileBuddy was feasibly implemented in a busy clinic, acceptable to this high-risk population, and effectively promoted preliminary ECC-related behavior changes. Larger, long-term studies are warranted to further investigate the impact of the MySmileBuddy program.


Assuntos
Cárie Dentária/prevenção & controle , Clínicas Odontológicas/organização & administração , Hispano-Americanos/psicologia , Higiene Bucal/psicologia , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque , Pobreza/etnologia , Avaliação de Programas e Projetos de Saúde , Medição de Risco
13.
Soc Work Public Health ; 34(1): 28-38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789091

RESUMO

In the second decade of the 21st century societal advancements continue to fall short in closing the gap in social policies for Blacks and other people of color. From health to housing and education, people of color and low-income groups continue to struggle at a greater rate to receive services and support. Media coverage often reflects these disparities, particularly in urban communities. This analysis uses Critical Race Theory (CRT) as a theoretical tool to analyze the 2016 report Racism's Toll: Report on Illinois Poverty to illustrate the challenges faced in addressing social issues and how they are covered in the media. CRT provides a prism through which to examine coverage of health, housing, and education disparities and provides a context for understanding and seeking ways to change disparities in social policies and programs.


Assuntos
Meios de Comunicação de Massa , Racismo/etnologia , Racismo/psicologia , Teoria Social , Escolaridade , Humanos , Illinois , Pobreza/etnologia , Pobreza/psicologia , Psicologia Social , Política Pública , Comportamento Social
14.
Dev Psychol ; 55(3): 509-524, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30802103

RESUMO

Interpersonal and structural forms of racism contribute to a system of economic stratification in the United States in which children of color are disproportionately likely to be born into poverty and to remain poor as adults. However, only a small body of research has focused on Black and Latinx adolescents' developing beliefs about the causes of poverty or the relationship between such beliefs and their awareness of racism. The present study sought to contribute to this scholarship with a longitudinal investigation involving Black and Latinx adolescents (n = 457) attending urban secondary schools in 5 northeastern cities. Specifically, we investigated (a) these adolescents' change over time in their beliefs about the causes of poverty; (b) the relationship between their developing beliefs about the causes of poverty and changes in their awareness of racism; and (c) the role of a progressive schooling experience in influencing the adolescents' beliefs about the causes of poverty. Multivariate latent growth modeling revealed that participants demonstrated significant positive change over time in their conception of poverty as caused by structural factors as well as a significant relationship at each time point between adolescents' beliefs about the causes of poverty and awareness of interpersonal racism. However, we found that attending a secondary school featuring a progressive schooling model did not significantly predict adolescents' change in beliefs about the structural causes of poverty. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Desenvolvimento do Adolescente , Afro-Americanos , Hispano-Americanos , Pobreza , Racismo , Percepção Social , Adolescente , Afro-Americanos/etnologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pobreza/etnologia , Racismo/etnologia , Instituições Acadêmicas , Estudantes , Estados Unidos/etnologia
15.
Dev Psychol ; 55(3): 562-573, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30802107

RESUMO

An intersectional approach to human development emphasizes the multiple social categories individuals occupy, some of which confer privilege (e.g., being White) and some of which confer marginalization (e.g., being poor). This approach is needed especially in critical consciousness scholarship, and particularly in regard to understanding whether and how it may manifest among youth who simultaneously experience privileges due to some aspects of their identities and marginalization due to other aspects of their identities. We explored critical reflection (CR) about socioeconomic inequalities through interviews with 31 White young men from low-income and working-class backgrounds who were attending trade colleges in Pennsylvania. Participants were asked about their understandings of the causes of poverty in the United States and potential solutions. Multiple rounds of qualitative analysis were conducted to understand the potential manifestation of CR in responses. Inductive across-case thematic analysis yielded 11 themes describing participants' understandings of poverty. We then conducted case-based analyses to identify the specific attributions about poverty that each participant made (structural, fatalistic, and/or individual), the ways in which these attributions arose in responses, and how the pattern identified related to CR. Eight participants were identified as having some CR or the potential to develop CR, and their responses were explored for references to experiences that may have been related to CR as well as their membership in a privileged racial and gender group, and more marginalized socioeconomic group. Implications for examining and promoting CR in different groups of youth are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Grupo com Ancestrais do Continente Europeu , Pobreza , Classe Social , Pensamento , Adulto , Grupo com Ancestrais do Continente Europeu/etnologia , Humanos , Masculino , Pennsylvania/etnologia , Pobreza/etnologia , Pesquisa Qualitativa , Adulto Jovem
16.
Health Care Women Int ; 40(4): 347-364, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30794072

RESUMO

Obesity among South African women represents an important dimension of noncommunicable disease (NCD) risk. Experiences of weight are an under-explored frame of reference for intervention. Using three-part in-depth interviews with 20 women and 9 focus groups with a total of 57 women (N = 77) in one low-income neighborhood, I relate women's positive perceptions of fatness to belonging and experiences of hunger. Aware of public health obesity messaging, participants tried to lose weight, yet stress and food scarcity impacted weight gain. Whereas public health interventions focus on behavior, responses to NCDs must recognize the role of food systems and poverty in shaping risk profiles.


Assuntos
Peso Corporal , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Nível de Saúde , Fome , Pobreza/psicologia , Características de Residência/estatística & dados numéricos , Ganho de Peso/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Feminino , Grupos Focais , Abastecimento de Alimentos , Humanos , Entrevistas como Assunto , Pobreza/etnologia , Áreas de Pobreza , Pesquisa Qualitativa , África do Sul , População Suburbana
17.
Soc Work Public Health ; 34(1): 12-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30668268

RESUMO

Race and poverty are poignant factors in how individuals and communities experience the world. The reality is that more people of color than White people live in poverty (Milner, 2013). How these inequalities intersect with the mind and environment is of compelling importance. The experiences of race and living in poverty are riddled with innumerable stressors and barriers, and as a result are subject to the experience of a range of mental health issues. Those that live the experience of trauma related to race and poverty suffer disproportionately from a host of hardships that contribute to psychological distress that can have a profound effect on mental health and serve as intrapsychic binds. These internalized weights require therapeutic supports to alleviate the internal oppressive circumstances by those that are immersed in the experience on a daily basis. This article explores the intersection of these psychological binds and their effect on human behavior.


Assuntos
Grupos de Populações Continentais/etnologia , Grupos de Populações Continentais/psicologia , Transtornos Mentais/etnologia , Transtornos Mentais/psicologia , Pobreza/etnologia , Pobreza/psicologia , Humanos , Meio Social , Fatores Socioeconômicos , Estresse Psicológico/etnologia , Estados Unidos
18.
Soc Psychiatry Psychiatr Epidemiol ; 54(5): 533-541, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30671599

RESUMO

PURPOSE: Because segregation may shield blacks from discrimination as well as increase their exposure to concentrated poverty, its net impact on the mental well-being of black Americans is unclear. We investigated the intersection between segregation, neighborhood poverty, race, and psychological well-being. METHODS: Using data from the nationally representative 2008-2013 National Health Interview Survey merged with U.S. Census data, we examined the association between black-white metropolitan segregation (D-index and P-index) and psychological distress (a binary indicator based on the Kessler 6 score ≥ 13) for blacks and whites. Furthermore, we assessed whether neighborhood poverty explains and/or modifies the association. Logistic regression models were estimated separately for blacks and whites as well as for each segregation index. RESULTS: Higher D- and P-indices were associated with higher odds of psychological distress for blacks. Neighborhood poverty explained some, but not all, of the association. In models that allowed for the impact of metropolitan segregation to vary by neighborhood poverty, higher segregation was found to be detrimental for blacks who resided in high poverty neighborhoods but not for those living in low poverty neighborhoods. We found no evidence that segregation impacts the mental health of whites-either detrimentally or beneficially-regardless of neighborhood poverty level. CONCLUSIONS: The impact of segregation differs by neighborhood poverty and race. The psychological harm of structural racism, resulting in segregation and concentrated poverty, is not additive but multiplicative, reflecting a "triple jeopardy" for blacks, whereby their mental health is detrimentally impacted by the compounded effects of both neighborhood distress and racial segregation.


Assuntos
Afro-Americanos/psicologia , Transtornos Mentais/epidemiologia , Pobreza/psicologia , Características de Residência/estatística & dados numéricos , Segregação Social/psicologia , Adulto , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/etnologia , Transtornos Mentais/psicologia , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pobreza/etnologia , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
19.
Soc Work Public Health ; 34(1): 122-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636560

RESUMO

The National Urban League released a seminal report on the state of older African Americans in 1964. This report titled Double Jeopardy: The Older Negro in America Today presented data that documented the hardships faced by African Americans as they aged in a society that marginalized them. Using critical race theory (CRT), this article reviews the report and addresses the contemporary state of African Americans. It specifically focuses on income, education, poverty, and health status. The article also includes the scholarship of seminal scholars on the Black aged as context. It ends with policy implications that address changes that will continue to improve quality of life for older African Americans.


Assuntos
Afro-Americanos/estatística & dados numéricos , Teoria Social , Idoso , Escolaridade , Feminino , Nível de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Pobreza/etnologia , Qualidade de Vida , Estados Unidos
20.
Med Anthropol ; 38(3): 210-223, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30247078

RESUMO

Puerto Rico's politically liminal status as a US territory has dire consequences for Puerto Rico's economy: the island does not receive the same funding as states for health insurance. In addition, Puerto Rico's unraveling health care system, coupled with the island's high poverty rate and the medical brain drain, interact. I weave my research on depression into this article as an example of the ways in which political and economic factors aggravate disease.


Assuntos
Assistência à Saúde/etnologia , Acesso aos Serviços de Saúde , Seguro Saúde , Antropologia Médica , Humanos , Pobreza/etnologia , Porto Rico/etnologia
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