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Medicaid and Supplemental Nutrition Assistance Program (SNAP) are two large-scale safety net programs in the U.S. that provide public assistance to the low-income population. Over the years both programs have undergone several policy changes and have evolved to cover more needy individuals. This three-paper dissertation is a culmination of three research studies, two of which examine the effect of the Affordable Care Act’s (ACA) Medicaid expansion on outcomes of realized access to dental care i.e., dental visits and out-of-pocket dental care spending, respectively, while the third paper explores the relationship between SNAP participation and dental visits (realized access), and between SNAP participation and unmet dental care need due to cost (perceived access)., The few studies that have examined the impact of the Medicaid expansion on dental visits utilization have shown somewhat mixed findings and are mostly limited to examining early impacts (1-2 years post-expansion). Thus, Study I of this dissertation examined the longer-term impacts of states’ Medicaid expansions on dental visits utilization, by their adult dental benefits coverage level. Restricted data from the Medical Expenditure Panel Survey (MEPS) for the years 2011 through 2017 were obtained; the sample included adults aged 21-64 years with income up to 138% of Federal Poverty Level. A quasi-experimental Difference-In-Difference (DID) study design was used to examine the overall and year-by-year impacts of the Medicaid expansion on annual dental visits based on a states’ adult dental benefits coverage level (i.e., extensive, limited, and emergency-only/no benefits). Overall, expansion states, compared to non-expansion states, saw a 3-6 percentage point increase in annual dental visits in the post-expansion period (2014-2017), relative to the pre-expansion period (2011-2013). Year-by-year examinations revealed that the Medicaid expansion was associated with a significant increase in the likelihood of an annual dental visit among low-income adults in states with extensive benefits in 2014 (nearly 5 percentage points), and in states with limited and emergency-only/no dental benefits in both 2014 (6 percentage points for both) and 2016 (4 and 5 percentage points, respectively)., Expanding Medicaid also has the potential to reduce out-of-pocket dental care spending among low-income adults gaining coverage through Medicaid, especially among states that provide comprehensive adult dental benefits. Thus, Study II of this dissertation examined the impact of states’ Medicaid expansion on out-of-pocket dental care spending among low-income adults residing in states that provided extensive adult dental benefits. A DID study design with a two-part (hurdle) modeling approach was utilized to analyze post-expansion year-by-year changes in: a) the probability of incurring any out-of-pocket dental spending, and b) the amount of out-of-pocket spending (conditional on any spending) between expansion states with extensive benefits and non-expansion states. Overall, a greater proportion of adults in expansion states with extensive dental benefits (58%) reported zero dollars in out-of-pocket dental care spending, compared to those in non-expansion states (31%). Our DID analysis found that, compared to non-expansion states, adults residing in states that provided extensive adult dental benefits and expanded Medicaid were significantly less likely to incur any out-of-pocket dental spending in the first two years of implementing the expansion (2014 and 2015)., There is growing interest in examining SNAP’s spillover impacts on improving healthcare access and outcomes, postulated to be due to SNAP’s ability to reduce food-insecurity thereby potentially freeing up some financial and cognitive resources to seek care. Thus, Study 3 of this dissertation examined the association between participation in SNAP and realized and perceived access to dental care among low-income adults. A sample of SNAP income-eligible adults aged 19-64 was created by pooling MEPS data for the years 2011 to 2017. Applying a propensity score method to control for important differences in characteristics between participants and eligible non-participants, and using a Doubly-Robust approach, multivariable logistic regressions modelling the impact of SNAP participation on annual dental visits and unmet dental care need due to cost were performed. Interestingly, we found that SNAP participants, compared to eligible non-participants, have significantly lower odds of having an annual dental visit (approximately 20%) and significantly greater odds of reporting unmet dental care need due to cost (approximately 40%)., In conclusion, the results of the three studies in this dissertation provide some important insights into the dental care access impacts of the ACA’s Medicaid expansion and provide foundational evidence on the relationship between participation in the Supplemental Nutrition Assistance Program and dental care access among low-income adults. Results from Study I are suggestive of a positive link between the expansion of Medicaid and increased dental visits. However, longer-term impacts were less consistent and varied based on states’ adult dental coverage level thereby warranting further research. Study II results are encouraging and show that providing comprehensive dental benefits in Medicaid adult dental programs is protective against incurring any out-of-pocket expense for those who utilize dental care, with the potential to benefit more low-income individuals when these states expand Medicaid eligibility. Lastly, Study III results show that SNAP participation is associated with lower dental visits utilization and greater unmet dental care need due to cost. While we postulate that this may be due to several reasons, such as, SNAP benefits not being enough to offset non-food costs, and perhaps, the most disadvantaged of all SNAP-eligible families who tend to have fewer resources being more likely to enroll in the program, further research is needed to fully investigate and understand the underlying causal mechanisms through which these associations operate.

We study the local effects of new market-rate housing in low-income areas using microdata on large apartment buildings, rents, and migration. New buildings decrease rents in nearby units by about 6% relative to units slightly farther away or near sites developed later, and they increase in-migration from low-income areas. We show that new buildings absorb many high-income households and increase the local housing stock substantially. If buildings improve nearby amenities, the effect is not large enough to increase rents. Amenity improvements could be limited because most buildings go into already-changing neighborhoods or buildings could create disamenities such as congestion.

BackgroundHousehold food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.ObjectiveOur aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.DesignSecondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.Participants/settingParticipants in study 1 (n= 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n= 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.Main outcome measuresThe primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.Statistical analysisMultivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.ResultsIn study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P= .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P= .045).ConclusionsThese findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.

Background. Episodic future thinking (EFT) has shown efficacy in laboratory settings. We conducted a pilot goal-oriented EFT (GoEFT) intervention in a real-world setting to help low-income overweight or obese mothers lose weight. This paper presents intervention acceptability and efficacy. Methods. The study used a single-group, before–after design. During the 3-week intervention, participants (N = 15) completed weekly web-based lessons and online health coaching sessions to manage stress and emotion, eat healthier, and be more physically active. Participants completed online surveys at baseline and immediately after the intervention. They also completed an interview to evaluate intervention acceptability. We applied paired t-tests to evaluate efficacy and used content analysis to discover interview themes. Results. Participants consistently identified the intervention as acceptable, noting the usefulness of pre-written goals, GoEFT strategies, and goal progress evaluations. The intervention effectively promoted weight loss (d = −0.69), fruit and vegetable intake (d = 0.45–0.49), and emotion control (d = 0.71). It also reduced fat (d = −0.51) and added sugar intake (d = −0.48) and alleviated stress (d = −0.52). Moreover, the intervention increased autonomous motivation (d = 0.75–0.88) and self-efficacy (d = 0.46–0.61). Conclusion. The GoEFT intervention was acceptable to participants, showing strong preliminary efficacy.

Pregnancy in women with sickle cell disease (SCD) is fraught with complications, some of which are life-threatening. Managing pregnancy in these women can be challenging, especially with poor resources, which is often the case in low-income countries. In Nigeria, for instance, up to 90% of patients pay out of pocket for medical care due to the poorly developed health insurance system, and this worsens the morbidity and mortality associated with this condition. We describe a pragmatic approach to routinely managing pregnant women with SCD in the antenatal period, showing the feasibility of effective management of these high-risk pregnancies in limited-resource settings. We also present the case of a pregnant Nigerian woman with SCD who has intrauterine growth restriction (IUGR) and acute chest syndrome (ACS), conditions that are life-threatening for the fetus and the mother, respectively, and require prompt intervention. We highlight how we successfully managed this woman in a cost-effective manner by employing relatively inexpensive tests for diagnosis and treating her effectively with oxygen, appropriate antibiotics and manual exchange blood transfusion for the ACS, and finger pulse oximeters to monitor oxygen saturation. We explore pathophysiological concepts to IUGR in women with SCD and briefly discuss the appropriate mode of delivery, including the options for pain relief in labor.

This paper presents the results of thermal comfort and air quality studies in naturally ventilated residential buildings in Kampala City, Uganda. Questionnaire surveys were used for obtaining occupant subjective thermal sensation votes. Indoor and outdoor measurements for air temperature (Ta), Mean Radiant Temperature (MRT), relative humidity, air speed, and air quality were done for seven buildings over fifteen days during the month of June 2019. DesignBuilder software was used to develop the reference building model and to simulate strategies for improvement of thermal comfort. Survey results showed that 67.8% of the respondents were comfortable with the indoor thermal environment. The indoor air temperature range was 22.7°C - 27.9°C which lies within the 80% acceptable limits set by ASHRAE 55. The measured indoor MRT range was 24.24°C - 25.57°C. Measured levels of indoor PM2.5 were double the World Health Organization recommended limits, while the levels of PM10 were thrice the recommended limits of ASHRAE 62.1. The CO2 concentrations were within the limits set by ASHRAE 62.1. The developed model predicted comfortable indoor conditions with a temperature range of 23.6°C - 25.3°C based on the 80% acceptable limits set by ASHRAE 55. The results show that majority of occupants preferred cooler temperatures during the day which is justified by the use of adaptive measures to obtain thermal comfort.

Particularly in low-income nations, infectious illnesses continue to be a significant global health burden. The interaction of stem cells with infectious diseases has become a fascinating field of study with bright therapeutic potential. This review article seeks to give readers an overview of how cells interact with one another in disease, with a particular focus on how stem cells interact with a few specific infectious diseases and their therapeutic potential in low-income nations. The definition and several types of stem cells are introduced at the outset of the review, with a focus on their capacity for regeneration and immunomodulation. The significance of stem cells in tissue repair and regeneration is next discussed, emphasizing their potential to lessen the damaging effects of infectious illnesses on host tissues.The article also examines the behaviour and function of stem cells as well as the direct and indirect effects of pathogens on stem cells. Examining the immune systems function in controlling the interaction between infections and stem cells helps to understand the intricate cellular cross-talk involved. The review examines the therapeutic potential of stem cell-based therapies for infectious diseases in the context of low-income nations. It addresses the potential of stem cell treatments for conditions like HIV, malaria, tuberculosis, and neglected tropical diseases while highlighting the developments and difficulties associated with applying these treatments in settings with limited resources.Overall, this review demonstrates the complex relationship between stem cells and infectious diseases and offers insights into the potential therapeutic applications of stem cell-based therapies in low-income nations. It emphasizes the requirement for additional study, teamwork, and the creation of affordable and widely available stem cell therapies to effectively combat infectious diseases and enhance healthcare outcomes in settings with limited resources. &nbsp

Aim: To understand the experience of low-income older adults living in poverty in a high-income country. Design: A qualitative study based on Gadamer's hermeneutic phenomenology. Methods: A convenience sample of twenty-seven low-income older adults were interviewed in-depth between September 2021 and January 2022. Fleming's method for conducting phenomenological qualitative studies was followed and ATLAS.ti software was used for data analysis. Results: Three main themes were extracted from the analysis: (i) ‘living in the shadow of poverty’, (ii) ‘unprotected by the ‘social shield’ of the welfare state’ (iii) ‘the struggle to attain good health’. Conclusion: Living in poverty affects all spheres of life. Older adults living in poverty feel excluded from social support policies and laws. This has a negative impact on the older adults' mental health and can lead to social isolation. Implications for the Profession and/or Patient Care: Nursing interventions to promote health amongst older adults living in poverty should include an assessment of the patient's social determinants and a focus on increasing social participation. Older people living in poverty experience difficulties accessing formal social support so nurses should implement patient navigation interventions that aim to help them overcome the complexities of the system. Nursing interventions to improve mental health amongst older adults living in poverty are much needed. Impact: Living in poverty increases older adults' vulnerability. Older adults living in poverty suffer from mental health issues as they live under constant pressure to meet their basic needs and lack formal social support. These findings are important for nurses, who play a pivotal role in the design, implementation and evaluation of policies and interventions that promote health equity. Reporting Method: The study has been conducted following the COREQ guidelines. Patient or Public Contribution: There has been no public or patient involvement in the design or development of the study., Knowledge Transfer Programme from the University of Almería, Grant/Award Number: TRFE-SI-2021/004

The Chinese Dietary Guidelines propose a balanced diet for healthy living, but the affordability of this diet needs to be considered, especially for low-income households. To investigate the affordability of a healthy diet, this study analyzes the daily retail prices of 46 food items in 36 Chinese cities from 2016 to 2021. This study compares expenditure, diet composition, and nutritional status in two scenarios aligned with the guidelines. The results show that the mean minimum cost of a balanced diet exceeds the current per capita food expenditure for at least 182.85 million urban households. This suggests that low-income people would need to increase their expenditure by at least 20–121% to achieve the recommended diets. This study also identifies affordable and nutrient-dense foods such as standard flour, eggs, black beans, and cabbage, which policymakers should focus on when monitoring food prices. The findings recommend a combination of social and food system policies to reduce prices and make healthy diets accessible. This study identifies the gaps in the Chinese Dietary Guidelines for ensuring accessibility for vulnerable groups and provides a template for policymakers and researchers to track diet affordability using available food price data in China, contributing to China’s 2030 Health Plan and the UN’s Sustainable Development Goals.

Due to a rapidly growing population and economy, an increase in emissions from urban growth, industrial growth, and energy use hurt the environment’s health. This research examines how tourism, population, income, renewable energy, and electricity consumption affect carbon emissions in twenty-six low-income countries. There is no cross-sectional dependence (CSD) problem, so quantile regressions (QR) and generalized method of moments (GMM) are used. Results show that the environment is obtaining benefits because of tourism. CO2 emissions are rising because the per capita income, electricity consumption, and population are growing. CO2 emissions can be lowered by using more renewable energy and growing the economy faster. Environmental Kuznets Curve (EKC) is also valid in low-income countries. Thus, increasing income will not be harmful to the environment. Similarly, increasing tourism, renewable energy, and rising GDP per capita benefit low-income countries. The government can focus on sustainable tourism. Policymakers may convince more people to use renewable energy resources and grow the sustainable tourism industry. This study recommends that the government reduce greenhouse gas emissions, promote tourism that is good for the environment, take initiatives to limit population growth, and use renewable energy.

Although cancer survival rates have been improving in the United States over the past 30 years, cancer treatment facilities still struggle to achieve patient treatment volumes that match demand for their services. My capstone team and I studied the treatment workflow at UVA’s Cancer Center through a combination of interviews, observations, and statistical analysis. We discovered that there was significant room for process improvement at the center and determined that two strategies, a new drug pre-preparation approach and a novel scheduling approach, could increase chair utilization without subjecting nurses to additional strain. From a human factors standpoint, our research showed that increasing cancer treatment efficiency would improve patient experiences and decrease nurse workload. Indeed, future work at this cancer center and at cancer centers around the country must be evaluated holistically, from both a throughput and human impact perspective. Cancer care can also be viewed through an infrastructure lens. Susan Star’s infrastructure framework helps us understand that cancer care is embedded within pre-existing healthcare systems, learned as a part of membership by patients, and built on an installed base of other pieces of infrastructure. For my thesis project, I investigated the impact of the Affordable Care Act (ACA) on cancer outcomes for low-income patients using Star’s framework and statistical analysis. My study found that cancer mortality rates fell significantly in the decade following the ACA’s passage, but that cancer mortality rates in persistent poverty counties lagged rates in nonpersistent poverty counties by a decade. Moreover, the mortality rate gap between persistent and nonpersistent poverty counties only barely decreased during this time period. Unfortunately, the ACA was not significantly correlated with improvements in cancer treatment for low-income patients between 2010 and 2020. My capstone and thesis projects examine cancer care from different angles, but they are connected by their twin desires to understand and improve cancer treatment across the country. Together, these two projects help us understand how hospital-level and policy-level approaches can provide future cancer patients the cancer care they deserve.

During the summer of 2022, the Finance Platform team in an American banking firm headquartered in Virginia noticed that its data preview and download feature was malfunctioning. More specifically, miscommunication between the feature’s backend microservice and the frontend User Interface (UI) component caused erroneous behavior in the application when users attempted to preview larger and more complex datasets. Because this feature’s user base consisted primarily of the firm’s employees due to it comprising a portion of their internal application, my internship focused on replacing the existing feature with an improved version. My technical report details the steps that my internship team and I took to create an upgraded data preview and download backend service and its respective UI component. We hoped that doing so would rectify the previous feature’s shortcomings. My summer internship, which also served as my technical project, was managed using agile methodologies. Moreover, its technology stack included the Spring framework and Apache Spark for the backend, the Angular framework for the frontend, and Amazon Web Services (AWS) to satisfy data storage requirements. Utilizing the provided combination of tools and technologies allowed us to efficiently replace the existing service with one that incorporated a more comprehensive set of endpoints (e.g., preview, download, download zip) and a redesigned preview response object. To maintain consistency with the company’s coding practices, our team also created a UI component using Angular to facilitate a more user-friendly experience when previewing and downloading the selected datasets. Although the newly created service and UI component performed slower than we had originally anticipated, they allowed users to successfully preview and download a more diverse range of datasets with minimal challenges. However, potential next steps would include extensive regression and performance testing, improving performance time by leveraging newer technologies, and integrating this feature into the firm’s production environment. Despite my technical project focusing on modifying the existing data preview and download feature in the firm’s internal web application, this company also offers a myriad of other technological products and services to its customers. Even though I was only able to interact with a subset of the firm’s products, I was the most intrigued by Eno, its chatbot. Over the past few decades, advancements in fields including Artificial Intelligence (AI) and Machine Learning (ML) have helped revolutionize how businesses communicate with their customer base. More specifically, a majority of these companies across various industries have been rapidly transitioning away from customer support teams and into adopting chatbots. While chatbots have undoubtedly aided businesses by increasing productivity and minimizing cost, the STS paper investigates how generative chatbots in the banking industry impact the retention rate of low-income customers. Chatbots are merely computer programs that are designed with the intent of simulating and comprehending ordinary human conversation. Although earlier chatbots such as ELIZA, PARRY, and ALICE typically exhibited limited functionality because of their underlying rule-based technology, the progression of computer science has allowed the creation of generative chatbots such as Capital One’s Eno and Amazon’s Alexa among many others. In an attempt to narrow down the scope of the research topic, the STS paper solely focuses on generative chatbots. While chatbots have been widely popularized and even idolized in certain circumstances, this paper draws on various research (e.g., academic papers, research articles) to examine how aspects of a chatbot including functionality, credibility, and emotional objectivity are perceived by different social groups. Due to the nature of my topic, the social groups are stratified by both income and race. Moreover, a majority of the research focuses on the relationship between chatbots and the low-income community. To better understand the relationships between chatbots and the impacted social groups, the STS paper relies on the Social Construction of Technology (SCOT) framework. Given that this framework revolves around the concept that society shapes technology, it effectively supplements my analysis of how this technology is being continuously adapted in response to both the approvals and criticisms of different social groups such as the low-income population. Finally, a paper that concentrates on chatbots and their implications within communities would be incomplete without discussing the new chatbot that has taken the AI and ML fields by storm – ChatGPT. To acknowledge chatbots of this caliber, my research paper briefly examines how ChatGPT can potentially modify the banking landscape. Additionally, it touches on what this may mean when considering the ever-evolving relationship between the low-income population and this technology.

Background Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. Method Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. Results Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. Conclusions Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.

Low-income housing plays an important, but frequently overlooked, role in energy use reduction. Barriers persist for low-income households to participate in energy efficiency programs and adopt efficient lifestyles. However, there has been only limited research into energy efficiency barriers faced by low-income households. Existing energy research studies primarily focus on homeowners whose demographic and socio-economic profiles are likely to be very different from low-income households or renters—limiting the applicability of previous findings to low-income households. This study aims to identify and evaluate the importance of the energy efficiency barriers faced by low-income households. A questionnaire survey was conducted with 212 low-income households in Australia. After randomly dividing the data into calibration and validation samples, an exploratory factor analysis (EFA) of the calibration sample identifies four energy efficiency barrier factors of financial, decision-making, information, and split incentives. These four factors are then validated by confirmatory factor analysis (CFA) of the validation sample in terms of goodness-of-fit, reliability, and validity to confirm financial as the most highly rated energy efficiency barrier. This research contributes to bridging the knowledge gap of the energy efficiency barriers of low-income households and providing a validated CFA model as a tool for assessment. The results provide a better understanding of the barriers involved and research evidence to facilitate the formulation of policies to overcome them.

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

In the context of successive global crises and rising household food insecurity in wealthy European countries there is renewed attention to the role of school meals as a welfare intervention. However, little is known about the extent to which school meals are a resource for low-income families living in different contexts. Drawing on a mixed methods study of food in low-income families in three European countries, this paper adopts a realist ontological stance and an embedded case study approach to address this question. The research concerns low-income families with children aged 11–15 years in the aftermath of the 2008 financial crisis in the UK, Portugal and Norway. Based on a comparative, multi-layered analysis of macro-, meso- and micro-level contexts, we argue that publicly funded, nutritious school meals protect children from the direct effects of poverty on their food security, whilst underfunded and weakly regulated school food provision compounds children’s experiences of disadvantage and exclusion. The paper concludes with recommendations for public policies that conceptualise school meals as a collective resource, like education, to which young people as bearers of the right to food are entitled.

To investigate the trend of healthcare needs among elders in low-income countries (LICs) and how changes in healthcare access and quality (HAQ) have correlated with these changes from 1990 to 2019, this study used estimates from the global burden of disease (GBD) 2019 study, including prevalence, years of life lost (YLLs), years lived with disability (YLDs), life expectancy (LE), health-adjusted life expectancy (HALE) and the HAQ index for years 1990 and 2019. We found increases in numbers of YLLs, YLDs, and prevalent cases due to NCDs, and the rate of increase was higher for all indicators of non-communicable diseases (NCDs) when compared with communicable, maternal, neonatal and nutritional diseases among elders. We also observed increases in LE and HALE among all countries. However, this was also challenged by increases in unhealthy life years (ULYs) and their constant percentage of LE. The HAQ index of LICs was also found to be low, although it had increased during the period. A reduction in the burden of acute diseases explains the increase in LE, but increases in ULYs and the NCD burden were also observed. LICs need to improve their HAQ to counter the growing threat of longer but less healthy lives.

People with disabilities experiencing low socioeconomic position are priority populations when considering access to veterinary care. In this population, intersectional inequities lead to adverse health outcomes for both those individuals and the companion animals they care for. Community-based veterinary clinics provide an opportunity to target these inequities from a culturally sensitive lens, intending to improve human and animal outcomes. We conducted a process evaluation of a student-led community-based clinic for this population to better understand client satisfaction, assess learning outcomes among veterinary students, and improve program delivery and services. During academic year 2020–2021, the monthly clinics had 162 appointments in total with a median 15 DVM candidates volunteering at each clinic. Clients and volunteers responded to survey questionnaires designed to elicit information about their experiences with the clinic, including open-ended questions for further elucidation of measurable indicators of client-, patient-, and student-level impact. Clients attributed enrollment in the clinic with improved quality-of-life and reduction of financial burden; the program saved clients approximately $2,050 per pet during the evaluation year. Furthermore, the clinic widely facilitated completion of the college's core Primary Care and Dentistry learning outcomes. Beyond curriculum-standard learning objectives, students also reported positive attitude changes and increased readiness to provide care to people with disabilities and people experiencing low socioeconomic position. The results of this evaluation have significant implications for both veterinary and public health pedagogy. Especially, they highlight the significance of community health practice in veterinary trainee education.

Racial/ethnic and socioeconomic differences were shown to have an influence on child fruit and vegetable intake. This study examined the associations between parent and child fruit and vegetable intake and the home nutrition environment among Hispanic/Latino and African American families. Through a cross-sectional study design, self-reported surveys (n = 6074) were obtained from adult–child dyad participants enrolled in Brighter Bites, an evidence-based health promotion program, in the fall of 2018. For every once/day increase in frequency of parent FV intake, there was an increase in child FV intake by 0.701 times/day (CI: 0.650, 0.751, p < 0.001) and 0.916 times/day (CI: 0.762, 1.07; p < 0.001) among Hispanic/Latinos and African Americans, respectively. In Hispanic/Latino participants, significant positive associations were found between fruits as well as vegetables served at mealtimes ≥3 times/week (p < 0.001), family mealtimes 7 times/week (p = 0.018), parent–child communication about healthy eating and nutrition at least sometimes during the past 6 months (p < 0.05), and frequency of child FV intake, after adjusting for covariates. In African American participants, a significant positive association was found in fruits served at mealtimes ≥1 times/week (p < 0.05), and vegetables served at mealtimes ≥5 times/week (p < 0.05). Meals cooked from scratch a few times a day/all the time were significantly positively associated with frequency of child FV intake for both Hispanic/Latino (p = 0.017) and African American (p = 0.007) groups. The relationship between home nutrition environment and child FV intake varied by race and ethnicity. Future programs should consider designing culturally tailored interventions to address racial/ethnic-specific influences that match the child’s race, culture, and ethnicity.

Background: Parent mentors are a potential community-based mechanism for delivering behavioral interventions. For communities at a higher risk of obesity and challenges with access to care, such as migrant and seasonal farm workers, this may be an effective intervention for obesity. This study examined the effect of parent mentors on weight outcomes. Methods: This randomized clinical trial assigned parents of 2- to 5 year-old children enrolled in Head Start 1:1:1 to control, a parent mentor teaching We Can!, or a parent mentor teaching an intervention derived from positive deviance methods. The parent mentor arms were designed to have weekly interactions and monthly community meetings over 6 months. The primary outcome was change in adiposity, as measured by body mass indices. Results: We randomized 188 parents, and 155 completed the 6-month visit. Most parents, 107 (58%), had less than a high school education, and 170 (90%) reported Latino ethnicity. In the intention-to-treat analysis, no difference between the groups was observed for change in percent distance from the median or BMI z-score. The median number of interactions was 14 (IQR 10-20) over 6 months for those who did engage, though 24 of 118 (20%) had no interaction. Those with no interactions in We Can! had a mean increase in change from median of 6.7 [standard deviation (SD) = 8.2]; those with higher participation experienced a 0.4 (SD = 9.2) change, p = 0.04. Conclusions: Parent mentors were not effective in changing the adiposity indices in this study overall, with some evidence of efficacy after accounting for participation. Clinicaltrials.gov registration number: NCT03330743.

Social safety nets as response to extreme poverty alleviation in African low-income countries still strive to fit and reinvent themselves in order to ensure their main goal achievement. The concept"s definition suffers so far of common stand fluctuating importantly referring to institutions, time, place and circumstances. In the context of African low income countries like Benin, safety nets programs play narrowed functions. They address issue of living conditions of most vulnerable, ensure that households" means of subsistence are protected and help them to invest in human capital through children" schooling meanwhile in transition and developed economies these programs occur as sophisticated. In cash and in kind transfers can"t be efficiently achievable owing largely to their unaffordable financial cost, to existing administrative capability concern as well as to significant technical challenges involving managerial, conceptual, monitoring, reporting skills" shortage and data availability and reliability. However, such nations dispose likelihood to overcome these undermining challenges simply throughout their rich natural resources" re-appropriation and locally transformation, {"references":["Alderman, H. (2002). Subventions en tant que filets sociaux de sécurité: efficacité et défis. Série d'introduction aux filets sociaux de sécurité, Washington, DC: World Bank","Cherrier, C. (2020, janvier). filets sociaux et securite alimentaire : une historique des enjeux. Iinter-ReseauxDeveloppement Rural. Consulté le 2 juin 2022, à l\"adresse https://www.inter","reseaux.org/wp-content/uploads/gds79_filets_sociaux-san-historique_version_longue.pdf","Fox, L. (2003). Uneintroductionauxfiletssociaux de sécurité dans leséconomies de","transition (No. 0306). SocialProtectionDiscussionpaper","Gillion, C., Turner, J., Bailey, C., &Latulippe, D. (2000).Social security pensions: Development and reform. Geneva: ILO.","Grosh, M., Del Ninno, C., Tesliuc, E., &Ouerghi, A. (2008). Forprotectionandpromotion: Thedesignandimplementation of effectivesafetynets. World Bank Publicationsfiletpremier"]}

This article presents a novel methodology to assess the financial risk to crops in highly weather-volatile regions. We use data-driven methodologies that use singular value decomposition techniques in a low-income economy. The risk measure is first derived by applying data-driven frameworks, a Principal Component Analysis (PCA), and Singular Spectrum Analysis (SSA) to productive coffee crops in Colombia (163 weather stations) during 2010–2019. The objective is to understand the future implications that index insurance tools will have on strategic economic crops in the country. The first stage includes the identification of the PCA components at the country level. The risk measure, payouts-in-exceedance ratio, or POER, is derived from an analysis of the most volatile-weather-producing regions. It is obtained from a linear index insurance model applied to the extracted singular-decomposed tendencies through SSA on first-component data. The financial risk measure due to weather volatilities serves to predict the future implications of the payouts-in-exceedance in both seasons—wet and dry. The results show that the first PCA component contributes to forty percent of the total variance. The seasonal forecast analysis for the next 24 months shows increasing additional payouts (PO), especially during the wet season. This is caused by the increasing average precipitation tendency component with POERs of 18 and 60 percent in the first and second years. The findings provide important insights into designing agricultural hedging insurance instruments in low-income economies that are reliant on the export of strategic crops, as is the case of Colombian coffee.

Background: A pilot study was performed at a low-income emergency care clinic to assess the humoral immune response to the Johnson & Johnson (J&J) COVID-19 vaccine (Ad26.COV2.S) to better understand how to evaluate the COVID-19 health status of its Hispanic patient population following vaccination. Methods: This study used the Clungene® SARS-CoV-2 IgG/IgM Rapid Test Cassette to determine the presence of binding antibodies resulting from the J&J COVID-19 vaccine. The Clungene test principle is based on the receptor-binding domain (RBD) of the spike protein. Antibodies targeting the spike protein are considered an appropriate measure of humoral response from spike-based vaccines. Results: The study confirmed previous research that antibodies wane over time, and results are consistent with reported vaccine efficacy. There was a statistically significant relationship between the humoral immune response and demographic and health status variables. Conclusions: COVID-19 negative patients can be easily and efficiently monitored to determine the success and durability of COVID-19 vaccines in low-income minority populations. The use of simple low-cost spike targeted COVID-19 antibody lateral flow devices may serve as a useful adjunct to assist community-based physicians on the COVID-19 health status of its patients. Further research is needed to confirm the utility of this approach.

Pharmaceuticals are widely used in Africa due to the high burden of human and animal diseases. However, a review of the current practices and pollution risks arising from the disposal of pharmaceuticals in low-income settings in Africa is still lacking. Therefore, the present review examined the literature to address the following questions: (1) what are the key factors driving the accumulation of unused and expired pharmaceuticals?, (2) what are the current disposal practices for unused and expired pharmaceuticals, and wastewater (feces and urine) containing excreted pharmaceuticals?, (3) what are the potential environmental and human health hazards posed by current disposal practices?, and (4) what are the key research needs on the disposal of pharmaceuticals in low-income settings? Evidence shows that, in low-income settings, wastewater comprising predominantly of feces and urine containing excreted pharmaceuticals often end up in on-site sanitation systems such as pit latrines, septic tanks, and the environment in the case of open defecation. Unused and expired pharmaceuticals are disposed of in pit latrines, household solid waste, and/or burned. The pollution risks of current disposal practices are poorly understood, but pharmaceutical pollution of groundwater sources, including those used for drinking water supply, may occur via strong hydrological connectivity between pit latrines and groundwater systems. Potential high-risk pollution and human exposure hotspots are discussed. However, compared to other environmental compartments, the occurrence, dissemination, fate, and human health risks of pharmaceuticals in the pit latrine-groundwater continuum are still understudied. Future research directions are discussed to address these gaps using the Source-Pathway-Receptor-Impact-Mitigation (SPRIM) continuum as an organizing framework.

This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8–13 years (x̄ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40–2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18–6.93; girls: OR = 1.78, 95% CI: 1.13–2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and theduration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.

BACKGROUND: Low-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth. METHODS: We pooled anthropometric and demographic data for 1 132 069 children (aged

Informal financial support is a vital yet under-examined source of welfare for people on low incomes. This thesis explores why and how people draw on networks of family, friends and neighbours for financial support to cover their basic living costs and considers the significant practical and emotional implications the practice has for individuals, their relationships and wider support networks. It takes as its starting point Robert Pinker’s (1971, 1979) view of social policy as a discipline that should take into account how ordinary people go about enhancing their own welfare and the welfare of their family members and friends in their everyday lives. The findings are based on unstructured interviews with fifty working-age social housing tenants living in the South West of England centred around a support network mapping exercise. The research identifies informal financial support as a distinctive form of support among the broad range of informal help and care people engage in on a daily basis. It highlights the significant work involved in providing and navigating informal financial support within a context of poverty, as well as the often challenging clash participants experienced between societal norms of independence and support, and the reality of their interdependent lives. For many participants, informal financial support was “the ultimate safety net”, but the research finds that the practice exposed people and their networks to multiple negative impacts and associated risks, including relationship breakdown, isolation and financial insecurity. The study concludes by arguing for a social policy based on an ethic of care that recognises and supports people's interdependence across households, while also working to prevent and mitigate the negative effects of informal financial support.

Rapid urbanization pressure and poverty have created a push for affordable housing within the global south. The design of affordable housing can have consequences on the thermal (dis)comfort and behaviour of the occupants, hence requiring an occupant-centric approach to ensure sustainability. This paper investigates occupant behaviour within the urban poor households of Mumbai, India and its impact on their thermal comfort and energy use. This study is a first-of-its-kind attempt to explore the socio-demographic characteristics and energy-related behaviour of low-income occupants within Indian context. Three occupant archetypes, Indifferent Consumers; Considerate Savers; and Conscious Conventionals, were identified from the behavioural and psychographic characteristics gathered through a transverse field survey. A two-step clustering approach was adopted for occupant segmentation that highlighted considerable diversity in occupants’ adaptation measures, energy knowledge, energy habits, and their pro-environmental behaviour within similar socio-economic group. Building energy simulation of the representative archetype behaviour estimated up to 37% variations for air-conditioned and up to 8% variation for fan-assisted naturally ventilated housing units during peak summer months. The results from this study establish the significance of occupant factors in shaping energy demand and thermal comfort within low-income housing and pave way for developing occupant-centric building design strategies to serve this marginalized population. The developed low-income occupant archetypes would be useful for architects and energy modelers to generate realistic energy use profiles and improve building performance simulation results.

Previous research shows that low-income and first-generation college students are less likely to obtain the benefits associated with attending graduate school. No-loan programs, which typically administer financial aid through institutional grants, are designed to improve access and success among students from low-income backgrounds, but we know very little about the influence of no-loan programs after students enroll and eventually graduate from college. This study examines the impact of no-loan program participation on graduate school enrollment by leveraging a novel institutional dataset and applying regression discontinuity, difference-in-differences, and propensity score weighting approaches. Results indicate that no-loan program participation has a positive and relatively consistent impact on graduate school enrollment among low-income and first-generation students.

Drawing on a comprehensive panel data of 137 low income and developing countries, this study queries the macro-economic drivers of Public Private Partnership (PPP) in these countries. PPP is mainly used as a method to address infrastructure needs of nation states which cannot allocate their financial resources towards infrastructure investments and/or cannot secure finance through other instruments. Previous studies in the field remain partial as they included a limited number of macro-economic factors and a smaller number of countries. Our findings suggest that general government balance, population size, money supply and the share of investments in GDP are significant determinants of PPP activity.

To explain an emerging trend towards deteriorating living conditions among low-income households across several (West-)European countries, it makes sense to investigate domains of socio-economic regulation that impact on expenditures, rather than incomes. I focus specifically on the domain of housing. Multilevel analyses for 28 countries (EU-SILC) demonstrate that redistributive housing policies such as rental market regulation and housing allowances weaken the cross-sectional (between-country) positive association between a low-income and living conditions-deprivation, while also benefiting living conditions across the broader population. Regarding changes over time, increased uptake of housing allowances throughout the Great Financial Crisis (2008/2009) seems to have shielded in particular renters from deteriorating living conditions, and might have compensated for declining availability of social housing. Higher house prices and price volatility, indicating housing market financialization, are associated with increased living conditions-deprivation for renters and low-income owners, both cross-sectionally and within countries over time. Anti-poverty policies should thus take a broader perspective, and take better account of provision for housing and other basic needs.

This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child’s sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children’s structure, parent work responsibilities, sleep-hindering environment, and parent’s emotional capacity. Parent’s intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.

BackgroundCaregiver sensitivity is associated with positive child outcomes, and improving sensitivity is often the aim of parenting-directed interventions. However, sensitivity was conceptualized in Western cultures, and its application in populations with different backgrounds is still limited.ObjectiveThis study aimed to foster a contextualized cultural understanding of the meaning and nature of sensitivity by assessing the possibility of evaluating sensitivity in a low-income population living in Ethiopia and describing the nature of (in)sensitive parenting. Moreover, the associations between sensitivity and discipline, the quality of the environment, and individual characteristics were explored.MethodsParental sensitivity was coded on naturalistic video-recorded observations of free interactions between 25 female primary caregivers and their children. Caregivers completed questionnaires on discipline strategies and the level of satisfaction with the environment (access to basic needs, quality of house condition, community and family support, quality of learning opportunities, and working conditions).ResultsThe assessment of sensitivity in this population was possible, with caregivers showing the full range of sensitivity levels. A description of manifestations of sensitivity in this population is provided. A K-means cluster analysis evidenced that high sensitivity was associated with high satisfaction regarding housing conditions and family environment. No association between sensitivity and discipline emerged.ConclusionThe findings show the feasibility of assessing sensitivity in this sample. The descriptions of observed behaviors contribute to understanding culturally specific aspects of sensitivity to consider when assessing sensitivity in similar populations. The study provides considerations and guidelines to inform the structure of culturally-based interventions to promote sensitive parenting in similar cultural and socioeconomic situations.

Eligibility and benefits for anti-poverty income transfers in the U.S. are based on both the means and the household characteristics of applicants, such as their filing status, living arrangement, and marital status. In this paper we develop a dynamic structural model to study the effects of the U.S. tax-transfer system on the decisions of non-college-educated workers with children. In our model workers face uninsurable idiosyncratic risks and make decisions on savings, labor supply, living arrangement, and marital status. We find that the U.S. anti-poverty policy distorts the cohabitation/marriage decision of single mothers, providing incentives to cohabit. We also find quantitatively important effects on savings, and on the labor supply of husbands and wives. Namely, the model yields a U-shaped relationship between the earnings of one spouse and the labor supply of the other spouse, a result that we also find in the data. We show that these U-shaped relationships stem in part from the current design of anti-poverty income programs, and that the introduction of an EITC deduction on the earnings of secondary earners—as proposed in the 21st Century Worker Tax Cut Act—would increase the employment rate of the spouses of workers earning between $15K and $35K, especially of female spouses.

Shelter is one of the fundamental needs of human survival aside food and clothing. However, provision of adequate housing to accommodate people in urban areas has been a challenge in developing countries, including Ghana. This has caused many Ghanaians, especially the low-income group, to resort to the rental sector for their housing needs. It is widely discussed in the literature that each city user is to be accorded the needed right to utilise what exists in the city, including decent accommodation. This article examines the strategies put in place by lowincome house tenants to cope with the challenges of renting houses in the Wenchi Municipality, in order to rightly utilise urban housing. The study used a quantitative approach and a questionnaire survey to collect data from 245 tenant household heads. Purposive and systematic sampling techniques were used to select the respondents for the study. The data was analysed using SPSS. The study revealed that rental problems faced by tenants and adaptation measures developed to cope in cities and bigger towns are not different from what exists in the smaller towns. The study recommended that rent control should be strengthened to perform its duties in the rental sector well enough to protect the interest of the urban low-income renters.

Menstrual Hygiene Management (MHM) is typically a constant reality for post menarche and premenopausal females globally. However, unlike other natural routine physiological experiences, a healthy monthly MHM comes with considerable financial implications. Hence, this study examines the financial ability of girls and women in a Nigerian low-income community to access materials needed for MHM monthly. The possible implication of the COVID-19 pandemic was also considered. Semi-structured questionnaires were administered to 130 respondents selected via systematic-random sampling. Data were analyzed using SPSS version 20. The respondents’ age ranged between 14 to 40 years, while 82.3% worked informal jobs. Half of the respondents reported they were unable to purchase sanitary pads and other items required for monthly MHM. Over 65% of the respondents revealed they suffered anxiety thinking about the financial burden associated with monthly MHM, while about one-third of the respondents were more financially capable before the pandemic. Common alternatives to sanitary pads used were tissue paper, cloth napkins, old sanitary towels, and newspapers. Moreover, 64% of the respondents reported had at least a form of vaginal/urinary tract infection in the past 3 months. The results clearly show that period poverty remains a barrier to achieving gender equality. The fact that 1 out of every 2 females in the study area reportedly suffered period poverty shows the dire need for socio-economic interventions. Local and State Governments must consider subsidizing products required for MHM to improve and maintain the health of girls and women in low-income communities.

This study was carried out to determine the composition of solid wastes generated by some households in low-income areas of Jos Plateau State. Point source daily collection of household wastes from selected homes that were initially identified and categorized as low-income households were carried out for one week. The collected waste samples were weighed and sorted into food, ash/unburnt wood, plastic film/bags, fines, miscellaneous combustible, papers/cards, textiles, waste from electrical and electronic equipment (WEEE), glass, metals, dense plastic, garden waste and others. The components of these solid wastes were further classified into biodegradable (65.2%), recyclable (13.2%) and residual (21.6%). Biodegradable materials in the waste stream per household ranged from 1.7 kg to 18.3 kg per week. The recyclable materials produced by households varied from 0.4 kg to 2.9 kg and residual waste ranged from 0.6 kg to 6.0 kg per week. Urbanization and population growth are solely responsible for high increasing rate of solid wastes. The average household size found in the study area is 6.3 compared to an average household size of 4.6 Nigeria Demographic and Health Survey and 5.5 for Jos – Bukuru metropolis.

Background: One in eight people with heart disease has poor medication adherence that, in part, is related to copayment costs. This study tested whether eliminating copayments for high-value medications among low-income older adults at high cardiovascular risk would improve clinical outcomes. Methods: This randomized 2×2 factorial trial studied 2 distinct interventions in Alberta, Canada: eliminating copayments for high-value preventive medications and a self-management education and support program (reported separately). The findings for the first intervention, which waived the usual 30% copayment on 15 medication classes commonly used to reduce cardiovascular events, compared with usual copayment, is reported here. The primary outcome was the composite of death, myocardial infarction, stroke, coronary revascularization, and cardiovascular-related hospitalizations over a 3-year follow-up. Rates of the primary outcome and its components were compared using negative binomial regression. Secondary outcomes included quality of life (Euroqol 5-dimension index score), medication adherence, and overall health care costs. Results: A total of 4761 individuals were randomized and followed for a median of 36 months. There was no evidence of statistical interaction ( P =0.99) or of a synergistic effect between the 2 interventions in the factorial trial with respect to the primary outcome, which allowed us to evaluate the effect of each intervention separately. The rate of the primary outcome was not reduced by copayment elimination, (521 versus 533 events, incidence rate ratio 0.84 [95% CI, 0.66–1.07], P =0.162). The incidence rate ratio for nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death (0.97 [95% CI, 0.67–1.39]), death (0.94 [95% CI, 0.80 to 1.11]), and cardiovascular-related hospitalizations (0.78 [95% CI, 0.57 to 1.06]) did not differ between groups. No significant between-group changes in quality of life over time were observed (mean difference, 0.012 [95% CI, –0.006 to 0.030], P =0.19). The proportion of participants who were adherent to statins was 0.72 versus 0.69 for the copayment elimination versus usual copayment groups, respectively (mean difference, 0.03 [95% CI, 0.006–0.06], P =0.016). Overall adjusted health care costs did not differ ($3575 [95% CI, –605 to 7168], P =0.098). Conclusions: In low-income adults at high cardiovascular risk, eliminating copayments (average, $35/mo) did not improve clinical outcomes or reduce health care costs, despite a modest improvement in adherence to medications. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02579655.

In Chile, low-income women who are mothers are confronted daily with a normative ideal that exacerbates them as caregivers, together with public demands and social policies that value their hyper-rationality and hyper-austerity in the management of their families. This emphasis on their reproductive roles obliterates their emerging sense of intimacy and significant relations. Based on three case studies, in this article, we reflect on urban low-income women’s sense of and desire for intimacy that exceeds but does not exclude their maternal self. We present our findings based on three heuristic aspects of intimacy: rooted strategies for a renovated desire for intimacy; the desire to enjoy; and life outside the house and the desire for meaningful relations. We observe that these women’s efforts in their search for intimacy require them to orchestrate various strategies involving time and space management, money and relationships while resisting the normative pressures that place them mainly as caregivers.

We investigate whether the Affordable Care Act's Medicaid expansion, implemented in 2014, improved the mental health of young children whose parents are in the policy's target population. We study children ages 2 to 3 in families with incomes less than 138% of the federal poverty level.We use restricted National Health Interview Survey data covering the United States from 2010 to 2018 to conduct an event study-a flexible version of difference-in-differences-of the Medicaid expansion's effects on Mental Health Indicator values for young children. We estimate effects using ordered logit regression.Children's mental health was statistically significantly better in Medicaid expansion states, compared with non-expansion states, in 3 of 4 post-expansion years. There were no differences between expansion and non-expansion states in the pre-expansion period, lending support to the causal interpretation that the expansion improved children's mental health.While Medicaid expansion targets low-income adults, our evidence indicates it improves low-income children's mental health. The expansion is a two-generation investment in prevention. It helps lay a foundation for strong mental health in children's early years and beyond.

La modernización es uno de los conceptos más importantes para entender la ciudad, sus dinámicas institucionales y sociales. Es importante diferenciarlo de otros conceptos asociados. El presente texto pretende hacer un panorama de las miradas modernizadoras oficiales referidas a la ciudad de Bogotá y a la vivienda dentro del periodo señalado (1920-1977), contrastarlas con las experiencias y vivencias de la gente que llega a la ciudad expulsada del campo y que no es tenida en cuenta por estas miradas, se organiza y la construye por su propia cuenta. Modernization is one of the most important concepts for understanding institutional and social dynamics of the cities. It is important to differentiate it from other associated concepts. This text aims to provide an overview of the official modernizing views on the city of Bogotá and housing during this period, face them with the experiences of the people who arrived to the city expelled from the countryside. Those new Bogotá residents are aside, they need to organize and built by themselves. mauricio.tellez@esap.edu.co Semestral www.saber.ula.ve/regeoven

Although international guidelines exist for the prevention of surgical site infections, their implementation in diverse clinical contexts, especially in low and middle-income countries, is challenging due to the lack of available resources and organizational structure of facilities. The goal of this project was to develop a series of video training aids to highlight best practices in surgical infection prevention in hospitals with limited resources and to provide practical solutions to common challenges faced in these settings. Using the validated Clean Cut education framework for infection prevention developed by Lifebox, a charity devoted to improving surgical and anesthetic safety, we partnered with clinicians in one Ethiopian hospital to create six educational videos giving practical guidelines for infection prevention under resource variable conditions. These include: 1) proper use of the WHO Surgical Safety Checklist, 2) hand and skin antisepsis, 3) confirming instrument sterility, 4) maintaining the sterile field, 5) antibiotic prophylaxis, and 6) gauze counting. Gaps in available online educational materials were identified in each of the six areas. Videos were created providing setting-specific education and addressing gaps in existing materials for each of the infection prevention topics. These videos are now integrated into infection prevention curricula through Lifebox in Ethiopia and ongoing data collection to evaluate acceptability and efficacy is ongoing. Surgical education videos on infection prevention topics addressing location-specific resources and workarounds can be useful to hospitals operating in resource-limited settings for training staff and supporting quality and safety efforts in surgery.

ObjectiveThe objective of this formative study was to gather women's perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine.MethodsTwenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro.ResultsMost women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities.ConclusionsAmong low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations.InnovationDesigning a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

Many low-income households in rich countries have very little wealth, but the role of intergenerational wealth transmission in underpinning this deficit is not known. This article seeks to fill that gap by investigating patterns of past wealth transfer receipt for low-income versus other households in seven rich countries and assessing the contribution that these transfers, or their absence, make to current wealth levels. We find that households on low incomes are relatively disadvantaged in terms of intergenerational transfers received in the past, both in terms of the likelihood of having received any and the amounts received by those who do benefit from such transfers. The role that this disadvantage plays in the linkage between current low-income and low wealth is assessed and evidence presented that it is significant. Simulation of a universal wealth transfer scheme or ‘capital endowment’ on reaching adulthood for two countries shows that such a policy could lead to a marked decline in the proportion of low-income adults with negative or no wealth. This and alternative or complementary policy responses to these wealth deficits merit the most serious attention.

This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the COVID-19 pandemic.Using a nationally representative sample of 6,607 middle- and low-income U.S. adults, the authors examined the proportion and correlates of EIP receipt among eligible adults and the associations among planned EIP-financed expenses, challenges with paying expenses, and clinical characteristics.Of the sample, 78.8% reported that they received the EIP, and 82.3% of EIP recipients reported that it had a positive impact on their life. Being a veteran (odds ratio [OR]=2.59), being married (OR=1.82), having a history of schizophrenia spectrum disorder (OR=1.74) or posttraumatic stress disorder (OR=1.51), and screening negative for recent suicidal ideation (OR=0.49) were associated with EIP receipt. Planned expenses with the EIP were savings, paying debt, and rent and accounted for 63.4% of the total amount. Screening positive for mental health or drug use problems was positively associated with greater planned expenses for substances and gambling. EIP receipt also was associated with fewer problems paying daily expenses, but participants who screened positive for mental health or alcohol use problems were more likely to report problems paying past-month daily expenses.Unconditional cash transfers such as the EIP may be important for sustaining the living situation of middle- and low-income populations. The management of funds is important to consider, especially among adults experiencing mental health and substance abuse problems, and such cash transfers may represent opportunities for financial literacy and money management interventions.

This article summarizes findings from the literature on the emotional and birth outcomes of women with low income receiving different types of prenatal care. This literature review included studies published between 2015 and 2020. The results indicated that women with low income have challenging experiences in traditional models of prenatal care. Evidence of improved birth outcomes with nontraditional prenatal care is mixed, but qualitative findings indicate that it is associated with better emotional outcomes for women with low income when compared to traditional prenatal care. Future research should investigate ways to improve the negative interpersonal and structural dimensions that can characterize prenatal care for women with low income.