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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.

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.

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.

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.

Socioeconomic status is one of the personal factors contributing to positive well-being among disadvantaged groups. However, many studies in different countries have found that low socioeconomic status leads to negative well-being in work and non-work domains. Unfortunately, evidence on this issue from the Malaysian context is scarce. Therefore, this paper aims to investigate the influence of socioeconomic status on life and job satisfaction among low-income employees working in the public sector. A quantitative research design was employed, using a self-report questionnaire as the tool to gather the data. A total of 265 respondents from eight Johor local authorities in Malaysia were obtained using the convenience sampling technique. SPSS version 26.0 and SmartPLS version 3.0 structural equation modeling were used for the descriptive and inferential analysis respectively. The findings indicate that socioeconomic status has a positive influence on life and job satisfaction. Therefore, the study contributes insights into the socioeconomic status factors which determine well-being, specifically life satisfaction and job satisfaction, with respect to low-income employees working in the Malaysian public sector.

PurposeLack of access to supermarkets and fresh produce continues to be a problem for low income consumers in many countries. The purpose of this research was to identify the shopping preferences and needs of such consumers in the Eastern U.S. Additionally, the research sought to determine the interest and preferences of low income consumers in a mobile grocery intervention which would provide neighborhoods with a consistent, convenient shopping experience.Design/methodology/approachA mixed methods approach included conducting focus groups in low-income neighborhoods in Philadelphia, Pennsylvania, U.S.A. and a quantitative survey (n = 202) administered via Survey Monkey to low-income consumers. Thematic analysis was conducted on focus group data and surveys were administered and analyzed to assess applicability of themes identified to consumers over a larger geographic area.FindingsResults indicated that consumers in food desert neighborhoods reported an interest in purchasing a wide range of food staples, household goods, and personal items from any shopping intervention. Participants indicated a need for a more convenient overall shopping experience for a range of foods and goods in addition to fresh food choices. Findings indicate that mobile interventions to increase food access may benefit from expanding products available through the intervention beyond fresh produce and perishable goods.Originality/valueThis research explored purchasing preferences with low income consumers living in food deserts. It identifies products and goods they would prefer to see in an intervention to increase food access and is unique in that it explores the wants and preferences of consumers living in food deserts.

BACKGROUND. The objective of this study is to understand the effect of Medicaid expansion under the Affordable Care Act (ACA) on patterns of surgical care among low-income breast cancer patients. Emerging literature suggests cancer patients in Medicaid expansion states are presenting with earlier stages of disease. However, less is known regarding the implications of Medicaid expansion on patterns of surgical care in low-income women. PATIENTS AND METHODS. We compared nonmetastatic 30–64-year-old uninsured or Medicaid-insured Ohio breast cancer patients diagnosed 4 years before and 4 years after the state’s 2014 Medicaid expansion (study group); the control group was the privately insured. Time-to-surgery (TTS) was defined as days from diagnosis to surgery. Demographic and treatment variables before and after expansion were examined in multivariate analysis. RESULTS. There was a 10.4% point increase in breast conservation therapy (BCT) in the study group (pre-ACA 26.3%, post-ACA 36.7%; p < 0.01) compared with a 5.8% point increase in the control group (pre-ACA 36.0%, post-ACA 41.8%; p < 0.01). Disparities in reconstruction narrowed between the study (pre-ACA 21.4%, post-ACA 34.5%; p < 0.01) and the control (37.0% pre-ACA, 44.1% post-ACA group p < 0.01) groups. There was no statistically significant change in mean TTS in the study group (pre-ACA 42.1 days, post-ACA 43.1 days p = 0.18) but there was an increase in TTS in the control group (pre-ACA 35.0 days, post ACA 37.0 days; p < 0.01). CONCLUSIONS. Medicaid expansion appears to have narrowed disparities in the utilization of BCT and reconstruction in low-income women. However, there was no improvement in surgical delay.

Community-supported agriculture (CSA) is an alternative food marketing model in which community members subscribe to receive regular shares of a farm's harvest. Although CSA has the potential to improve access to fresh produce, certain features of CSA membership may prohibit low-income families from participating. A ‘cost-offset’ CSA (CO-CSA) model provides low-income families with purchasing support with the goal of making CSA more affordable. As a first step toward understanding the potential of CO-CSA to improve access to healthy foods among low-income households, we interviewed 24 CSA farmers and 20 full-pay CSA members about their experiences and perceptions of the cost-offset model and specific mechanisms for offsetting the cost of CSA. Audio recordings were transcribed verbatim and coded using a thematic approach. Ensuring that healthy food was accessible to everyone, regardless of income level, was a major theme expressed by both farmers and members. In general, CSA farmers and CSA members favored member donations over other mechanisms for funding the CO-CSA. The potential time burden that could affect CSA farmers when administering a cost-offset was a commonly-mentioned barrier. Future research should investigate various CO-CSA operational models in order to determine which models are most economically viable and sustainable.

Summary Background Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. Methods For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. Findings Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. Interpretation These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. Funding Bill & Melinda Gates Foundation.

This study describes the public policies of the DKI Jakarta Provincial Government on housing assistance for law-Income Communities. DKI Jakarta as the center of Government and economy attract people to come to the city. The scarcity and the high price of land in DKI Jakarta factors into the number of Low-Income Communities in the city who struggle to own housing/ property. The study aims to analyze the policy formulation of DKI Jakarta Provincial Government on the assistance in providing decent housing needs the policy formulation of the DKI Jakarta Provincial Government for assistance in providing decent housing needs for Low-Income Communities. The research uses descriptive qualitative methods by using primary and secondary data. Data and information are obtained through interviews with the actors involved in the process of policy formulation, surveys and taking photographs related to the Zero Rupiah Down Payment House and document that can support research. From the analysis, it is found in the formulation of the Zero Rupiah Down Payment House Program policy that there should be stronger legal basis and a set of wage margin for Low-Income Communities in DKI Jakarta as well as supervision in the implementation of the program so that it is targeted to the Low- Income community by paying attention to aspects of alignments to the community need.

Low-income government provided housing has been continually transformed by its beneficiaries, especially women. The transformations are a major sign that there is discontentment about the houses since low-income households are excluded from the design process of these houses. By transforming the houses, the low-income households are trying to fit their houses or environments to their ways of living. This paper intends to review the housing transformations at the Masese Women’s Self-Help Housing Project at Masese, Jinja, in Uganda to understand how women practice space. Studying the spatial alterations can help guide architects towards finding inclusive housing design approaches that can benefit the low-income households and prevent governments and donors from spending finances on futile housing prototypes that get eventually abandoned. The paper adopts a qualitative methodology comprising of precedent studies at Masese, and a literature review to analyse the various housing transformations in an attempt to address the problem of inadequate housing for low-income households.

Purpose The conceptualization of the Base of Pyramid (BOP) proposes that low-income markets can lead to profitable opportunities for businesses. The purpose of this study is to identify key success factors of a BOP business strategy based on a case study of the discount retailer, Dollar General, in the USA. Design/methodology/approach The research design used in this research is an in-depth case study of Dollar General in the USA. Qualitative methods are applied in both the primary and secondary data collection and during the follow-on data analysis of Dollar General. Findings Dollar General’s strategic profile is achieved through the combination of the following four actions which are tailored to compete effectively at the BOP in the USA: creating the neighborhood discounter, raising aspirational appeal, reducing service and eliminating internationalization. Research limitations/implications The case is specific to Dollar General in a US cultural context. Practical implications The case of Dollar General demonstrates how a discounter retailer should not only follow a low-cost strategy to compete at the BOP. Its ability to craft a distinctive strategy is coherent with meeting the logistical, rational and emotional needs of the low-income consumer in the USA. Social implications Many businesses have neglected rural areas of the USA as being unprofitable. The ability for businesses such as Dollar General to serve the BOP segment can foster the socio-economic well-being of communities. Originality/value The overwhelming body of the BOP literature is based on emerging markets. To the best of the authors’ knowledge, this is one of the few studies to investigate BOP business strategy in the USA.

Objectives: This study sought to: 1) under­stand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods: We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results: Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pres­sure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was as­sociated with lower odds of overweight/obe­sity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions: These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population. Ethn Dis. 2021;31(4):537-546; doi:10.18865/ed.31.4.537

STUDY OBJECTIVES: Black individuals and individuals of low socioeconomic status are at increased risk for obstructive sleep apnea (OSA). The Berlin Questionnaire is one of the most widely used screening tools for OSA; however, there is limited research on its diagnostic accuracy in low-income Black populations. METHODS: This study analyzed data from an ongoing study taking place among a cohort from 2 predominantly Black neighborhoods in Pittsburgh, Pennsylvania (96.3% Black, 79.6% female). The sample included 269 individuals without a prior diagnosis of OSA who completed the Berlin Questionnaire and also participated in a home sleep apnea test. An apnea-hypopnea index ≥ 15 events/h was used to identify individuals with moderate or severe OSA. RESULTS: 19.3% of individuals met criteria for moderate to severe OSA based on home sleep apnea test, while 31.2% of participants screened as high risk for OSA based on the overall Berlin index. Using apnea-hypopnea index ≥ 15 events/h as the reference standard, the Berlin Questionnaire had a sensitivity of 46.2%, specificity of 72.4%, positive predictive value of 28.6%, and negative predictive value of 84.9% among this sample. Analyses stratified by sex suggested that the Berlin Questionnaire had better diagnostic validity in women than men. CONCLUSIONS: The Berlin Questionnaire has lower sensitivity and positive predictive value in our sample than those observed in general population samples. The measure performed better among women, though a higher proportion of men fell into the moderate or severe OSA range based on the home sleep apnea test. Given the significant downstream consequences of OSA, utilizing screening tools that better detect OSA in Black communities is key. CITATION: Holliday SB, Haas A, Dong L, et al. Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample. J Clin Sleep Med. 2021;17(10):1987–1994.

Objective:In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL – a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood’s existing food stores after the opening of this supermarket.Design:Quasi-experimental study.Setting:Two low-income African American communities in Chicago, IL.Participants:Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened.Results:Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018.Conclusions:Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago’s Englewood community.

Purpose: To assess state-level variation in changes in uninsurance among Black, Hispanic, and low-income Americans after implementation of the Affordable Care Act (ACA). Methods: We analyzed data from the Behavioral Risk Factor Surveillance System from 2012 to 2016, excluding 2014. For Black, Hispanic, and low-income (

This research examines associations between maternal depressive symptoms and parenting practices among Head Start eligible, low-income families. Among 3,780 mothers, four types of childcare were id...

We test whether the service sector can contribute to economic growth in low-income and lower-middle income countries despite the likely presence of Baumol’s ‘cost disease’. We employ the non-linear...

Today there is an acute issue of helping children in difficult situations. Children, faced with" adult " problems, often do not find support in their own families. Such problems as alcoholism and unemployment of parents, poverty, difficulties in relationships, loss of loved ones, abuse, social problems of parents can be the causes of difficult life situation of the child. If you do not provide timely assistance to the child, wounds from psychological and physical injuries can lead to serious consequences. In order to assist children from lowincome families in difficult life situations, the country has social rehabilitation centres for minors, whose activities are aimed at identifying and eliminating the causes and conditions that contribute to the poor family, neglect and homelessness of minors. The activities of these institutions are aimed at providing social, psychological and other assistance to minors, their parents or legal representatives in the elimination of difficult situations; restoration of the social status of minors in peer groups; promotion of the return of minors to low-income families, restoration of family and social ties of the child.

The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p = .019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = −0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.

Financial inclusion is crucial in fostering individual prosperity, poverty eradication and stimulating economic growth. It is therefore a major policy concern for majority of governments across the world. Despite the rampant growth of financial technology in Kenya, the number of adults who are financially excluded is still high among the rural area residents. Lack of financial services access in rural areas has resulted to rural economic growth retardation and inequality. Further, financial exclusion has led to increased poverty levels because those excluded have been forced to depend on their limited savings to pursue their entrepreneurial interests. Small businesses have had no choice but to rely on their inadequate earnings to pursue viable business opportunities. The main objective of this study was to establish the effect of financial technology loans on financial inclusion among the unbanked low-income earners in Makueni County. Descriptive research design was used, with the target population being the unbanked low-income earners over the age of 18 in Makueni County. A sample size of 384 respondents was chosen using the convenience sampling technique. Personal interviews were conducted using an interview guide to collect primary data. The study found that fintech loans have a positive and significant effect on financial inclusion among the unbanked low-income earners in Makueni County. According to the findings of the study, since the unbanked people in Makueni County associate the use of financial technology loans to meeting personal financial needs and especially coping up with day-to-day expenses and emergencies, this study recommends that such people embrace the use of the fintech loans more as it will aid them in improving their financial lives to a greater extent. This is because for instance, by using the fintech loans, they can create employment for themselves and generate sufficient income by financing micro businesses using this credit.

Background Exposure to chronic stressors may contribute to the development of psychoneurological symptoms (i.e., fatigue, cognitive dysfunction, sleep disturbance, depressed mood, and pain) that can compromise maternal function. Objectives In two studies of low-income mothers, we investigated the presence of psychoneurological symptoms and explored associations between mothers' stressors and psychoneurological symptoms as well as between symptoms and function. We also considered the possible mediating role of the symptoms between stressors and function. Methods We conducted secondary analyses of psychoneurological symptoms in two studies of low-income mothers of infants and toddlers in the United States. Study 1 sampled Latina women with limited English proficiency, while Study 2 was conducted with English-speaking women from diverse backgrounds. In both studies, symptoms were measured using items from the Center for Epidemiological Studies Depression Scale and the Medical Outcomes Study Short-Form Health Survey. Maternal function was measured through self-report and researcher observation. In Study 2, stressors were measured using the Everyday Stressors Index. Multiple linear regressions were used to investigate associations while controlling for relevant covariates. Results In both studies, mothers endorsed a wide range of psychoneurological symptoms. In Study 1, psychoneurological symptoms had significant negative associations with role function, social function, and developmental stimulation. In Study 2, psychoneurological symptoms had significant negative associations with role function, social function, and physical function. Using Aroian test for mediation, we found that psychoneurological symptoms mediated all significant relationships between stressors and maternal functions in Study 2. Discussion In two samples of low-income mothers, psychoneurological symptoms were prevalent and associated with chronic stressors and with maternal function and may mediate the association between those two factors. These findings extend prior research on depressive symptoms in mothers by investigating pain as an additional key symptom. The studies advance symptom science by highlighting psychoneurological symptoms in a heterogeneous sample without known health conditions.

The fact that people with HIV (PWH) who have an undetectable viral load cannot sexually transmit HIV has been disseminated under the messaging "Undetectable = Untransmittable" (U = U). U = U messaging intends to destigmatize HIV by demonstrating that PWH can have healthy sexual lives. Among a sample of low-income heterosexually active Black and Latino adults, we aimed to (1) measure the prevalence of U = U awareness and (2) determine its association with anticipated HIV stigma. Low-income heterosexually active adults were recruited through respondent-driven sampling in New York City. Among Black and Latino participants who self-reported not having HIV, multiple linear regression was used to determine the association between U = U awareness with the following types of anticipated HIV stigma, as determined by principal component analyses: (1) general; (2) dating related; and (3) sex related. Of 485 participants, 35% were aware of U = U. Those who were aware reported less dating-related [adjusted B: -0.20; 95% confidence interval (CI): -0.37 to -0.03] and sex-related (adjusted B: -0.15; 95% CI: -0.29 to -0.002) anticipated HIV stigma. Although the prevalence of U = U awareness was much lower than reported in other populations (e.g., gender and sexual minorities and PWH), prevalence was moderate in our sample, given that awareness efforts have generally not focused on heterosexually active adults. Our findings provide preliminary evidence that U = U awareness may have an impact on anticipated HIV stigma related to dating and sex. Additional methods to disseminate U = U messaging and dismantle HIV stigma in this population should be explored.

Purpose Rejecting building information modeling (BIM) can negatively impact the architectural, engineering and construction (AEC) industries. While BIM is trending globally, its implementation in post-conflict low-income economies is still limited. The purpose of this paper is to identify the critical factors for implementing BIM in a post-conflict low-income economy, using Afghanistan as a case study. Design/methodology/approach This study identifies potential affecting factors for BIM implementation through reviewing existing literature and interviewing AEC professionals in Afghanistan. Then, the factors are inserted into a questionnaire survey and disseminated with Afghanistan’s AEC practitioners. The collected data was analyzed to determine the critical factors. Also, the underlying relationships between the critical factors were established through factor analysis. Findings A total of 11 critical factors are affecting BIM implementation in Afghanistan. From those, nine factors can be grouped into the following three components: technological, environmental and organizational. Two factors, “cost-benefit of implementing BIM” and “market demand for BIM,” are recurring in low- and middle-income economies. Conversely, the “presence of appropriate projects to implement BIM” is the unique critical factor for Afghanistan that might affect other post-conflict low-income economies. Originality/value This study focuses on affecting factors for BIM implementation in post-conflict low-income economies, using Afghanistan as a reference rather than other types of economies that have been widely studied.

Background: Anthracycline therapy-related cardiac dysfunction (ATRCD) is the most notorious adverse side-effect of chemotherapy. It has become a significant cardiovascular health concern for long-term cancer survivors. With the emerging concept of subclinical ATRCD and newer diagnostictools (Speckle Tracking Echocardiography (STE) and biomarkers), detecting anthracycline cardiac toxicity at an early stage has become an important step to prevent severe cardiac dysfunction and improve the cardiovascular outcome in cancer survivors. Despite the increasing population at risk in sub-Saharan Africa (SSA), there is no contemporary data in Uganda to address the burden, pathogenesis and risk factors of subclinical ATRCD. This big gap in knowledge has led to a lack of local guidelines for monitoring and management of ATRCD. Methods: SATRACD (Detecting Subclinical Anthracycline Therapy Related Cardiac Dysfunction In Low Income Country) study is an observational prospective cohort study. Three hundred and fifty-three anthracycline naïve cancer patients will be recruited at baseline. Patients are followed up on completion of anthracycline-based chemotherapy and at 6 months after completion of anthracycline therapy. Data on demographics, cancer profile and clinical presentation will be collected at baseline. Comprehensive cardiac assessment will be performed at each visit, including electrocardiogram, conventional echo- cardiography, STE, cardiac and oxidative stress markers. We will be able to determine the incidence of subclinical and clinical ATRCD at 6 months after completion of anthracycline therapy, determine whether hypertension is a major risk factor for ATRCD, evaluate the role of conventional echocardiography parameters, and biomarkers for detecting subclinical ATRCD. Conclusion: This SATRACD study will provide contemporary data on Ugandan cancer patients who have subclinical and clinical ATRCD, help in the development of local strategies to prevent and manage ATRCD, and improve cardiovascular outcome for Ugandan cancer survivors. Keywords: SATRACD study; subclinical anthracycline therapy; cardiac dysfunction; low income country.

I present evidence on the relationship between broadband pricing and labor market outcomes for low-income individuals. Specifically, I estimate the effects of a Comcast service providing discounted broadband to qualifying low-income families. I use a triple differences strategy exploiting geographic variation in Comcast coverage, individual variation in eligibility, and temporal variation pre- and postlaunch. Local program availability increased employment rates and earnings of eligible individuals, driven by greater labor force participation and decreased probability of unemployment. Internet use increased substantially where the program was available. (JEL I32, J22, J31, L82, L86)

Purpose: Obesity among children from low-income families is becoming a social problem. The aim of this study was to evaluate the effectiveness of an obesity prevention program that included physical activity, nutrition education, behavioral modification, and primary caregiver participation components among children from low-income families.Methods: The study analyzed a nonequivalent control group using a pretest-posttest design. A total of 77 children were recruited from six community childcare centers using purposive sampling. For the intervention group (n=40), the pretest was administered before the combined intervention program involving the participants' primary caregivers was conducted for 8 weeks. The posttest was conducted immediately after the program and again four weeks after the program.Results: Flexibility (F=4.64, p=.020), muscular endurance (F=11.22, pp=.010), body image satisfaction scores (F=4.74, p=.012), and self-esteem scores (F=3.81, p=.029) showed significant differences and interactions between group and time for the intervention and control groups.Conclusion: Strategies to actively engage the primary caregivers of low-income families in children's obesity programs are needed. Obesity prevention programs for children based on the program in this study should be routinely developed, and continuing attention should be given to children from low-income families.

A cross-sectional study was conducted to (1) examine breastfeeding initiation and continuation rates, and; (2) investigate association between food insecurity and breastfeeding status, among low-income mothers. Mothers of infants two-months or younger were recruited from a local pediatric clinic serving primarily low-income families. Upon giving consent, mothers were interviewed in-person or over the phone in either English or Spanish. Of the total 92 mothers interviewed, 90% initiated breastfeeding, but only 24% were doing exclusive breastfeeding at 2 months of infant's age. After controlling for socio-demographics, it was found that food-insecure mothers were less likely to continue with breastfeeding (β = -1.51, p = .024). Future research is warranted to understand pathways through which food insecurity affects breastfeeding and how this disparity can be prevented to ensure a safe and secure start for infants worldwide.

Purpose Participation in micro-family takāful plans amongst low-income earners remains low despite the various initiatives promoted by the Malaysian Government. Therefore, this study aims to conduct an in-depth examination on the indicators of having micro-takaful tafakul in Malaysia. Design/methodology/approach Questionnaires were distributed to respondents residing in Selangor, the state with the highest recorded percentage of low-income earners in Malaysia. Regression analysis was conducted in this study. Demographic characteristics and knowledge were treated as the independent variables, whereas the tendency of having a micro-family takāful plan was considered the dependent variable. Findings Gender and knowledge on the benefits of micro-family takāful plans have significant and positive effects on the tendency of having a micro-family takāful plan. Married and employed women are more likely to own a micro-family takāful plan compared with their male counterparts. Research limitations/implications This study contributes to the growing literature on the research of micro-takāful determinants in Malaysia. Practical implications Industry players and regulators need to tailor the operating and marketing strategies of micro-family takāful plans based on the gender and knowledge of potential participants. The industry may also improve the features of takāful plans to ensure that they are even more attractive and comprehensive. Originality/value This study offers a much deeper analysis compared with past research owing to the identified dimensions of a demographic factor that can influence the tendency of having micro-family takāful plans. Besides, this study offers a comprehensive measurement of the knowledge on micro-family takāful plans by considering all aspects (i.e. concept, importance and benefit) of these plans. Moreover, this study examines the influence of each element of knowledge on the tendency of having a micro-family takāful plans, a topic that was rarely studied in the past.

Objective: The objective of this study was to examine whether delivering technology-assisted case management (TACM) with medication titration by nurses under physician supervision is cost effective compared with usual care (standard office procedures) in low-income rural adults with type 2 diabetes. Methods: One hundred and thirteen low-income, rural adults with type 2 diabetes and hemoglobin A1c (HbA1c) ≥8%, were randomized to a TACM intervention or usual care. Effectiveness was measured as differences in HbA1c between the TACM and usual care groups at 6 months. Total cost per patient included intervention or usual care cost, medical care cost, and income loss associated with lost workdays. The total cost per patient and HbA1c were used to estimate a joint distribution of incremental cost and incremental effect of TACM compared with usual care. Incremental cost-effectiveness ratios (ICERs) were estimated to summarize the cost-effectiveness of the TACM intervention relative to usual care to decrease HbA1c by 1%. Results: Costs due to intervention, primary care, other health care, emergency room visits, and workdays missed showed statistically significant differences between the groups (usual care $1,360.49 vs. TACM $5,379.60, p=0.004), with an absolute cost difference of $4,019.11. Based on the intervention cost per patient and the change in HbA1c, the median bootstrapped ICERs was estimated to be $6,299.04 (standard error=731.71) per 1% decrease in HbA1c. Conclusion: Based on these results, a 1% decrease in HbA1c can be obtained with the TACM intervention at an approximate cost of $6,300; therefore, it is a cost-effective option for treating vulnerable populations of adults with type 2 diabetes.

The use of personal finance smartphone apps results in an improvement in various measures used to assess financial knowledge and skills, attitudes and motivations, and financially capable behaviors for those in low-income households. Those provided with smartphone apps demonstrated increased self-confidence in financial decision-making and financial literacy and improved their ability to delay self-gratification and their sense of being able to effect change. Financially capable behavior changes manifested in being better able to keep track of finances and manage unexpected bills. User engagement with finance apps could be improved by targeting users with a specific financial decision-making problem, personalizing the apps through push notifications to encourage ongoing user engagement, and incorporating game mechanics.

Means-based reduced-fare programs can help address transit rider fare equity. The objective of this study is to synthesize the current state of reduced-fare programs for low-income transit riders. The reduced-fare programs of the 50 largest transit agencies in the United States were examined and agencies with programs for low-income riders were compared based on three dimensions: eligibility and enrollment, fare media and discount pricing, and estimated transit expenditure by eligible riders. The results reveal that 17 of the 50 largest transit agencies have low-income reduced-fare programs. Of these, 14 agencies administer the programs themselves, while three use partnerships with social service organizations to administer them. Additionally, nine of the 14 agencies that administer their own programs provide a 50% discount on fares and require participants to have an income at or below 125% to 200% of the federal poverty level for eligibility. Using a method developed to evaluate the “fare burden” of transit riders with different income levels, it was determined that low-income reduced-fare program participants at the income eligibility threshold typically spend an estimated 2% to 6% of their annual income on transit, although very-low-income people may need to spend much higher shares of their incomes on transit fares. These results indicate that agencies may need to reevaluate the structure of their existing low-income reduced-fare programs and implement tiers of discounts to ensure that fare equity is being extended to all riders.

The promotion of financial inclusion is important for the combating of financial exclusion in many countries, including South Africa. Nonetheless, most low-income earners living in rural areas and informal settlements are still struggling to gain access to basic financial products and financial services in South Africa. This status quo has been caused by a number of factors such as the absence of an adequate financial inclusion policy, the geographical remoteness of financial institutions to most low-income earners, rigid identity documentary requirements, a lack of access to reliable and affordable Internet connection by low-income earners living in informal settlements and rural areas, a lack of financial illiteracy, the high costs of financial services, unemployment and poverty, over-indebtedness, and cultural and psychological hindrances to low-income earners in South Africa. Consequently, these factors have somewhat limited the access to financial services offered by financial institutions to low-income earners living in rural areas and informal settlements. In many countries, including South Africa, the financial sector is relying on innovative technology, especially in banking institutions, to aid in the offering of financial services to their customers. It is against this background that this article discusses selected legal and related challenges affecting the regulation and use of innovative technology to promote financial inclusion for low-income earners in South Africa. The article further discusses possible measures that could be adopted by the government, financial institutions and other relevant regulatory bodies to promote the use of innovative technology to combat the financial exclusion of low-income earners in South Africa.

Today, several developing countries struggle to improve the cost and time performances of major infrastructure works due to various reasons. Cost overrun and delay are one of the major challenges being faced by the construction and infrastructure sector. Hence, the aim of this study is to explore the extent of cost overrun and schedule delays in building and road infrastructure projects across the Ethiopian construction industry. Primary data were collected through a structured questionnaire survey to evaluate the potential risks leading to those challenges. Various data analysis tools were employed, to investigate the critical causes of cost overrun and delays in infrastructure projects. .e findings reveal that the minimum cost overrun for building construction projects is found to be 2%, whereas the maximum and average cost overruns are 248% and 35%, respectively. For road infrastructure projects, the minimum, maximum, and average cost overruns are found to be 1%, 61%, and 18%, respectively. Similarly, the minimum, maximum, and average delays recorded in building construction projects are 9%, 802%, and 143%, respectively, whereas, in road infrastructure projects, the minimum delay is found to be 3%, the maximum delay is 312%, and an average schedule delay of 110% is recorded. In addition, the top risk factors leading to cost overrun in infrastructure projects are inflation, inaccurate cost estimates, and variations, whereas the major risks causing schedule delays are variations, economic conditions, and escalation of material prices. Further, practical implications and key recommendations were provided to curb cost overrun and delay in infrastructure projects., This project was funded by the Construction Works Regulatory Authority of Ethiopia (CWRA/LB/008/2013)

Aim: To assess the severity of persistent pulmonary hypertension (PPH) in congenital diaphragmatic hernia (CDH) neonates solely using oxygenation index (OI). Study Design: A prospective study was c...

With the rise of neoliberalism, community leisure practitioners have access to fewer resources, which requires adopting the business-like practices of private sector organizations. To ensure access...

BACKGROUND: Adverse childhood experiences (ACEs) are stressors that can have lifelong detrimental health effects. ACEs are a concern for children of immigrant parents. METHODS: The low-income mothers of 75 rural farmworker and 63 urban non-farmworker 8-year old Latinx children in immigrant families completed a standardized ACEs inventory. RESULTS: 47.1% of mothers reported no ACEs, 33.3% reported 1, 8.7% reported 2, and 10.9% reported 3 or more. A logistic regression model indicated that urban versus rural children had a higher odds (OR=2.35, 95% CI=1.01,5.48) of at least one ACE. Children living in families with 2 versus 1 adults (OR=0.10, 95% CI=0.02,0.49) and 3 versus 1 adults (OR=0.12, 95% CI=0.02,0.78) had a lower odds of at least one ACE. DISCUSSION: ACEs prevalence was similar to other children in immigrant families, with children living in urban communities having twice the likelihood of experiencing an ACE. Detailed research is needed on locality-based ACEs prevalence.

The nature of tenure ‘contracts’ that exist within the low-income settlements involves more than title deeds. Accordingly, ‘tenure security’ manifests itself beyond legal or de jure construction as...

Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress.

Background: Rates of postpartum visit attendance are low among all women, and particularly for low-income women. Experts in obstetrics, women's health, and health disparities are calling for novel, holistic approaches to postpartum care to better meet the needs of women and that respond to existing health care disparities. Materials and Methods: We conducted a single-site parallel-arm randomized controlled trial to determine the feasibility and effect of a co-located, co-timed 4–6 weeks postpartum obstetrics visit and well-newborn pediatric visit (i.e., “mommy-baby visit”) compared with an enhanced usual postpartum visit, that is, staff scheduled the postpartum visit for the patient before hospital discharge. Results: One hundred sixteen women, of whom 76.7% (n = 89) were Latina immigrants, were enrolled postdelivery and randomized to a mommy-baby visit (n = 58, 49.5%) or to enhanced usual care (n = 58, 50.4%). Almost all study participants attended their postpartum visit (n = 109, 94.0%). There was no significant difference in postpartum visit attendance rate by randomization assignment (91.4% of mommy-baby vs. 96.6% of enhanced usual care participants). Study participants, mommy-baby intervention and enhanced usual care arms combined, were significantly more likely to attend the postpartum visit than historical controls (94.0% vs. 69.7%, respectively, p

An innovative interdisciplinary public health–based endocrine specialty clinic (ESC) program included nurse practitioner–provided care to low-income pregnant women with gestational diabetes mellitus (GDM). Among underserved adults, Medicaid-insured clients may experience better care access and health outcomes than those without insurance. This program review found that uninsured and Medicaid-insured women with GDM similarly (P > .05) achieved blood glucose goals (HbA1C

To assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants.Prospective, comparative, with repeated measures.Four Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices.Participants included 270 mother-infant dyads.We assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding.More than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p .001; and 7%, 15%, and 28.46% at 5 months, p .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants.Ongoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.

This paper explores the ‘patchwork adaptability’ of low-income residents living in south-eastern Bangalore in India to demonstrate the socially embedded ways that city dwellers patch their water su...

This study identified coping and sociodemographic correlates and predictors of depressive symptoms in mothers at risk for clinical depression. A descriptive, cross-sectional design was employed. A convenience sample of 88 low-income or ethnic-minority mothers aged 21 to 45 completed a depression scale, demographic data sheet, and responded to an open-ended question. Content analysis, descriptive, and inferential statistics was used for data analysis. Exactly 42.5% of mothers reported high depressive symptoms (>16). Lower income levels ( r = .342, p = .01) and head-of-household status ( r = .220, p = .04) were significantly associated with higher depressive symptoms. Those who used social support coping had lower depressive symptoms than those who did not ( t = 2.50, p = .014). Those using emotion-focused coping only had higher depressive symptoms than those using a mix of coping strategies ( t = 2.60, p = .011). Healthcare providers can employ vigilant depression screening and encourage utilization of a mix of problem and emotion-focused coping strategies to reduce depressive symptoms and prevent clinical depression.

Housing policy for low-income renters seeks to deconcentrate poverty by moving the poor to neighborhoods offering opportunities for safety, good education, and gainful employment. Federal law compe...

Traffic-related air pollution has been associated with adverse cardiovascular health effects in near-road residents. Transportation parameters are important surrogate variables to determine spatial variation of air pollution and consequential health outcomes. We used land-use regression models to explore associations between cardiovascular (metabolic syndrome [MetS]) health outcomes collected from a sample of low-income participants ( N = 4,959) and transportation parameters within a defined impact zone of a participant’s residence. We hypothesize cardiovascular risk factors are associated with spatially distributed transportation parameters and land-use data. MetS risk factors (waist circumference, blood pressure, triglycerides, HDL-cholesterol, and glucose) were obtained from 4,945 participants between 2014 and 2020 across the city of El Paso, Texas. Traffic-related and land-use variables were acquired from the El Paso MPO and the U.S. Census Bureau within two impact zones of 500 m and 1,000 m radius, centered at each participant resident’s home latitude and longitude coordinates using GIS. The increase in street length within 500 m radius was found to associate with increases in BMI, waist circumference, triglycerides, and glucose ( p

This article presents ethnographic accounts of the mobile phone mediated experiences of connection and intimacy among young low-income women in Dhaka, Bangladesh. It argues that mobile phones are a...