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Difficult life circumstances can make anyone vulnerable. For example, families of children with special needs are at risk, as are families facing other stressful circumstances, such as poverty or parental mental illness. This article builds on previous action research by Plavcak (2020) and introduces a new research problem. We conducted a qualitative analysis of action diary data to answer two new research questions: 1) In what forms did vulnerability appear in students' families, and 2) What approaches did professionals use to reduce perceived vulnerability? Our findings suggest that families of children with special needs should be approached with sensitivity, flexibility, and balanced interventions. It is important to understand families in the context of their lives, including the emotional stages of caring for a child with special needs and other difficult circumstances they may face. Interventions should be tailored to the specific needs of families and developed collaboratively with them.

Low-income tropical regions, such as Haiti, grapple with environmental issues stemming from inadequate sanitation infrastructure for fecal sludge management. This study scrutinizes on-site sanitation systems in these regions, evaluating their environmental impacts and pinpointing improvement opportunities. The focus is specifically on systems integrating excreta valorization through composting and/or anaerobic digestion. Each system encompasses toilet access, evacuation, and sludge treatment. A comparative life cycle assessment was undertaken, with the functional unit managing one ton of excreta in Haiti over a year. Six scenarios representing autonomous sanitation systems were devised by combining three toilet types (container-based toilets (CBTs), ventilated improved pit (VIP) latrines, and flush toilets (WC)) with two sludge treatment processes (composting and biomethanization). Biodigester-based systems exhibited 1.05 times higher sanitary impacts and 1.03 times higher ecosystem impacts than those with composters. Among toilet types, CBTs had the lowest impacts, followed by VIP latrines, with WCs having the highest impacts. On average, WC scenarios were 3.85 times more impactful than VIP latrines and 4.04 times more impactful than those with CBTs regarding human health impact. Critical variables identified include the use of toilet paper, wood shavings, greenhouse gas emissions, and construction materials. HIGHLIGHTS This study analyzes the on-site sanitation chain components throughout their life cycle, assessing three types of toilets in Haiti and two sludge valorization scenarios, resulting in six scenarios.; Scenario 6 had the highest sanitary impact, while Scenario 3 had the lowest.; Scenario 4 showed the highest ecosystem impacts, with Scenario 1 displaying the lowest impact.; Key hotspots identified: toilet paper, wood shavings and GHG emissions.;

Preschool attendance problems negatively impact children's school readiness skills and future school attendance. Parents are critical to preschoolers' attendance. This study explored parental barriers and solutions to preschool attendance in low-income families. School-district administrative data from a racially/ethnically diverse sample of parents with children attending the district's half-day preschool program were obtained (N = 111). Subsamples of parents participated in a phone interview and follow-up, in-person interview. Parents valued early learning and preschool. Children missed school due to illness, problems with child care, transportation, and family life. Differences in attendance rates appeared by school, family demographics, and race/ethnicity. African-Americans and Hispanics experienced more barriers than Whites and Asians, and were more likely to miss school because of illness and medical appointments. Hispanics were more likely to miss for vacation. Parents noted a lack of social connection with other parents in the school/neighborhood, making seeking help to resolve attendance barriers difficult.

Healthy students learn better, yet most current investments in schoolchildren focus on education and learning while largely neglecting the health of the learner. Some school-based interventions, such as school feeding and deworming, are already successfully targeted at this age-group, but the efficiency and cost-effectiveness of such programs could be greatly enhanced by better integrated delivery alongside other priority health interventions. A symposium at the society's 68th annual meeting launched a process to explore how integrated delivery of school-based interventions can address prevalent health conditions in school-age children.

This study examines the income effect on health spending and health behaviors in Vietnam. We measure income shock by lottery prizes, controlling for spending on the lottery. Lottery prizes have no significant effect on the healthcare utilization of individuals. However, we find that lottery winnings result in a significant increase in spending on healthcare. A 1% increase in lottery winnings results in a 0.08% increase in expenditure on medicine and a 0.09% increase in the total amount individuals spend on healthcare. The effect on expenditure on healthcare tends to be larger for older people. A concern with increased income is the unexpected effect on risky health behaviors, such as smoking and drinking. In this study, we do not find that lottery prizes lead to greater spending on tobacco and alcohol. [ABSTRACT FROM AUTHOR]

BackgroundAsthma disproportionately affects individuals with lower income. High uninsured rates are a potential driver for this disparity. Previous studies have not examined the effect of the Affordable Care Act (ACA) on asthma-related outcomes for individuals with low income.Research questionWhat is the impact of insurance status and the ACA on asthma outcomes for adults 18 to 64 years of age in households with low-income status?Study design and methodsThis study was a pooled cross-sectional observational study using National Health Interview Survey data from 2011 through 2013 and 2016 through 2018. Individuals 18 to 64 years of age with a history of asthma and low income were included. Survey-weighted regression modeling and mediation analysis was used to explore the relationship of insurance status and asthma control. Univariate and multivariate survey-weighted regression modeling then was used to evaluate the correlation of the ACA and asthma outcomes.ResultsWe identified 4,043 individual observations. Having health insurance was correlated with improved asthma outcomes (OR, 1.25). This relationship was completely mediated by cost barriers to medications and physician visits. Although the ACA resulted in significant changes in insurance status (OR, 2.4), no statistically significant change was found in asthma outcomes. Furthermore, cost barriers to both medications and physician visits persisted in the insured population, 20.7% and 30.0%, respectively.InterpretationInsurance coverage is associated with improved asthma control for adults 18 to 64 years from households with low socioeconomic status. The ACA reduced the rates of uninsured, but did not have the same magnitude of effect on reducing cost barriers. The persistence of cost barriers may explain in part the lack of population-level improvement in asthma control.

The pandemic has impacted every aspect of academic life, including study abroad (SA), with 93% of programs canceled worldwide in 2020 (IIE, 2020). Long lasting consequences for SA are expected (Dietrich, 2020): a reduction in participation rates, an increase in online SA, and changes both in the nature and the importance of the factors that students consider for SA, with a potential new emphasis on health and personal safety. Our mixed-methods study relies on surveys and interviews to investigate COVID's impact on students' notions of the nature of SA as well as the factors guiding their choices. The MSA (Motivation to SA questionnaire: Anderson & Lawton, 2015) was adopted, adding two new factors: health and language learning. Two hundred twenty-nine participants were recruited during 2021; they belong in one of three categories: (1) students whose SA plans were canceled due to the pandemic; (2) students planning to SA; and (3) students who had not and will not participate in SA. Results indicate that the original MSA factors remain unaltered, that language development is an important motivation to participate, and that health-related factors rank high, especially for minority and low-income students for whom it is almost the number one factor, suggesting the possibility that participation rates for members of these groups are further reduced. Additionally, interview data reveal that for students, SA programs are defined by an immersive academic experience in another country. However, participants value online collaborations with students and faculty at international institutions when integrated in their on-campus coursework.

There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Research 5, 1-144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs--an 8-19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.

PURPOSE Since 2011, US authorities have supported the following 2 approaches to healthier body fat composition: the Centers for Disease Control and Prevention National Diabetes Prevention Program's calorie counting (CC) approach and the US Department of Agriculture's MyPlate (adherence to federal nutrition guidelines). The purpose of this study was to compare the effect of CC vs MyPlate approaches on satiety/satiation and on achieving healthier body fat composition among primary care patients. METHODS We conducted a randomized controlled trial comparing the CC and MyPlate approaches from 2015 to 2017. The adult participants were overweight, of low income, and were mostly Latine (n = 261). For both approaches, community health workers conducted 2 home education visits, 2 group education sessions, and 7 telephone coaching calls over a period of 6 months. Satiation and satiety were the primary patient-centered outcome measures. Waist circumference and body weight were the primary anthropometric measures. Measures were assessed at baseline, 6 months, and 12 months. RESULTS Satiation and satiety scores increased for both groups. Waist circumference was significantly decreased in both groups. MyPlate, but not CC, resulted in lower systolic blood pressure at 6 months but not at 12 months. Participants for both MyPlate and CC reported greater quality of life and emotional well-being and high satisfaction with their assigned weight-loss program. The most acculturated participants showed the greatest decreases in waist circumference. CONCLUSIONS A MyPlate-based intervention might be a practical alternative to the more traditional CC approach to promoting satiety and facilitating decreases in central adiposity among low-income, mostly Latine primary care patients. Key words: clinical trial; obesity treatment; nutrition intervention; Latine; immigrant https://doi.org/10.1370/afm.2964, INTRODUCTION New strategies are needed to improve the success of obesity treatment in the primary care setting. (1) The dominant behavioral intervention approach to treating obesity has emphasized energy restriction [...]

Exposure to respirable crystalline silica dust is one of the most common and severe risks due to the associated health outcomes among workers and results in many occupational-related lung diseases, such as silicosis and lung cancer. The study aimed to determine knowledge, attitudes, and practices on occupation health and safety among mine workers exposed to crystalline silica dust in Lesotho. A descriptive retrospective cross-sectional study design was used in the study. A record review guide was used to retrieve secondary data from the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) project, which were thereafter entered into STATA software, version 17 for descriptive and inferential analysis. The study participants were purposively selected. Most participants were between the ages of 31 to 40 years of age and there was a significant difference between the genders with 35 (9%) females and 350 (91%) males. The majority of the participants had a high school level of education (305, 79%). The knowledge was generally positive in the study with a knowledge score mean of 13.43 (standard deviation: 2.99). The miners agreed with most attitude statements except for A1 (25%), A2 (35%), A3 (18%), and A4 (31%). The practice of exposed mine workers in the study was influenced by working in a dolerite mine (p = 0.003), knowledge score (p ˂ 0.001), and having an attitude about health and safety rules at the mine (p ˂ 0.001; 95% CI: 0.92 to 0.79), while age was a protective factor in the study. The findings of this study highlighted positive knowledge, attitudes, and practices toward occupational health and safety among mine workers. However, more educational programs can be implemented to ensure all mine workers understand the importance of good knowledge, positive attitude, and appropriate practices towards occupational health and safety in their environment. [ABSTRACT FROM AUTHOR]

Exposure to respirable crystalline silica dust is one of the most common and severe risks due to the associated health outcomes among workers and results in many occupational-related lung diseases, such as silicosis and lung cancer. The study aimed to determine knowledge, attitudes, and practices on occupation health and safety among mine workers exposed to crystalline silica dust in Lesotho. A descriptive retrospective cross-sectional study design was used in the study. A record review guide was used to retrieve secondary data from the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) project, which were thereafter entered into STATA software, version 17 for descriptive and inferential analysis. The study participants were purposively selected. Most participants were between the ages of 31 to 40 years of age and there was a significant difference between the genders with 35 (9%) females and 350 (91%) males. The majority of the participants had a high school level of education (305, 79%). The knowledge was generally positive in the study with a knowledge score mean of 13.43 (standard deviation: 2.99). The miners agreed with most attitude statements except for A1 (25%), A2 (35%), A3 (18%), and A4 (31%). The practice of exposed mine workers in the study was influenced by working in a dolerite mine (p = 0.003), knowledge score (p ˂ 0.001), and having an attitude about health and safety rules at the mine (p ˂ 0.001; 95% CI: 0.92 to 0.79), while age was a protective factor in the study. The findings of this study highlighted positive knowledge, attitudes, and practices toward occupational health and safety among mine workers. However, more educational programs can be implemented to ensure all mine workers understand the importance of good knowledge, positive attitude, and appropriate practices towards occupational health and safety in their environment.

Mounting evidence finds that early life environmental factors increased the probability of autism spectrum disorder. We estimated prospective associations between early life environmental factors and autism spectrum disorder symptoms in children at the age of 2 years in a population-derived birth cohort, the Barwon Infant Study. Autism spectrum disorder symptoms at the age of 2 years strongly predicted autism spectrum disorder diagnosis by the age of 4 years (area under curve = 0.93; 95% CI (0.82, 1.00)). After adjusting for child's sex and age at the time of behavioural assessment, markers of socioeconomic disadvantage, such as lower household income and lone parental status; maternal health factors, including younger maternal age, maternal pre-pregnancy body mass index, higher gestational weight gain and prenatal maternal stress; prenatal alcohol; environmental air pollutant exposures, including particulate matter < 2.5 [mu]m at birth, child secondhand tobacco smoke exposure at 12 months, dampness/mould and home heating with oil, kerosene or diesel heaters at 2 years postnatal. Lower socioeconomic indexes for area, later birth order, higher maternal prenatal depression, and maternal smoking frequency had a dose-response relationship with autism spectrum disorder symptoms. Future studies on environmental factors and autism spectrum disorder should consider the reasons for the socioeconomic disparity and the combined impact of multiple environmental factors through common mechanistic pathways. [Written with the Barwon Infant Study Investigator Group.]

Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334 [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. Methods: We analyzed cross-sectional data from the Health in Common Study ("N" = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. Results: Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. Conclusion: Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population. (Contains 2 tables.)

Objective: To explore food shopping behaviors among low-income families over the course of the month. Design: Two researchers conducted 13 90-minute focus groups. Setting: Two community organizations serving low-income populations and a university campus. Participants: Low-income adults (n = 72) who were the primary household food shoppers and who had at least 1 child less than 18 years old. Variables Measured: Shopping behavior changes during 1 month. Analysis: Focus groups were recorded, transcribed, and coded independently by 2 researchers. Descriptive statistics were used to evaluate sociodemographic variables such as age, sex, race/ethnicity, and participation in food assistance programs. Results: Economics played a key role in participants' food shopping behaviors and influenced food availability throughout the month. To overcome economic barriers, participants used food and emergency assistance programs and engaged in menu planning, price matching, storing food, using credit cards, and receiving financial assistance from family members and/or neighbors. Conclusions and Implications: Low-income families made strategic decisions to maintain a food supply throughout the month. These results suggest limited economics throughout the month may hinder families' ability to consume a varied, nutrient-rich diet, which may have an impact on future health status. (Contains 2 tables.)

Objective: Because health literacy is related to healthcare outcomes, this study looked at reading and comprehension levels in a sample of urban, low-income persons. Design: This was a descriptive exploration of reading comprehension levels, controlled for medical problems that could impact on vision and therefore ability to read. Setting: Ninety persons were recruited in the waiting areas of a healthcare provider serving the homeless and urban poor. Method: Visual acuity and blood pressures were obtained and for diabetic patients measures of glycaemic control were recorded. Reading and comprehension was tested with the Wide Range Achievement Test (WRAT) 4 standardized assessment. Limited demographic data was obtained. Descriptive and frequency statistics were calculated as well as Pearson "r" coefficients. Results: Results indicated that most participants were healthy or had well controlled conditions. No health parameters were significantly related to reading/comprehension scores. Reading and comprehension scores were lower than standardized norms with mean reading just under grade 10 and comprehension at mid-ninth grade. The mean composite scores placed them in the lower 30th percentile of readers. Women scored below men in all areas. Conclusion: Participants in this study had reading and comprehension levels at beginning high school level. They may have difficulty understanding healthcare hand-outs and instructions. Healthcare information sources should be written at levels comprehensible to clients, and alternative methods of information dissemination should be considered. (Contains 1 table, 2 figures, and 1 note.)

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of "Healthy People 2020" objectives. (Contains 4 tables.)

As part of a multi-state study on health message development, a group of family researchers, Extension faculty, and a learning technologist used audience-response systems, or "clickers," to display and record focus group participants' responses to questions. This article describes how the authors used clicker technology in focus group settings, clicker training for facilitators, and lessons learned. The clicker technique is useful to collect local and personal data anonymously in group settings for program evaluation purposes. Implications for future research and Extension education are discussed.

The experience of poverty embodies complex, multidimensional stressors that may adversely affect physiological and psychological domains of functioning. Compounded by racial/ethnic discrimination, the financial aspect of family poverty typically coincides with additional social and physical environmental risks such as pollution exposure, housing burden, elevated neighborhood unemployment, and lower neighborhood education levels. In this study, we investigated the associations of multidimensional social disadvantage throughout adolescence with autonomic nervous system (ANS) functioning at 17 years. Two hundred and twenty nine low-income Mexican-American adolescents (48.6% female) and their parents were assessed annually between the ages of 10 and 16. Participants' census tracts were matched with corresponding annual administrative data of neighborhood housing burden, education, unemployment, drinking water quality, and fine particulate matter. We combined measures of adolescents' electrodermal response and respiratory sinuses arrhythmia at rest and during a social exclusion challenge (Cyberball) to use as ANS indices of sympathetic and parasympathetic activity, respectively. Controlling for family income-to-needs, youth exposed to greater cumulative water and air pollution from ages 10-16 displayed altered patterns of autonomic functioning at rest and during the social challenge. Conversely, youth living in areas with higher housing burden displayed healthy patterns of autonomic functioning. Altogether, results suggest that toxin exposure in youths' physical environments disrupts the ANS, representing a plausible mechanism by which pollutants and social disadvantage influence later physical and mental health.