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Aims and objectives: The existing literature indicates that shared book reading is associated with benefits in children’s home language development. Parents play a significant role in shaping children’s language outcomes. The purpose of this study was to investigate the relations among the quality of parents’ shared book reading, children’s language output, receptive vocabulary, and expressive vocabulary outcomes in the home language of dual language learners (DLLs) to inform book reading practices that can support DLLs’ early home language development. Methodology: 36 Mexican American (43–67 months) and 31 Chinese American (38–70 months) DLLs and their mothers, who were home language dominant, were recruited from Head Start programs, which are federally funded programs that provide early childhood education to low-income children, in Northern California. Data and analysis: Utterances produced by the parents during parent–child shared book reading were coded for cognitive demand levels. DLLs’ home language expressive vocabulary and receptive vocabulary and information about parents’ demographics and parent–child shared reading frequency were collected. Correlations and hierarchical regression analyses were computed. Findings/conclusions: The findings demonstrated possible cultural differences in mothers’ book reading quality regarding cognitive demand. Although maternal statements and questions were not significantly associated with DLLs’ home language receptive and expressive vocabulary for both groups, asking yes/no, referential, and inferential questions were more likely to evoke more language output from DLLs. Originality: This study extends the literature on home language development of low-income DLLs during parent–child shared reading, as only a few studies have investigated the significance of shared reading in the home language. Significance/implications: The findings of this study yield important implications for parents’ shared reading practices with low-income DLLs. Using all levels of cognitively demanding speech and encouraging DLLs to talk during shared reading may benefit their home language development.

Background and aims: Population‐level alcohol use data are available from high‐income countries, but limited research has been conducted in sub‐Saharan Africa. This systematic review and meta‐analysis aimed to summarize population‐level alcohol use in sub‐Saharan Africa. Method: Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance‐related disorders' and 'prevalence' and 'sub‐Saharan Africa'. We included general population studies on alcohol use (including any use, high‐risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub‐Saharan African adolescents (10–17) and adults (18+) were extracted. Analyses included life‐time and past 12‐ and 6‐month alcohol use. Results: We included 141 papers. Among adolescents, the life‐time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3–37.1%], 36.2% (CI = 18.4–56.1%) in the past year and 11.3% (CI = 4.5–20.4%) in the past 6 months. Among adolescents, 12‐month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0–27.8%) and 4.1% (CI = 1.4–7.9%), respectively. Among adults, the life‐time prevalence of alcohol use was 34.9% (CI = 17.7–54.1%), 27.1% (CI = 5.0–56.4%) in the past year and 32.2% (CI = 19.8–46.0%) in the past 6 months. Among adults, the 12‐month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0–30.4%) and 4.3% (CI = 0.8–9.8%), respectively. The highest weighted life‐time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6‐month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. Conclusion: Alcohol use patterns vary across countries and subregions within sub‐Saharan Africa, and comprehensive population‐level data on alcohol use remain scarce in numerous sub‐Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

This paper explores the relationships between low‐income single mothers and their adolescent and early adult children utilizing qualitative interview and focus group data with youth from three Canadian cities. The research explored youth provisioning roles in these families. Provisioning, a concept widely understood in the global south, refers to labour used to sustain low‐income families and includes emotional labour, care work, trade and exchange and paid labour. Findings from this study identified strong expressions of positive attachment and close relationships between youth and their family members. The paper queries whether positive attachment may be built through roles where youth see themselves as integral parts of a family team and where their contributions are acknowledged. These findings invite us to explore and perhaps challenge the oft‐reported correlations between living in a low‐income, lone mother‐led family and poor childhood outcomes and poor attachment. Can these outcomes be mediated and can the provisioning roles youth undertake possibly be such mediators? [ABSTRACT FROM AUTHOR]

Infrastructure for water, sanitation, hygiene, cleaning, and waste management is essential for supporting safe environmental conditions in healthcare facilities. Routine maintenance is important for preventing infrastructure breakdowns, but few studies have examined healthcare facility maintenance practices. This study documented environmental maintenance tasks in healthcare facilities in Niger, described bottlenecks to maintenance, and assessed strategies for coping with breakdowns. At 34 rural healthcare facilities in Niger, we conducted quantitative surveys to assess frequency of maintenance tasks and held qualitative interviews with healthcare facility staff to understand bottlenecks to maintenance. On at least a monthly basis, 4% of healthcare facilities inspected their water source and pump for the purpose of detecting and replacing worn parts, 15% inspected water taps and basins, and 29% inspected incinerators. Healthcare facility staff described barriers to accessing government funds for maintenance. Instead, they paid out of their own salaries or raised funds through appeals to community members or revenue generation initiatives. Other bottlenecks included ill-defined management responsibilities and difficulty of finding skilled technicians for maintenance. Findings highlight opportunities to support healthcare facilities in budgeting, advocacy, and training skilled technicians. Initiatives to install infrastructure at healthcare facilities will be more sustainable if they are accompanied by postconstruction planning, training, and funding for maintenance. [ABSTRACT FROM AUTHOR]

Background: Low income communities are vulnerable to non-communicable diseases (NCDs), which affect their economy and disability status. An effective approach to address the NCD burden is through the multidimensional concept of health-promoting lifestyle. Another preferred approach by the population worldwide for NCD treatment is natural health product (NHP). Studies on NHP and health-promoting lifestyle among this vulnerable population, specifically the low-income urban community, are limited. Therefore, this study, aimed at investigating the NHP knowledge and health-promoting lifestyle, and to determine the factors associated with health-promoting lifestyle in a low income urban community in Cheras, Kuala Lumpur. This study has focused on sociodemographic characteristics, annual health monitoring activities, and health status, which are modifiable and non-modifiable factors. Methods: Phase 1 of the study involves developing the Malay-version NHP knowledge questionnaire, whereas Phase 2 involves a cross-sectional study of 446 randomly selected low-income respondents to determine their level of health-promoting lifestyle and the associated factors. The respondents' sociodemographic, socioeconomic, health monitoring activity, health status, and NHP knowledge data were obtained using the newly developed Malay-version NHP questionnaire and the Health-Promoting Lifestyle Profile II (HPLP II) questionnaire. The independent variables include sociodemographic status, annual health monitoring activities, health status and NHP knowledge were analysed using simple and multiple linear regression. Results: In this study, the 10-item NHP knowledge questionnaire developed in the Malay version contains two domains [safe use (eight items) and point of reference (two items)] (total variance explained: 77.4%). The mean of NHP knowledge score was 32.34 (standard deviation [SD] 7.37). Meanwhile, the mean score of health-promoting lifestyle was 109.67 (SD 25.01). The highest and lowest scores of health-promoting lifestyles are attributed to spiritual growth and physical activity, respectively. Ethnicity is associated with a higher health-promoting lifestyle level, same goes to the occupational status − NHP knowledge interaction. "Unclassified" education status and annual blood glucose level monitoring are associated with a lower level of health-promoting lifestyle. Conclusion: A new questionnaire in Malay version was developed to measure NHP knowledge. Compared to other subpopulations, the respondents' health-promoting lifestyle levels in this study were low, associated with ethnicity, education status, and health monitoring activities. The findings provided insight into the interaction between NHP knowledge and occupational status, which is associated with a higher health-promoting lifestyle level. Accordingly, the future health-promoting lifestyle intervention programmes in healthcare delivery should target these factors. [ABSTRACT FROM AUTHOR]

Previous research has outlined evident disparities in the prevalence of chronic conditions among African Americans compared to other groups, with low-income African American men disproportionately affected by almost every disorder. Self-management programs are useful tools for managing chronic disorders beyond the doctor’s office. This monograph provides a detailed looking into the current state of the research on low-income African American men with chronic health conditions. An intersectional approach is used to provide a nuanced synthesis of relevant literature. The project outlines the need for programs designed to engage low-income African American men with skills, resources, and tools for managing chronic conditions. Authors argue that improvements to traditional self-management programs can be realized by emphasizing culture, including end-users in the creation of programs, and offering culturally tailored strategies to improve health. Thus, any targeted program must include culturally detailed information about nutrition, exercise, stress, mental health, and leveraging social support. [ABSTRACT FROM AUTHOR]

This field report describes the accessibility and perceived effectiveness of a free acupuncture program among a group of predominantly low-income Hispanic/Latino adults. Surveys, developed based on the Levesque Conceptual Framework of Access to Health Care, were administered to clients. Baseline (n = 245) and 6-week follow-up (n = 79) surveys were analyzed to document early program findings. A majority of clients were Hispanic/Latino (72.7%) and female (73.1%). Most reported their original pain complaint was treated very well/well (98.7%). Clients reported an average 1.2 points pain level decrease (scale 1–10) at follow-up (p < 0.0001). Early program results suggest this acupuncture program was accessible and well received by low-income Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Introduction: The popularity of yoga has surged in recent years; however, yoga practitioners have remained a largely homogenous population. Research reflects that most practitioners are of a higher socioeconomic status. There are access barriers to yoga for lower income individuals, likely due to factors such as financial constraints and logistical challenges. The primary goal of this review was to synthesize literature on yoga research among low-income populations and better understand the feasibility and acceptability of such interventions. A secondary goal was to assess the consistency of metrics for reporting feasibility and acceptability across such studies using the CheckList Standardizing the Reporting of Interventions for Yoga (CLARIFY) guidelines as a framework. Third, the authors sought to propose additional standardized CLARIFY guidelines that may enhance reporting on the diversity of yoga research populations, adherence, and retention. Methods: The electronic databases PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, and Google Scholar were searched in May 2022 using a prespecified search string. Articles assessing a yoga intervention in predominantly low-income adult populations were deemed eligible for inclusion. Results: The search resulted in 512 potential articles. Eleven were deemed eligible for inclusion. The included studies reported mostly positive effects of yoga on the target outcome (i.e., pain/disability, quality of life/wellness, and psychiatric symptoms). Recruitment and retention data showed generally good attendance and high study completion rates. Common study design components included recruitment embedded within preexisting medical settings, proximal yoga locations, and mitigation of yoga-related costs. Finally, the authors noted inconsistency in the reporting of adherence, retention, and other sociodemographic characteristics of participants and yoga instructors (e.g., race, ethnicity, and income). Discussion: Yoga may promote physical and mental health for low-income individuals. Important facilitators to access are noted, such as proximal study settings, as well as barriers such as the need for childcare that can be addressed in future research. In addition, several study design considerations could help address the specific needs of low-income participants in yoga research, such as compensating participants, recruiting within existing medical settings, and providing yoga-related equipment at no cost. Finally, the authors suggest specific ways to enhance reporting of study metrics related to socioeconomic diversity, by adding to the preexisting CLARIFY guidelines. [ABSTRACT FROM AUTHOR]

This study is among the first to review current evidence on the association between public subsidized housing and physical health (i.e. health outcomes, health behaviours, and health care use) in low-income households and provides direction for future research and policy. A systematic search of four databases produced 125 articles. Among quantitative peer-reviewed articles published within the past 28 years (1995–2022), 24 examine this particular relationship. Additionally, the bulk of this work is cross-sectional and limited primarily to the US. Although there is some degree of evidence that subsidized housing is associated with improved health, inconsistent results prevent a robust conclusion. The specific type of intervention, targeted group, along with the quality of the neighbourhood and housing all contribute to this heterogeneous mix of findings. This review underscores a need for future research that analyzes causal relationships across a large and varied geographic space using a robust set of physical health outcomes. [ABSTRACT FROM AUTHOR]

Existing literature suggests many victims of housing loss due to disaster need emergency shelter, and low-income individuals are at risk of becoming chronically homeless without assistance in the transition to conventional housing. In response, FEMA provides Transitional Sheltering Assistance (TSA) to victims of housing loss. However, the extent to which sheltering needs are met by TSA has not been investigated, especially among low-income households. Analyzing FEMA's administrative data including all damaged housing units in Harris and Galveston counties (N = 283,085), we found that low-income victims of housing loss not only had greater sheltering needs but also were less likely to access TSA than their counterparts not of low-income status. When both groups were in need of shelter, the chance of obtaining TSA for low-income victims of housing loss was much lower than that for their counterparts. Our study highlights the critical sheltering needs of low-income households in a natural disaster, and advocates for a broader and more equitable distribution of TSA. [ABSTRACT FROM AUTHOR]

The epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization's Global Burn Registry to fill this gap. The GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. Of 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). Similarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients. [ABSTRACT FROM AUTHOR]

National lockdowns and containment measures to control the spread of COVID-19 led to increased unemployment, lower household incomes and reduced access to affordable and nutritious foods globally. This study aimed to examine changes and correlates of household food insecurity experience and mitigation strategies adopted in peri-urban Peru during the COVID-19 pandemic. Low income households with children age < 2 years in Lima and Huánuco participated in three repeated cross-sectional surveys from 2020 to 2022 (n = 759). We assessed changes in household food insecurity experience using the Food Insecurity Experience Scale. Correlates of moderate-severe food insecurity were analysed using univariate and multivariable linear mixed-effect regressions. We also assessed perceived impacts of the pandemic on livelihoods, coping strategies and receipt of financial or food assistance. Moderate-severe food insecurity was 47.0% in 2020 (survey 1) decreasing to 31.1% in 2022 (survey 3). In adjusted analyses, food insecurity was higher in households with perceived reduced income (β = 12.69 [6.82; 18.56]); in the lower socio-economic status (SES) tertiles (compared to the relatively highest SES tertile; middle tertile (β = 20.91 [9.89; 31.93]), lowest tertile (β = 39.37 [28.35; 50.40]); in households with ≥ 2 children < 5 years (β = 8.78 [2.05; 15.50]); and in Lima (compared to Huánuco; β = 10.47 [1.27; 19.67]). Food insecurity improved more among the relatively lowest SES compared to the relatively highest SES households between survey 1 and 3 (interaction p = 0.007). In conclusion, almost half of households experienced moderate-severe food insecurity mid-pandemic with greater risk observed in the most socio-economically disadvantaged households. The inequality gap in food insecurity associated with SES narrowed over time likely due to household coping strategies and reduced poverty. [ABSTRACT FROM AUTHOR]

Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19–25 in the United States were low‐income and a third lacked health insurance coverage—both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low‐income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well‐being of low‐income young adults ages 19–25. Using 2010–2017 National Health Interview Survey data, I estimate policy effects by applying a difference‐in‐differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well‐being for low‐income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non‐Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups. [ABSTRACT FROM AUTHOR]

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p -values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma. [ABSTRACT FROM AUTHOR]

Screening for viral hepatitis is considered a high‐priority area in the Veterans Health Administration (VHA). Yet, few studies have examined viral hepatitis screening test use among low‐income veterans who are considered high‐risk with limited healthcare access. Using cross‐sectional data from 933 participants in the 2021–2022 National Veteran Homeless and Other Poverty Experiences (NV‐HOPE) study, we examined rates and correlates of lifetime screening for hepatitis B (HBV) and hepatitis C (HCV) infections. Multivariable logistic regression models evaluated characteristics associated with HBV/HCV screening. Nearly 16% and 21% reported lifetime HBV and HCV screening, respectively. These rates are considerably lower than HBV (47.3%) and HCV (92.9%) screening rates documented among contemporaneous veterans in VHA electronic health records. In the NV‐HOPE data, veterans 50–79 years were more likely than those ≥80 years of age to ever‐screen for HBV/HCV. Whereas, household income was inversely related to lifetime screening behaviours, veterans reporting ‘other’ employment types (vs. full‐time/part‐time employment) were more likely to ever‐screen for HBV/HCV. Ever‐screening for HBV was more likely among veterans reporting non‐Hispanic ‘other’ (vs. non‐Hispanic ‘white’) race, housing instability, Medicaid insurance, as well as drug use and cognitive disorder histories. Living with ≥5 members (vs. alone), histories of alcohol use, cancer, and liver disorders were also correlated with ever‐screening for HCV. HIV/AIDS history correlated with ever‐screening for HBV/HCV. In conclusion, fewer than one‐third of low‐income US veterans ever‐screened for HBV/HCV, with lower screening rates among those less likely to be exposed to viral hepatitis, thereby informing interventions aimed at promoting available screening, treatment and vaccinations for HBV/HCV. [ABSTRACT FROM AUTHOR]

Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p =.10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity. [ABSTRACT FROM AUTHOR]

Sexual intimacy, characterized as the experience between individuals of sharing general affection and sexual activity with one another within the Personal Assessment of Intimacy in Relationships inventory, is positively related to relationship satisfaction and stability. However, many studies of couple therapy have shown that it only results in small-sized (and often non-significant) improvements in sexual intimacy. Furthermore, there are numerous financial, logistical, and psychological barriers to couple therapy. Thus, the current study sought to examine whether two brief online relationship education programs (OurRelationship and ePREP) could overcome these barriers and yield similar-sized effects to more intensive couple therapy. In two independently collected samples of low-income couples (NSample 1 = 742 Couples; M AgeSample 1 = 33.19; NSample 2 = 671 Couples; M AgeSample 2 = 33.48), the current study found that: OurRelationship (d = 0.24–0.28) and ePREP (d = 0.26–0.34) produced small-sized changes in sexual intimacy relative to a waitlist control condition in both samples, the magnitude of the effect size replicated in a second sample and, with rare exception, these changes were generally not moderated by key variables of interest. Given that web-based relationship education is significantly shorter, less expensive, and more accessible than in-person couple interventions, web-based relationship education could be considered a viable candidate for couples experiencing concerns with sexual intimacy. [ABSTRACT FROM AUTHOR]

Background: The use of tobacco is a significant global public health issue. According to the World Health Organization, tobacco use is a considerable risk factor for many diseases and causes more than 8 million deaths per year, with a disproportionate impact on low- and middleincome countries. Therefore, this systematic review was conducted to identify the factors influencing tobacco use among youth in low-income, lower-middle-income, and upper-middle-income countries. Study Design: A system review. Methods: The review followed the PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42023430552). Several data sources were utilized, including PubMed, Scopus, ScienceDirect, MEDLINE, CINAHL, and ProQuest, and cross-sectional data from participants aged 15-24 underwent investigation. Original full-text articles have been published between 2015 and 2023. Out of the 2892 studies, 20 were included in this review after two reviewers confirmed the eligibility criteria. Results: The average age of the participants was (mean ± standard deviation: 19.45 ± 1.686). Most studies were conducted in lower-middle and upper-middle-income countries. Frequently reported influences were at the individual and social levels, including demographic, economic, and psychological parameters, attitude and knowledge, individual behavioral factors, parental education, family member tobacco use, stressful life events, and social networks. At the environmental level, factors included secondhand smoke exposure, community context, media channels, and access to tobacco. Conclusion: The findings demonstrated a significant association between youth tobacco use and individual-, social-, and environmental-level factors. Consequently, specific interventions targeting these factors should be deployed to mitigate youth tobacco use in various socioeconomic settings. [ABSTRACT FROM AUTHOR]

Nutrition education and food resource management (FRM) can assist food-insecure individuals in acquiring healthy and affordable food. We aimed to assess the relationships between FRM skills and healthy eating focus with diet quality and health-related behaviors in low-income adults during the COVID-19 pandemic. This cross-sectional study was conducted using an online survey of 276 low-income adults living in a low-food-access community in Northeast Connecticut. Through analysis of covariance, adults who usually or always had a meal plan, considered reading nutrition labels important, made a grocery list, were concerned about their food healthiness, and rated their diet quality as very good/excellent reported higher diet quality (frequency-based and liking-based scores) (p < 0.05 for all). Individuals who considered reading food labels very important and reported having a good diet reported less frequent pandemic-related unhealthy behaviors (consumption of candy and snack chips, soda or sugary drinks, weight gain, smoking) (p < 0.001). Furthermore, higher-frequency-based diet quality was associated with lower risk of overweight or obesity (OR: 0.37; 95% CI: 0.18, 0.76; p-trend < 0.01). Thus, FRM skills and healthy eating focus were associated with higher diet quality and healthier self-reported changes in diet, weight, and smoking behaviors during the pandemic. [ABSTRACT FROM AUTHOR]

To examine the relationship between food and housing insecurity and the continuation of breastfeeding, interviews were conducted with 203 birthing parents in English or Spanish. The study was conducted between August 2019 and March 2021 in the southeastern U.S. The breastfeeding rate among participants was 52%. Multivariate analysis indicated that birthing parents experiencing housing insecurity were less likely to be breastfeeding at 4 months of infant's age (p =.019). Future research is warranted to understand how housing insecurity might contribute to the discontinuation of breastfeeding through stress, poor rent affordability and the lack of clean and safe environments. [ABSTRACT FROM AUTHOR]

Despite widespread availability of human papillomavirus (HPV) vaccines and recommendations for routine use, awareness and uptake of HPV vaccination are not universal. We assessed self-reported history of HPV vaccination in a sample of low-income men and women recruited from the community using respondent-driven sampling as part of the National HIV Behavioral Surveillance (NHBS) survey in San Francisco. Of the 384 respondents, a minority (12.5%) reported they had received the HPV vaccine. In multivariate analysis, independent associations with HPV vaccination history were female sex (adjusted odds ratio [AOR] = 3.76, 95% confidence interval [CI] = [1.73, 8.17]), younger age (AOR = 0.89 per year, 95% CI = [0.86, 0.92]), and education above high school (AOR = 2.84, 95% CI = [1.37, 5.90]). Missed opportunities for HPV vaccination were evident in 84.4% of respondents having visited a health care provider in the last year, including 40.1% tested for a sexually transmitted infection, and entry into higher education programs (33.4%).

OBJECTIVES: To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States-the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales-in a low-income predominantly Latinx population in California. METHODS: Data were collected from July 2020 to June 2023 from surveys of low-income pregnant and birthing people in Fresno, California, participating in the Engaging Mothers and Babies; Reimagining Antenatal Care for Everyone (EMBRACE) trial. Research staff administered the 26-item PCPC-US scale at 30-34 weeks gestation (n = 315) and the 35-item PCMC-US scale at 10-14 weeks after birth (n = 286), using the language preferred by the participant (English or Spanish). We assessed construct, criterion, and known group validity and internal consistency of the scales. RESULTS: 78% of respondents identified as Latinx. Factor analysis identified one dominant factor for each scale that accounted for over 60% of the cumulative variance, with most items loading at > 0.3. The items also loaded adequately on sub-scales for dignity and respect, communication and autonomy, and responsive and supportive care. Cronbachs alpha for the full scales were > 0.9 and between 0.70 and 0.87 for the sub-scales. Summative scores range from 0 to 100, with higher scores indicating higher person-centered care. Correlations with scores on scales measuring prenatal care quality and birth experience provided evidence for criterion validity, while associations with known predictors provided evidence for known-group validity. CONCLUSIONS: The PCPC-US and PCMC-US scales, which were developed using a community-engaged process and found to have good psychometric properties in a largely high-income sample of Black women, were shown to also have good psychometric properties in a sample of low-income primarily Latinx women. Both scales provide valid and reliable tools to measure person-centered care experiences among minoritized communities to support efforts to reduce existing birth inequities.

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between low-income and non-low-income adults and across race-ethnicity. We utilized data from the COVID-19's Unequal Racial Burden online survey, which included baseline (12/17/2020-2/11/2021) and 6-month follow-up (8/13/2021-9/9/2021) surveys. The sample included 1,500 Black/African American, Latino, and White low-income adults living in the U.S. (N = 500 each). A non-low-income cohort was created for comparison (n = 1,188). Multinomial logistic regression was used to assess differences in vaccine willingness and uptake between low-income and non-low-income adults, as well as across race-ethnicity (low-income adults only). Only low-income White adults were less likely to be vaccinated compared to their non-low-income counterparts (extremely willing vs. not at all: OR = 0.58, 95% CI = 0.39-0.86); low-income Black/African American and Latino adults were just as willing or more willing to vaccinate. At follow-up, only 30.2% of low-income adults who reported being unwilling at baseline were vaccinated at follow-up. White low-income adults (63.6%) appeared less likely to be vaccinated, compared to non-low-income White adults (80.9%), low-income Black/African American (70.7%), and low-income Latino adults (72.4%). Distrust in the government (46.6), drug companies (44.5%), and vaccine contents (52.1%) were common among those unwilling to vaccinate. This prospective study among a diverse sample of low-income adults found that low-income White adults were less willing and less likely to vaccinate than their non-low-income counterparts, but this difference was not observed for Black/African American or Latino adults. Distrust and misinformation were prevalent among those who remained unvaccinated at follow-up.

Abstract Background Low income communities are vulnerable to non-communicable diseases (NCDs), which affect their economy and disability status. An effective approach to address the NCD burden is through the multidimensional concept of health-promoting lifestyle. Another preferred approach by the population worldwide for NCD treatment is natural health product (NHP). Studies on NHP and health-promoting lifestyle among this vulnerable population, specifically the low-income urban community, are limited. Therefore, this study, aimed at investigating the NHP knowledge and health-promoting lifestyle, and to determine the factors associated with health-promoting lifestyle in a low income urban community in Cheras, Kuala Lumpur. This study has focused on sociodemographic characteristics, annual health monitoring activities, and health status, which are modifiable and non-modifiable factors. Methods Phase 1 of the study involves developing the Malay-version NHP knowledge questionnaire, whereas Phase 2 involves a cross-sectional study of 446 randomly selected low-income respondents to determine their level of health-promoting lifestyle and the associated factors. The respondents’ sociodemographic, socioeconomic, health monitoring activity, health status, and NHP knowledge data were obtained using the newly developed Malay-version NHP questionnaire and the Health-Promoting Lifestyle Profile II (HPLP II) questionnaire. The independent variables include sociodemographic status, annual health monitoring activities, health status and NHP knowledge were analysed using simple and multiple linear regression. Results In this study, the 10-item NHP knowledge questionnaire developed in the Malay version contains two domains [safe use (eight items) and point of reference (two items)] (total variance explained: 77.4%). The mean of NHP knowledge score was 32.34 (standard deviation [SD] 7.37). Meanwhile, the mean score of health-promoting lifestyle was 109.67 (SD 25.01). The highest and lowest scores of health-promoting lifestyles are attributed to spiritual growth and physical activity, respectively. Ethnicity is associated with a higher health-promoting lifestyle level, same goes to the occupational status − NHP knowledge interaction. “Unclassified” education status and annual blood glucose level monitoring are associated with a lower level of health-promoting lifestyle. Conclusion A new questionnaire in Malay version was developed to measure NHP knowledge. Compared to other subpopulations, the respondents’ health-promoting lifestyle levels in this study were low, associated with ethnicity, education status, and health monitoring activities. The findings provided insight into the interaction between NHP knowledge and occupational status, which is associated with a higher health-promoting lifestyle level. Accordingly, the future health-promoting lifestyle intervention programmes in healthcare delivery should target these factors.

Background: Extreme heat may discourage physical activity of children while shade may provide thermal comfort. The authors determined the associations between ambient temperature, shade, and moderate to vigorous physical activity (MVPA) of children during school recess. Methods: Children aged 8–10 (n = 213) wore accelerometers and global positioning system monitors during recess at 3 school parks in Austin, Texas (September–November 2019). Weather data originated from 10 sensors per park. The authors calculated shade from imagery using a geographic information system (GIS) and time-matched physical activity, location, temperature, and shade data. The authors specified piecewise multilevel regression to assess relations between average temperature and percentage of recess time in MVPA and shade. Results: Temperature ranged 11 °C to 35 °C. Each 1 °C higher temperature was associated with a 0.7 percentage point lower time spent in MVPA, until 33 °C (91 °F) when the association changed to a 1.5 lower time (P <.01). Each 1 °C higher temperature was associated with a 0.3 percentage point higher time spent under shade, until 33 °C when the association changed to a 3.4 higher time (P <.001). At 33 °C or above, the direct association between shade and MVPA weakened (P <.05), with no interaction effect above 33 °C (P >.05). Children at the park with the most tree canopy spent 6.0 percentage points more time in MVPA (P <.01). Conclusions: Children engage in less MVPA and seek shade during extreme heat and engage in more MVPA in green schoolyards. With climate change, schools should consider interventions (eg, organizing shaded play, tree planting) to promote heat safe MVPA. [ABSTRACT FROM AUTHOR]

The main phases of any housing project are planning, design, execution, regulation, and use. All the stakeholders involved in each phase can impact the project's status and progress. The study has explored the dynamics of acquiring five fundamental housing resources, i.e., physical, financial, construction capital, intellectual, and policy. The paper responds to the lack of research on resource acquisition and the patterns of stakeholder engagements, particularly in South Asian countries. The study provides the stakeholder model in the case of Pakistan as an interesting study of relationships between resource-acquiring patterns and engagement mechanisms that can be applied to other geographical contributions. Drawing on qualitative analysis from in-depth interviews with prime stakeholders, this paper concludes by highlighting policy resources as the focal point of resource-wise stakeholder engagement in low-income housing development. This paper highlights the complexities associated with amalgamated engagements with limited transparency on the patterns of resource acquisition for better navigating the provision of low-income housing in developing countries urbanizing at alarming rates.

Abstract Background Family-based treatment (FBT) is a front-line empirically supported intervention for adolescent anorexia nervosa, but it is often inaccessible to families from lower income backgrounds, as it is most typically available in specialty research and private practice settings. In preparation for a pilot trial of FBT delivered in the home setting, this study qualitatively examined provider perceptions of implementing FBT in lower-income communities. Methods Eating disorder clinicians working in community clinics (therapists, medical doctors, dietitians, and social workers; n = 9) were interviewed about their experiences using FBT. Interview transcripts were analyzed both deductively, using an approach consistent with applied thematic analysis, and inductively, using the Replicating Effective Programs implementation framework, to examine barriers to FBT implementation. Results Prevailing themes included concern about the time and resources required of caregivers to participate in FBT, which may not be feasible for those who work full time, have other caregiving demands, and/or lack family support. Psychosocial problems outside of the eating disorder, such as food insecurity, other untreated mental health concerns (in themselves or other family members), or externalizing behaviors on the part of the adolescent, were also discussed as barriers, and participants noted that the lack of cohesive treatment teams in the community make it difficult to ensure continuity of care. Conclusion Findings from this qualitative study indicate the need to address systemic socioeconomic barriers to improve the efficacy of implementation of FBT in the community and to understand how provider perceptions of these barriers influence their uptake of FBT.

Abstract Background Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity. Methods This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate. Results Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13–5.43; 2014 aOR 1.82, 95%CI 1.24–2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01). Conclusion Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations.

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Findings Conclusion Obstetrical fistula is an abnormal opening between the reproductive tract and lower urinary and/or gastrointestinal tract resulting from obstetrical complications, affecting nearly two million women worldwide. It imposes physical, economic, social, and mental consequences on the affected women. Treatment outcomes vary and, mostly, surgical treatment results in improved quality of life and successful subsequent pregnancy for survivors.The review aimed to chart and examine the treatment outcomes of obstetrical fistula surgical repair in low‐ and middle‐income countries.This is a scoping review study to identify treatment outcomes of obstetrical fistula surgical repair in low‐ and middle‐income countries. The search was conducted from databases (PUBMED, Embase, CINAHL, Scopus, and Web of Science), and gray literature (Google Scholar, Google, and conference proceedings).The eligibility criteria were constructed using a participant, concept, and context framework and included study types of primary research, reviews, and reports. Studies without full text and in languages other than English were excluded.The relevant characteristics of the included studies were extracted on an Excel spreadsheet and analyzed to chart treatment outcomes.The review examined the full text of 57 studies on the treatment outcomes of obstetrical fistula. The findings were grouped into two themes: early and late outcomes. The early outcomes included incontinence, surgical‐site infection, urine retention, hemorrhage, and retained catheter. The late outcomes included fistula recurrence, residual incontinence, quality of life, reproductive issues, mental health, family and social support, and financial status.The treatment outcomes of obstetrical fistula can be grouped into short‐term and long‐term outcomes. Although this review found adequate studies for the analysis, most study designs were poor. Stronger studies are recommended in the future to guide policy and decision‐making. We would like to suggest that researchers conduct systematic reviews and meta‐analyses independently for short‐term and long‐term outcomes. [ABSTRACT FROM AUTHOR]

In this study, we use a strengths-based approach to explore the ways that walking and cycling are practised and promoted in Māngere and Ōtara, two ethnically diverse, lower-income suburbs of Auckland, Aotearoa New Zealand. Using practice theory and positioning our research within a growing body of work on marginalised mobility cultures and the 'human infrastructure' of active transport, we find that family-centred, inclusive events; holistic promotion models; and strong volunteering and skills sharing networks are foundations of active mobility in South Auckland. Amongst the barriers to participation that were reported in our study, threats to safety stand out: They include road safety, concerns about personal security and stray dogs. Dealing with these threats requires advanced skills or 'competences' to sustain walking and cycling – particularly amongst women. We highlight the ways that infrastructural investment and community funding processes may help to overcome barriers and enable these communities to 'roll together'. [ABSTRACT FROM AUTHOR]

Based on interviews with low-income, Israeli mothers about their experience supporting children's remote-learning during COVID, this study offers theoretical insights about the accomplishment of natural-growth. The accomplishment of natural-growth is a theoretical concept coined by Lareau to describe the logics of low-income childrearing. Though concerted cultivation, which describes the logics of middle-class childrearing has garnered theoretical elaboration, little research has elaborated on practices for accomplishment of natural-growth. This study elaborates on these practices as they were revealed in mothers' narratives of adjustment to difficulties placed by remote-learning. The women described practices by which they sought to bind themselves and their children into a social network and to bridge out and utilize resources within and beyond this network. The analysis reveals that these practices work through social as opposed to cultural capital, revealing a childrearing logic based in a different type of capital than that of concerted cultivation. [ABSTRACT FROM AUTHOR]

This study examines how first-generation (FG) college students make meaning of their social class during their first-year of college. As a method, photovoice allowed for the creation of a rich set of data using student photos and accompanying narratives, through which three key themes were derived: (a) broken American dream, (b) honoring family sacrifices, and (c) lifting generations. This study informs both future practice and research by providing a deep understanding of the intersection of students' individual identities, contexts, and motivations through the lens of the social class worldview model (SCWM). [ABSTRACT FROM AUTHOR]

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Solid waste constitutes one of the most pressing environmental problems, requiring urgent action from urban managers to find appropriate management mechanisms. The rapid increase in municipal solid waste generation is undoubtedly due to the accelerated population growth rate triggered by massive rural-to-urban migration. This paper analyses solid waste management challenges in low-income communities in South Africa, using a case study from Alexandra, Johannesburg. Using qualitative and quantitative research approaches, findings revealed that solid waste is not reliably collected and transported in low-income communities in South Africa. The main obstacles include the scarcity of resources and equipment necessary for waste treatment. To widely involve residents of Alexandra Township in the waste management process, the municipal council should embark on a public awareness campaign. The findings further encourage effective waste sorting techniques, such as separating biodegradable from non-biodegradable waste, so that valuable goods can be taken to the local government recycling centre. The results further encourage the involvement of the homeless and unemployed in the recycling and waste management process, thereby reducing the shortage of human resources and creating jobs. These issues are analysed within the context of evolving arguments that focus on developing a pro-poor approach in solid waste management that may present an opportunity for achieving sustainable solid waste management in Johannesburg, South Africa. [ABSTRACT FROM AUTHOR]

There has been a growing emphasis on dissemination of empirically supported treatments. Dissemination, however, should not be restricted to treatment. It can and, in the spirit of the scientific-practitioner model, should also involve research. Because it focuses on the investigation of clinical routine as it takes place in local settings and because it can involve the collaboration of several stakeholders, practice-oriented research (POR) can be viewed as an optimal research method to be disseminated. POR has the potential of addressing particularly relevant gaps of knowledge and action when implemented in regions of the world that have limited resources for or experiences with empirical research, and/or in clinical settings that are serving clinical populations who are not typically receiving optimal mental care services - specifically, individuals in rural and inner cities that have limited economic and social resources. The establishment and maintenance of POR in such regions and/or settings, however, come with specific obstacles and challenges. Integrating the experiences acquired from research conducted in various continents (Africa, Europe, Latin America, and North America), the goal of this paper is to describe some of these challenges, strategies that have been implemented to address them, as well as new possible directions to facilitate the creation and growth of POR. It also describes how these challenges and ways to deal with them can provide helpful lessons for already existing POR infrastructures. [ABSTRACT FROM AUTHOR]

Living at or near poverty can be isolating for individuals and their families. Using the ecological perspective with emphasis on transactions across systems, we examine the social and community capital of urban, low-income individuals to understand the broader terrain that shapes and is shaped by some of their choices, and suggest the implications that our findings might have for anti-poverty initiatives. Data are from interviews with 181 urban residents involved in a federally funded workforce development training, a particular type of social support programming that endeavors to increase the human capital of participants so that they can compete more effectively in the labor market. Findings indicate that respondents have small, homogenous networks, live in resource depleted communities, and have limited sources of social support. We frame this as being caught in "urban silos," in which transactions to more resource-robust systems are minimal to non-existent. While the development of one's human capital is essential, because of these silos, it may not be sufficient for moving an individual and their family out of poverty. Job training, and other anti-poverty initiatives, need to intentionally assist participants in network building so they can better access opportunity pathways that provide jobs and other economic and social resources. [ABSTRACT FROM AUTHOR]

We use new survey data from 1,203 households in rural Eastern India to estimate cross-sectional models of overall energy use and embedded emissions. Findings indicate that the primary driver of household energy use is household size and affluence. This is unsurprising and consistent with findings from the engineering literature on energy demand. However, there is also a substantial and significant moderating influence of skills on energy use. For emissions, we observe a bifurcated relationship in line with educational attainment. For those that have completed secondary education or more, skills are negatively associated with energy use and emissions, whereas for those with lesser qualifications more skills are associated with more energy use and emissions. The results are consistent with the environmental Kuznets curve, which implies that a critical level of affluence is required before environmental impacts start lessening. The results also echo a sociological critique of human capital theory − that individual abilities are not productive in and of themselves, but rather in relation to socially determined opportunity structures. Our findings show that this could also hold for greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

This paper is a post hoc analysis and critical reflection of an unplanned methodology change made in the face of the unforeseen disruption brought by Covid-19 pandemic to a longitudinal study on children (N=462) from low-income families in Singapore. The research team was thrown into a state of intense ambivalence between waiting for life to come back to normal so that face-to-face survey could be resumed or to reformulate the methods and keep to the designed time intervals. This paper documents the framework that guided the urgent decision made for the change of data collection methods from f2f to video call survey, the trade-offs, implications on ethics and implementation results. Corroborating mixed post-hoc analysis methods of five qualitative focused group discussions with 39 survey interviewers who implemented the video-call survey, and statistical analysis of the consistencies of survey results over 3 time points, it was found that utilizing video call methodology did not lead to substantial difference in survey quality. The findings of this paper underscore the need for social science researchers to recognize the inevitability of uncertainties in the research fields and the need to strengthen one's preparedness for change while closely attending to the possible ethical implications. [ABSTRACT FROM AUTHOR]

Because housing is central to the recovery of individuals with experiences of homelessness and incarceration, it is important to consider how U.S. policies denying housing to residents with criminal histories can adversely affect racial and ethnic minorities and individuals with a history of homelessness. The state of Texas passed a rule specifying certain criteria that Low-Income Housing Tax Credit (LIHTC) supportive housing providers must use to screen tenants using criminal history. A retrospective cohort of 600 LIHTC supportive housing residents was used to estimate the potential impact of the rule. Based on this sample, the rule would have resulted in significantly higher proportions of Black and chronically homeless individuals being denied housing compared to the proportions of White and low-income individuals, respectively, who would have been denied housing. With the exception of drug convictions, there was no significant difference in recidivism between residents who would have been affected by the rule and unaffected residents who also had criminal justice involvement within a comparable time frame before move-in. [ABSTRACT FROM AUTHOR]

Background: Family-based treatment (FBT) is a front-line empirically supported intervention for adolescent anorexia nervosa, but it is often inaccessible to families from lower income backgrounds, as it is most typically available in specialty research and private practice settings. In preparation for a pilot trial of FBT delivered in the home setting, this study qualitatively examined provider perceptions of implementing FBT in lower-income communities. Methods: Eating disorder clinicians working in community clinics (therapists, medical doctors, dietitians, and social workers; n = 9) were interviewed about their experiences using FBT. Interview transcripts were analyzed both deductively, using an approach consistent with applied thematic analysis, and inductively, using the Replicating Effective Programs implementation framework, to examine barriers to FBT implementation. Results: Prevailing themes included concern about the time and resources required of caregivers to participate in FBT, which may not be feasible for those who work full time, have other caregiving demands, and/or lack family support. Psychosocial problems outside of the eating disorder, such as food insecurity, other untreated mental health concerns (in themselves or other family members), or externalizing behaviors on the part of the adolescent, were also discussed as barriers, and participants noted that the lack of cohesive treatment teams in the community make it difficult to ensure continuity of care. Conclusion: Findings from this qualitative study indicate the need to address systemic socioeconomic barriers to improve the efficacy of implementation of FBT in the community and to understand how provider perceptions of these barriers influence their uptake of FBT. Plain English summary: This study looks at reasons why providers think that family-based treatment for adolescent anorexia nervosa (FBT) is difficult to implement in community settings serving families from lower-income backgrounds. When interviewed, participants expressed concerned that FBT requires a lot of time and resources from families and that problems beyond the eating disorder (like having other mental health conditions or not having enough money to make ends meet) get in the way of treatment. [ABSTRACT FROM AUTHOR]

Background: Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity. Methods: This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate. Results: Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13–5.43; 2014 aOR 1.82, 95%CI 1.24–2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01). Conclusion: Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations. [ABSTRACT FROM AUTHOR]

Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022–23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city. [ABSTRACT FROM AUTHOR]

Most food access studies focus on large cities, examine traditional grocery stores, and only consider operational food outlets. This siloed approach exposes a gap in food access literature. Therefore, as a part of our assessment of Flint's food landscape, we examined closed food outlets in the city and surrounding townships. We investigated the relationship between the racial composition of census tracts and the number and type of defunct food outlets identified. We used Data Axle to collect and verify data on open and closed food outlets between September 2020 and December 2021. We made a final verification of the food outlet closures in June 2022. We used ArcGIS 10.8.1 and SPSS Version 28 to map and analyze the data. We used negative binomial regression models to determine differences in the likelihood of having an additional closed food outlet in census tracts with low and high percentages of Black residents. We also investigated the relationship between a census tract's median income and the likelihood of having an additional closed food outlet. There were 173 closed food outlets; 81 were in Flint, and 92 were in surrounding townships. The most frequently closed food outlets were restaurants; they accounted for 45.1% of the closures. The mean number of closed food venues in census tracts where less than 40% of the residents were Black was 1.5. The mean was similar in census tracts where 40% or more of the residents were Black; it was 1.6. This difference was not significant. However, the median income of a census tract was a significant predictor of the likelihood of having an additional closed food outlet. Every one-thousand-dollar increase in median income resulted in a 2% less likelihood of having an additional closed food outlet. The results of this study show that there is more to the food landscape of a city than its operational food outlets. Focusing exclusively on active food outlets does not accurately depict a city's food infrastructure. [ABSTRACT FROM AUTHOR]

The recent decision by the United States Supreme Court to limit affirmative action in college admissions could make it even more challenging for academically talented students of color to gain access to competitive schools. The importance of school counselors in guiding and supporting these students is now more crucial than ever. This qualitative study aimed to determine what school counselors need to know, do, and believe to help academically talented, Black students from low-income households gain admission into highly selective colleges and universities. Three broad themes and 10 subthemes emerged from the data analysis. The themes were (a) knowledge and awareness, (b) mindsets and beliefs, and (c) habits and practices. Implications for school counselor practice, training, and research are discussed. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer screening rates remain suboptimal, particularly among low‐income populations. Our objective was to evaluate the long‐term effects of Medicaid expansion on colorectal cancer screening. Design, Setting, and Participants: This cross‐sectional study analyzed data from 354,384 individuals aged 50–64 with an income below 400% of the federal poverty level (FPL), who participated in the Behavioral Risk Factors Surveillance System from 2010 to 2018. A difference‐in‐difference analysis was employed to estimate the effect of Medicaid expansion on colorectal cancer screening. Subgroup analyses were conducted for individuals with income up to 138% of the FPL and those with income between 139% and 400% of the FPL. The effect of Medicaid expansion on colorectal cancer screening was examined during the early, mid, and late expansion periods. Main Outcomes and Measures: The primary outcome was the likelihood of receiving colorectal cancer screening for low‐income adults aged 50–64. Results: Medicaid expansion was associated with a significant 1.7 percentage point increase in colorectal cancer screening rates among adults aged 50–64 with income below 400% of the FPL (p < 0.05). A significant 2.9 percentage point increase in colorectal cancer screening was observed for those with income up to 138% the FPL (p < 0.05), while a 1.5 percentage point increase occurred for individuals with income between 139% and 400% of the FPL. The impact of Medicaid expansion on colorectal cancer screening varied based on income levels and displayed a time lag for newly eligible beneficiaries. Conclusions: Medicaid expansion was found to be associated with increased colorectal cancer screening rates among low‐income individuals aged 50–64. The observed variations in impact based on income levels and the time lag for newly eligible beneficiaries receiving colorectal cancer screening highlight the need for further research and precision public health strategies to maximize the benefits of Medicaid expansion on colorectal cancer screening rates. [ABSTRACT FROM AUTHOR]

Dual language learners (DLLs), especially those from immigrant families in the United States, risk losing their home language as they gradually shift to speaking English as they grow up. Given the potential benefits of bilingualism on children's cognitive, linguistic, and social-emotional development, it is crucial to maintain children's home language to foster bilingual development. The current literature suggests that parental beliefs toward bilingualism and the language and literacy environment are linked to children's language development. With the growing number of DLLs living in the United States, little is known about what parental beliefs about bilingualism of their children are integrated into these bilingual households and parents' role in home language maintenance. The present study addresses the gap in the literature by investigating low-income immigrant families, specifically Chinese American and Mexican American families, and exploring the parental perceptions of children's bilingual language learning. Further, the present study examines the relations among parental perceptions of bilingualism, home language and literacy practices, and home language oral proficiency. Data were collected from a total of 41 Mexican American and 91 Chinese American low-income immigrant families with DLLs ages 50-88 months who had been recruited from Head Start programs and state-funded preschools in Northern California when the children were 3-4 years old. Information about shared reading frequency, home language exposure and usage, and parental perceptions of bilingualism was collected through parental interviews, and DLLs' home language oral proficiency was individually assessed. No significant difference in home language oral proficiency was observed between the two groups. Principal Components Analysis on the parental perceptions of bilingualism measure revealed two components, "Importance of Being Bilingual" and "English over Bilingualism." Stepwise regression analysis results show that "Importance of Being Bilingual" was associated with children's home language oral proficiency after controlling for culture, child age, the frequency of home language shared book reading, and child home language exposure and use. The results show that parents' positive beliefs toward bilingualism are related to the children's use of that language and their children's language outcomes. Implications and suggestions for home language and literacy support for DLLs are discussed.