Low-income Adult Women Research Articles

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications.

This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI). This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL® ) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods. The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01). The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.

Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children.

ObjectivesWe estimate the effect of the Affordable Care Act’s (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages.MethodsUsing data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions.ResultsThe ACA’s Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54 percent, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34 percent, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21 percent, p < 0.01).Conclusions for PracticeWithin the population of adult reproductive-aged women, we find a “fanning out” of effects from the ACA’s Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.

Body image (dis)satisfaction among low-income adult women

A better understanding of the factors that affect self-perception of body characteristics may play an important role in weight control practices. The objective of this study was to analyze body weight perception and body image satisfaction in low-income adult women in Southern Brazil. This was a cross-sectional survey study in a cohort of women recruited from areas of social vulnerability in the city of Porto Alegre, RS. A random sample (n=218) of women was interviewed, and socioeconomic and lifestyle factors, body image perception using the Stunkard Scale, body weight estimation, weight concern and duplicate anthropometric measurements were obtained. The average age of the low-income women was 56.3±9.5 years. The prevalences of overweight and obese individuals were 34.1% and 52.5%, respectively. Among all women, 83.0% were dissatisfied with their body image, and 68.9% of the women estimated their body weight correctly. In addition to BMI (body mass index), the proportions of women with a higher income (p=0.05), smoking history (p<0.01) and history of hypertension (p=0.04) were significantly different between groups according to body image satisfaction. Multivariate analyses using Poisson regression showed that black/mixed race, higher income, and underweight and obese women were more likely to be dissatisfied with their body image. The majority of women know their body weight and have body image dissatisfaction. Skin color, higher income and BMI were significantly associated with dissatisfaction. In addition, these women consider the "healthiest" body image to be thinner than the "ideal" body image, and the "ideal" image is one of normal weight and not too thin.

Construction of Healthy and Palatable Diet for Low Socioeconomic Female Adults using Linear Programming

Differences in socioeconomic profile may influences healthy food choices, particularly among individuals with low socioeconomic status. Thus, high-energy dense foods become the preferences compared to high nutritional content foods due to their cheaper price. The present study aims to develop healthy and palatable diet at the minimum cost based on Malaysian Dietary Guidelines 2010 and Recommended Nutrient Intake 2005 via linear programming. A total of 96 female adults from low socioeconomic families in Johor, South East Malaysia have been recruited for the present study. Anthropometric measurement; weight and height, socio-demographic information and 3-days food record have been collected from the subjects. In addition, data on food prices have also been collected. Then, a linear programming model has been developed to select the cheapest food combinations that could fulfil all the nutritional recommendations and palatable constraints in order to capture common dietary habit of the locals. Subsequently, healthy seven-days menus have been created using the optimal food servings estimated from the linear programming model. Dietary data have shown that the average energy intake among low-income adult women (1871 ± 317 kcal/day) is less than the nutrient recommendation. Thus, from the linear programming analysis, the minimum food cost has been estimated at RM6.55 (2.15 USD) for the total energy intake of 2000 kcal per day for a female adult which meets the recommendation of MDG 2010 and RNI 2005. In conclusion, linear programming may be a useful tool to develop healthy and palatable diets at a minimal cost in managing dietary problems among low socioeconomic groups where food expenditure becomes an important restraining factor. Eventually, low socioeconomics female adults would improve their nutritional intake by making wiser food choices to meet all the nutritional requirements, which lead to healthier life.

Integrating family planning and primary care at publicly funded organizations in Texas to repair the reproductive health safety net

Objectives: Following dramatic funding cuts in 2011 that closed 25% of clinics, the Texas state legislature aimed to rebuild family planning services by allocating US$100 million in 2013 to establish the Expanded Primary Health Care (EPHC) program, which covers primary care and contraceptive services for low-income adult women. We examine organizations' experiences providing family planning services during the EPHC program's first year.

Effect of physical intimate partner violence on body mass index in low-income adult women.

This study aimed to assess whether physical intimate partner violence affects the nutritional status of adult women with different levels of body mass index (BMI). This was a population-based cross-sectional study with 625 women selected through complex multistage cluster sampling. Information on physical intimate partner violence was obtained with the Revised Conflict Tactics Scales, and nutritional status was measured as BMI (kg/m2). A quantile regression model was used to assess the effect of physical intimate partner violence at all percentiles of BMI distribution. Physical intimate partner violence occurred in 27.6% of the women (95%CI: 20.0; 35.2). Mean BMI was 27.9kg/m2 (95%CI: 27.1; 28.7). The results showed that physical intimate partner violence was negatively associated with BMI between the 25th and 85th percentiles, corresponding to 22.9 and 31.2kg/m2. The findings support previous studies indicating that physical intimate partner violence can reduce BMI in low-income women.

Physical Activity and Nutritional Weight Loss Interventions in Obese, Low-Income Women: An Integrative Review

Obesity is epidemic in the United States and is considered a public health issue that disproportionally affects low-income women. Combating obesity among low-income women presents unique challenges that must be addressed if weight loss interventions are to be successful. The aim of this integrative review was to explore and synthesize the literature that addresses physical activity and nutrition interventions used to combat obesity in obese, low-income women. A search for original research published between 2006 and 2011 was conducted in online databases. In addition, a hand search of references was performed, and one author was contacted to clarify outcome data. Articles that met inclusion criteria targeted obese, low-income adult women; focused on physical activity or nutrition behavior as an intervention; and measured change in weight as a primary outcome. Studies that focused on women who were postpartum or breastfeeding and those that used pharmacologic or surgical interventions to augment weight loss were excluded. A total of 7 articles were chosen for critical appraisal. According to a synthesis of the current studies, specific weight loss interventions for physical activity and nutrition behavior change for obese, low-income women produced the desired outcome of weight loss. Participants among these studies voiced a preference for group interventions led by peers or medical professionals. Interventions led by peer educators were successful and had the advantage of lowering cost and increasing sustainability. Pragmatic nutrition education worked best, especially when cognizant of cost, food preferences, and culture. Even small increases in physical activity augmented weight loss; however, safety concerns prevented some low-income women from engaging in exercise. According to this synthesis of the best-available evidence, customized weight loss interventions are effective in obese, low-income women. By incorporating these evidence-based interventions, clinicians can be instrumental in decreasing the burden of obesity in obese, low-income women.

Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

Intimate partner violence and child maltreatment: Understanding intra- and intergenerational connections

Objective The purpose of this study is to assess the extent to which intimate partner violence and different forms of child maltreatment occur within and across childhood and adulthood for a high-risk group of women. Method Low-income adult women were interviewed, retrospectively, regarding their experiences with intimate partner violence and child maltreatment in childhood and adulthood, and intra- and intergenerational relationships between multiple forms of family violence were identified. Results Analyses demonstrated weak to moderate associations between various forms of violence within generations. Only weak support was found for the transmission of violence hypothesis that maltreated children are more likely to grow up to maltreat their own children. Stronger support was found for the theory of learned helplessness, whereby children maltreated or witness to violence during childhood are more likely to be victimized as an adult. Conclusion The results from this study suggest that interventions with children who are identified for one form of victimization should be assessed for other forms of victimization, and interventions should also address learned behaviors or beliefs associated with continued or future victimization.

Provision of Hormonal Contraceptives without a Mandatory Pelvic Examination: The First Stop Demonstration Project

First Stop, an 18-month demonstration project that operated in 1996-1997, was designed to offer low-income adult women in California hormonal contraceptives without requiring a pelvic examination. An evaluation was undertaken to assess the contraceptives adopted by First Stop clients, compare health risks of these women with risks among women using traditional family planning clinics and assess clients'satisfaction. Data on 2,065 First Stop clients and 1,507 women attending traditional clinics were collected through several self- and clinician-administered instruments, including questionnaires, a telephone survey and medical chart abstractions. After the initial First Stop visit, 38% of women adopted a more effective method than they had used at last sex, 4 7% remained with the same method, 12% switched to a less-effective method and 3% accepted no method. Of clients who were referred for additional medical care, 73% followed through on their referrals. Compared with clients at traditional clinics, First Stop clients were less likely to have a regular source of health care, but more likely to have made a health care visit in the past year. Most First Stop clients valued the project's services; 76% said it was important to be able to receive pills or injections without a pelvic examination. Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women's access to these methods and improve the chances that they will obtain other reproductive health services.

Access barriers and the use of prenatal care by low-income, inner-city women.

An important public health agenda in the United States is improving access to prenatal care, particularly for low-income women. The study discussed in this article was designed to determine which social, environmental, and psychological barriers are most likely to interfere with the early and regular use of prenatal health services. Low-income adult women hospitalized on the postpartum unit of a large urban medical center were interviewed about the barriers they experienced gaining access to prenatal care. Access barriers involving family and friends significantly increased the odds of receiving inadequate care, particularly not wanting anyone to know about the pregnancy and not having help getting to clinic appointments. Other important barriers included those related to the health care system and intrapersonal issues. Social workers are in an ideal position to help women eliminate barriers to access to prenatal care through clinical expertise in assessment, advocacy, outreach, and case management.