Low-income Households Research Articles

Heatwaves and hardship: Shortcomings and solutions for enhancing the low income home energy assistance program to mitigate extreme heat and energy insecurity

The Low Income Home Energy Assistance Program (LIHEAP) must adapt and evolve to keep pace with the challenges posed by climate change and increased economic strain. Urgent action is needed to improve LIHEAP to effectively address extreme heat and energy insecurity faced by low-income households and protect the health and well-being of disadvantaged groups spurred by climate change. In evaluating LIHEAP’s shortcomings, we demonstrate that there is a substantial gap between program eligibility and enrollment, such that many households are not receiving this vital benefit or do so mainly when facing a crisis. We also show that LIHEAP funds overwhelmingly support cold-weather states even as record-breaking heat is a critical stressor. The spatial mismatch we unveil shows that southern states receive less LIHEAP funds despite higher cooling degree days and higher rates of energy insecurity. The importance of swift action based on sound data and up-to-date research can enhance the efficacy of LIHEAP, expand its reach, and ultimately improve the living conditions of millions of energy insecure households. We offer several recommendations to improve LIHEAP to ensure that this critical lifeline program remains an effective tool to mitigate energy insecurity and safeguard livelihoods in the face of extreme heat.

Neighbourhood Environments and Lifestyle Behaviours in Adolescents With Type 1 Diabetes

ObjectivesEarly prevention strategies are needed to mitigate the high risk of cardiovascular disease in adolescents with type 1 diabetes (T1D). Residential neighbourhood features can promote healthy lifestyle behaviours and reduce cardiovascular risk, but less is known about their role in lifestyle behaviours in adolescents with T1D, and no studies used comparisons to healthy controls. MethodsWe examined associations between residential neighbourhood features and lifestyle behaviours in adolescents with T1D and healthy controls. Data were analyzed from the CARdiovascular Disease risk factors in pEdiatric type 1 diAbetes (CARDEA) study, a cross-sectional investigation of 100 adolescents with T1D (14 to 18 years) from a pediatric diabetes clinic in Montréal, Canada, and 97 healthy controls. Outcomes included physical activity and sedentary behaviour (accelerometry), screen time and sleep duration (questionnaires), and dietary habits (24-hour recalls). Cluster analysis of selected neighbourhood indicators computed for participants’ postal codes resulted in 2 neighbourhood types: central urban and peri-urban. Central urban neighbourhoods were characterized by very high population density, high active living index, numerous points of interest, higher social deprivation, higher residential mobility, and lower median household income compared with peri-urban neighbourhoods. Associations of neighbourhood type with lifestyle behaviours were estimated with multiple linear regressions and interactions by T1D status were tested. ResultsLiving in central urban neighbourhoods was associated with greater daily minutes of moderate-to-vigourous physical activity (beta = 8.61, 95% confidence interval 1.79 to 15.44) compared with living in peri-urban neighbourhoods. No associations were observed for other lifestyle behaviours, and no statistically significant interactions were found between neighbourhood type and T1D status. ConclusionFeatures that characterize central urban built environments appear to promote physical activity in adolescents, regardless of T1D status.

The Effects of the 2021 Child Tax Credit on Housing Affordability and the Living Arrangements of Families With Low Incomes

Access to safe and stable housing is important for child and adult well-being. Yet many low-income households face severe challenges in maintaining stable housing. In this article, we examine the impact of the 2021 temporary expansion to the Child Tax Credit (CTC) on housing affordability and the living arrangements of families with low incomes. We employ a parameterized difference-in-differences method and leverage national data from a sample of parents who are receiving or recently received Supplemental Nutrition Assistance Program benefits (N = ∼20,500), many of whom became newly eligible for the CTC. We find that the monthly CTC reduced parents’ past-due rent/mortgages (both amounts and incidence) and their reports of potential moves due to difficulties affording rent/mortgages. The CTC increased the likelihood that parents reported a change in their living arrangements and reduced their household size, both effects driven by fewer mothers living with a partner (and not a reduction in doubling up). We find some differences in effects by race and ethnicity and earnings. Our findings illustrate that the monthly credit improved low-income parents’ ability to afford housing, gain residential independence from partners, and reduce the number of people residing in their household.

Health at Home: Investigating Low-Income Housing Quality on Colfax Avenue

Abstract: Addressing housing insecurity contributes to health care programs as stable housing has positive health benefits. Home environmental hazards may reduce these potential health benefits and could increase morbidity for conditions such as asthma. This study examined housing and indoor air quality among urban low-income households in Colorado to inform housing-insecurity interventions. We conducted a community-engaged study among residents of motels, mobile homes, apartments, and single-family homes that included a survey on the home environment, health, and sociodemographic factors, spirometry, and indoor air quality measurement. We enrolled 60 households: 50% single-family homes, 37% apartments, and 13% residential motels. Perceived stress and depression were higher among motel residents compared with other housing types. We did not find differences in lung function by housing type. Indoor fine particulate matter (PM2.5) and black carbon concentrations were higher in motels than in other housing types. The differential health impacts of housing type support housing programs that jointly address security and quality.

The Impact of Age and Vaccine Conspiracy Beliefs on COVID-19 Vaccine Uptake among United States Adults.

This observational study examined the relationships between age, vaccine conspiracy beliefs, and COVID-19 vaccine uptake in emerging adults (ages 20-30) and middle-aged adults (ages 50-60) residing in the United States. It also examined sociodemographic predictors of vaccine conspiracy beliefs and COVID-19 vaccine uptake-political conservativism, household income, and educational attainment. We recruited 198 emerging adults and 198 middle-aged adults to complete an online survey assessing vaccine conspiracy beliefs and COVID-19 vaccination status. First, we found that emerging adults reported stronger vaccine conspiracy beliefs than middle-aged adults (estimated mean difference = 0.43, 95CI = 0.08, 0.79, p = 0.017), but that emerging adults and middle-aged adults did not differ in their likelihood of being vaccinated with estimated rates of COVID-19 vaccination uptake of 63% in emerging adults and 64% in middle-aged adults. Political conservativism was associated with stronger vaccine conspiracy beliefs and lower COVID-19 vaccine uptake. Lower household income and lower educational attainment were associated with lower COVID-19 vaccine uptake but not associated with vaccine conspiracy beliefs. Second, we found that age moderated the relationship between vaccine conspiracy beliefs and COVID-19 vaccine uptake; stronger vaccine conspiracy beliefs predicted lower COVID-19 vaccine uptake among middle-aged adults (B = -0.63, 95CI = -0.90, -0.36, p < 0.001) but were not associated with COVID-19 vaccine uptake among emerging adults (B = -0.21, 95CI = -0.47, 0.05, p = 0.12). These results provide insight into the sociodemographic and psychological factors that influence COVID-19 vaccine uptake. Our findings can help to inform the design of targeted public health interventions to increase vaccine uptake in the ongoing fight against COVID-19. Given the crucial role of vaccination in controlling the spread of COVID-19, it is also imperative for future studies to continue investigating how age and vaccine conspiratorial beliefs intersect to impact vaccine uptake.

Wage subsidy in the DRC: A CGE analysis

This paper analyzes the impact of wage subsidies on lower-skilled formal workers in the Democratic Republic of Congo (DRC). It employs a multi-sectoral, empirically-calibrated general equilibrium model to capture the economy-wide transactions between the formal and informal sectors and assess policy simulations in the DRC. The simulations, both in the short and long run, indicate that when the government provides wage subsidies to lower-skilled workers, it significantly improves the real disposable incomes of both formal and informal households. There is a general increase across formal and informal sectors in real household disposable incomes due to the wage subsidy. The results show that subsidy allocation narrows the income gap between high and low-income households, as well as between formal and informal sectors. The findings are insightful for wage policy simulations, as the wage subsidy targeting lower-skilled formal workers increases real GDP from the expenditure side by 1.19% and 3.19% in the short and long run, respectively, from the baseline economy.

The nexus between internet use and consumption diversity of rural household

Exploring approaches to improve rural household well-being has always been an important task. This research investigates the effect of Internet use on rural household well-being measured by household consumption diversity, utilizing the 2016, 2018, and 2020 China Family Panel Studies survey data. To assess rural household consumption diversity, we employ the Simpson index and Shannon−Weaver index. To address the endogeneity of Internet use, we regress an instrumental variable-based two-stage least square (2SLS) method. The results show that Internet use substantially improves rural household consumption diversity. The disaggregated analysis suggests that low-income and small households in Central China benefit the most in consumption diversity improvement from using the Internet. Moreover, the mechanism analysis results show that household deposits and households’ beliefs about accessing commercial activities can positively mediate the relationship between Internet use and consumption diversity of rural household. Our findings provide new evidence for the literature on the role of Internet use in improving household consumption diversity in rural China.

Low household income increases risks for chronic obstructive pulmonary disease in young population: a nationwide retrospective cohort study in South Korea

BackgroundLow socioeconomic status is a risk factor for chronic obstructive pulmonary disease (COPD); however, the association between low household income and COPD in young populations remains unclear.MethodsWe screened individuals aged...

Assessing the equity and coverage policy sensitivity of financial protection indicators in Europe

Progress towards universal health coverage is monitored by the incidence of catastrophic spending. Two catastrophic spending indicators are commonly used in Europe: Sustainable Development Goal (SDG) indicator 3.8.2 and the WHO Regional Office for Europe (WHO/Europe) indicator. The use of different indicators can cause confusion, especially if they produce contradictory results and policy implications. We use harmonised household budget survey data from 27 European Union countries covering 505,217 households and estimate the risk of catastrophic spending, conditional on household characteristics and the design of medicines co-payments. We calculate the predicted probability of catastrophic spending for particular households, which we call LISAs, under combinations of medicines co-payment policies and compare predictions across the two indicators. Using the WHO/Europe indicator, any combination of two or more protective policies (i.e. low fixed co-payments instead of percentage co-payments, exemptions for low-income households and income-related caps on co-payments) is associated with a statistically significant lower risk of catastrophic spending. Using the SDG indicator, confidence intervals for every combination of protective policies overlap with those for no protective policies. Although out-of-pocket medicines spending is a strong predictor of catastrophic spending using both indicators, the WHO/Europe indicator is more sensitive to medicines co-payment policies than the SDG indicator, making it a better indicator to monitor health system equity and progress towards UHC in Europe.

Receipt of Gender-Affirming Surgeries Among Transgender and Gender Diverse Veterans.

Gender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package. To describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest ("top") and genital ("bottom") surgeries. Cross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023. A total of 6653 Veterans (54% response rate) completed the survey. Self-reported "top" and "bottom" GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region. Among all respondents, 39% had ≥ 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18-39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master's degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery. GAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.

The smart TV in low-income migrant households: Enabling digital inclusion through social and cultural media participation

This paper reports on an ethnographic study that examined smart TV use in low-income migrant households in Australia. We find that the smart TV is used by migrant families for diverse forms of social and cultural participation. In addition, we find that YouTube – which is often accessed using the smart TV – is reshaping family media practices. We argue that while digital inclusion scholarship has focussed on access to and use of mobile phones, laptops and computers, the smart TV, perhaps more than any other device in the home, enables digital inclusion through intergenerational media engagement. This paper presents insights for policymakers and offers a new area for investigation for digital inclusion and media scholars.

IsiZulu-speaking caregivers' perceptions of child language stimulation.

South African children from low-income households are at higher risk of cognitive-linguistic difficulties because of multiple risk factors. Early language stimulation minimises the effects of risk factors and prepares children for literacy and learning. Understanding caregivers' perceptions of language stimulation is important because perceptions shape practices, which determine child language outcomes. This study explored the existing perceptions of language stimulation among 15 isiZulu-speaking caregivers from KwaDabeka township. A qualitative, descriptive research design was adopted and the caregivers were interviewed using a semi-structured interview schedule. The NVivo software programme supported the inductive, thematic analysis of the data. Although the caregivers held positive perceptions of language stimulation, their perceptions of benefit focussed on meeting children's basic physiological needs with less reference to the long-term benefits for literacy, employment and social integration. Providing language models, watching television, singing songs, and reading books were perceived to be examples of language-stimulating activities and techniques. The caregivers expressed a need to improve their knowledge of language stimulation and queried how they could be supported to achieve this outcome. This group of caregivers needed support to increase their awareness of the long-term benefits of language stimulation and their knowledge and use of evidence-based activities, stimuli and facilitation techniques.Contribution:Caregivers' existing perceptions could serve as a barrier to the effective language stimulation of children from low-income households in South Africa.

Intake of dietary flavonoids in relation to overactive bladder among U.S. adults: a nutritional strategy for improving urinary health.

The increasing influence of overactive bladder (OAB) on physical as well as mental health of individuals is becoming more pronounced annually, as evidenced by the urge urinary incontinence and nocturia. Symptoms in OAB patients may be influenced by inflammation and oxidative stress. Flavonoids are recognized as significant anti-inflammatory and antioxidant agents, which are commonly available in fruits, tea, vegetables, etc. Previous research has demonstrated the therapeutic potential of flavonoids and their subclasses in treating inflammation, and oxidative stress. Despite this, there remains a paucity of research exploring the potential correlation between flavonoid consumption, specifically within distinct subclasses, and OAB. Thus, our study aims to investigate the relationship between flavonoid intake and OAB to identify possible dietary interventions for OAB management. We utilized the survey data from the National Health and Nutrition Examination Survey (NHANES) and the USDA Food and Nutrient Database for Dietary Studies (FNDDS) to investigate the relationship between dietary intake of total and subclass flavonoids and the risk of OAB based on 13,063 qualified American adults. The dietary flavonoid intake was estimated from two 24-h dietary recalls. Weighted multivariate logistic regression model, quantile-based g-computation, restricted cubic spline model, and stratified analysis were used to explore the association between flavonoid intake and OAB, respectively. The participants diagnosed with OAB exhibited a higher percentage of being female, older, Non-Hispanic Black, unmarried, former drinkers, having a lower annual household income, lower poverty to income ratio, lower educational attainment, and a higher likelihood of being obese and smokers. Upon adjusting for confounding factors, the weighted logistic regression models revealed that the third quartile of consumption of anthocyanidin and the second quartile of consumption of flavone were significantly associated with the reduced odds of OAB, while total flavonoid consumption did not show a significant correlation with the risk of OAB. The quantile-based g-computation model indicated that flavone, anthocyanidin and flavonol were the primary contributors to the observed negative correlation. Furthermore, the restricted cubic spline models demonstrated a J-shaped non-linear exposure-response association between anthocyanidin intake and the risk of OAB (P nonlinear = 0.00164). The stratified and interaction analyses revealed that the relationship between anthocyanidin intake and the risk of OAB was significantly influenced by age (P interaction = 0.01) and education level (P interaction = 0.01), while the relationship between flavone intake and the risk of OAB was found to vary by race (P interaction = 0.02) and duration of physical activity (P interaction = 0.05). Our research suggests that consuming a diet rich in flavonoid subclass anthocyanidin and flavone is associated with a reduced risk of OAB, potentially offering clinical significance in the prevention of OAB development. This underscores the importance of dietary adjustments in the management of OAB symptoms.

Survey on health literacy and related factors among firefighters of emergency management departments in Southwest China

ObjectiveAlthough health literacy (HL) has emerged as a critical public health concern, research on HL in emergency management departments is limited. This study aimed to investigate the awareness of HL and associated factors among firefighters of emergency management departments in southwest China to provide a basis for carrying out targeted health education.MethodsA cross-sectional convenience sample of 1,742 firefighters from an emergency management department in southwestern China was surveyed from February to April 2023 using the Chinese Citizen’s Health Literacy Questionnaire (2019 version). The chi-square test, linear trend chi-square test, Fisher’s test, rank sum test, and multifactorial logistic regression model were used to identify influential factors associated with HL.ResultsThe HL level of the 1742 respondents was 34.3%. Age, ethnicity, education level, length of service, type of job, smoking status, types of parental jobs, annual household income, time of daily internet use, etc. (P < 0.05). The results of multivariate logistic regression analysis indicate that type of job (OR = 0.648, 95%CI:0.426–0.985), length of service (OR = 0.496, 95%CI:0.251–0.981), household income (OR = 1.900, 95%CI:1.443–2.502), daily internet usage time (OR = 0.726, 95%Cl:0.588–0.896), health status (OR = 0.750, 95%Cl:0.585–0.962) and frequency of organizing HL sessions (OR = 1.603, 95%Cl:1.101–2.330) were influencing factors affecting the HL of the officers and soldiers.ConclusionThe health literacy level of firefighters in the Emergency Management Department in Southwest China was 34.3%. Lower levels were found in the health-related skills dimension (HRS, 30.1%) and in infectious disease control (ID, 30.7%). Health information literacy (HI, 34.3%) was lower than the national level. The type of urban and rural areas, literacy level, and household income level may be the factors affecting the level of health literacy among the respondents. Therefore, health education and promotion interventions should target high priority dimensions (HRS, HI, and ID) and should focus on strengthening health literacy levels of firefighters with rural types, low education levels, and low household income to improve their health.

Racial and economic segregation and diabetes mortality in the USA, 2016–2020

BackgroundThe purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.MethodsWe conducted a cross-sectional ecological study...

Impact of Racial and Socioeconomic Disparities on Access to Interspinous Spacer for Treatment of Lumbar Spinal Stenosis: A Nationwide Medicare Analysis.

In mild to moderate lumbar spinal stenosis (LSS) where conservative care treatments fail, minimally invasive treatments, such as interspinous spacers without decompression or fusion (ISD), may be appropriate. While previous studies have demonstrated racial and socioeconomic disparities in the surgical treatment of LSS, there are limited data on how those factors impact accessibility to these procedures. This study explored demographic, socioeconomic, and geographic differences in the use of ISD. Using the Medicare 100% files from 2017 through 2022, this retrospective claims analysis identified when and if patients diagnosed with LSS received ISD implantation. Cox proportional hazards regression was used to examine the association between racial and socioeconomic characteristics and the rate of ISD implantation, stratified by geographic region. A total of 1,316,622 individuals met the inclusion criteria; 4730 (0.4%) underwent ISD implantation, with a mean (standard deviation) time to treatment of 11.9 (13.2) months after diagnosis. The likelihood of ISD implantation was higher for older patients (except for the oldest group), males, those with lower disease burden, and White patients. Cox regression revealed that the associations of racial and socioeconomic factors with ISD implantation varied by U.S. region. In the Midwest and Northeast, lower median household income was associated with a decreased likelihood of ISD implantation regardless of race, while in the South, Black patients were less likely to undergo ISD implantation regardless of income. The observed disparities in access to ISD implantation mirror existing trends in surgical interventions for LSS, suggesting further study and interventions are needed to address inequities.

Households’ access and expenditure on water services: Examining intra-urban differences in the Accra metropolis, Ghana

Despite years of investment into the water sector in Ghana, access to and expenditure on potable water for drinking and domestic use remain a challenge for most urban households. However, within the urban context, the severity of water challenges varies from one residential community to another, with less research attention often given to such intra-urban differences. To address this gap, this study examines differences in household access and expenditure on pipe-borne water in three varying socio-economic residential communities in Accra. The study used a convergent mixed method design and drew on secondary literature, to examine the differences in households' access to and expenditure on water. The findings revealed that Jamestown, a low-income residential community, had the lowest connection to the Ghana Water Company Limited (GWCL) grid, with many respondents depending on pipe-borne water outside dwellings operated by private water retailers. While the findings showed no significant differences in the regularity of flow and expenditure on water among the three varying socio-economic communities, the paper argues that low-income communities such as Jamestown are likely to be more affected due to existing socio-economic deprivation and vulnerability contexts. Based on the study findings, we recommend that efforts be made to increase investment in water infrastructure to enable households to connect to the GWCL grid. Attention should also be given to low-income households, who often lack the means to pay for services that will enable them to connect to the GWCL grid. Further, we recommend improved collaboration between local communities and GWCL as a way of fostering strategies that address the peculiar water challenges in local communities.

Engaging Nonphysician Staff in Practice Facilitation-Mediated Quality Improvement to Improve Health Outcomes in Under-Resourced Clinical Practices in New York City.

In New York City (NYC), hypertension and high cholesterol disproportionately affect residents with low household income and people of color. The NYC Health Department employed practice facilitation (PF) to help nonphysician staff assume added roles aligned with team-based care. The objective was to improve blood pressure (BP) and cholesterol management in 132 small primary care practices serving mostly patients of color. We categorized practices into higher or lower levels of integrated PF, defined as physicians and nonphysician staff collectively participating in PF. Higher integrated PF was associated with improvements in BP (rate ratio [RR]=1.09, P-value<.05) and cholesterol management (RR=1.12, P-value<.01). Nonphysician staff in higher integrated PF practices reported skills enhancement and improved teamwork. Involving nonphysician staff in PF-mediated quality improvement efforts can be an effective strategy to improve health outcomes in small clinical practices serving communities with a higher burden of chronic disease and disproportionately impacted by poverty and structural racism.

Nature participation during pandemic restrictions: results for different socio-economic groups and policy preferences in South Australia

ABSTRACT Nature participation is known to be an important health and wellbeing contributor. The COVID-19 pandemic brought unprecedented changes to peoples’ lives around the world. Also, in Australia, lockdown restrictions limited the way people lived and resulted in significant impacts on physical and mental wellbeing. This study investigated the characteristics and views of 2500 South Australian residents regarding both regular nature and COVID-19-induced nature participation, related stated health effects and policy preferences for increased nature engagement. Results highlight that being younger, female, Aboriginal or Torres Strait Islander as well as having families with children and living in more socio-economic advantaged and less rural areas was significantly associated with increased nature participation during the pandemic. Being unable to work, for example due to a disability, was significantly related to less nature visits during the pandemic and increased nature access issues. Access issues were also experienced by low income households and those living in socio-economic disadvantaged areas, as well as Aboriginal or Torres Strait Islander respondents. Future policies would benefit from considering the nature participation needs for all groups of society to alleviate existing inequities, particularly during pandemic restrictions.

Awareness, information sources, and beliefs regarding palliative care in the general population in Japan: a nationwide cross-sectional survey (INFORM study 2023).

The diversification of information sources and changes in social structures necessitates updates on the state of public awareness of palliative care. Therefore, we clarified the status and determinants of awareness, information sources, and beliefs, regarding palliative care in Japan. This nationwide cross-sectional survey included 10 000 participants aged ≥20years enrolled through random sampling using a two-stage stratification in 2023. We used a mailed self-administered questionnaire (INFORM Study 2023). The questionnaire items were selected (partially modified) from the Health Information National Trends Survey (USA) to ensure comparability, included palliative care awareness, information sources, and beliefs. Weighted logistic regression was conducted to explore the determinants of awareness. Of the 3452 participants that responded (response rate: 35.3%), 65.2% had palliative care awareness. The weighted logistic regression analysis revealed that respondents less likely to have any palliative care awareness were younger, were male, had limited education history, had lower household income, and were non-Internet users. Of these, sex had the clear association (adjusted odds ratio for female vs. male: 3.20 [95% CI: 2.66-3.85]). Across all age groups, healthcare professionals (58.5%) and the Internet (30.5%) were the most trusted source of information. Younger participants frequently received information online. Most participants believed that palliative care was beneficial, although 82.0% associated it with death. The Japanese population had a relatively high palliative care awareness, with the majority trusting information from healthcare professionals rather than the Internet. Further efforts are warranted to address barriers to receiving trustworthy palliative care information.