Persons Of Low Socioeconomic Status Research Articles

Impact of Human Immunodeficiency Virus Type-1-Associated Cognitive Dysfunction on Activities of Daily Living and Quality of Life

We examined the impact of neuropsychological (NP) impairment on activities of daily living (ADLs) and quality of life in human immunodeficiency virus type-1 (HIV-1)-infected persons of low socioeconomic status (SES). Thirty-nine patients were stratified into one of three groups: cognitively normal (n = 13), mild cognitive impairment (n = 15), and moderate/severe impairment (n = 11). Quality of life was assessed with the Sickness Impact Profile and ADLs were evaluated via structured interview performed in the patient's residence. While there were no significant differences across groups on disease stage, drug use, depression, or estimated premorbid IQ, cognitively impaired patients were more likely to be unemployed and fail social planning and medication management tasks. Our study confirms a previously reported association between NP impairment and unemployment among HIV-1-infected patients. The data also extend this relationship to a low-SES sample with a high base rate of unemployment, and to instrumental activities of daily living other than work.

Interpersonal processes of care in diverse populations.

Persons of lower socioeconomic status and members of racial and ethnic minority groups experience poorer health and increased health risk factors. A framework of interpersonal processes of care specifies distinct components and incorporates the perspective of diverse racial and ethnic or socioeconomic groups. Its dimensions, each with several domains, are communication (general clarity, elicitation of and responsiveness to patient concerns, explanations, empowerment), decision making (responsiveness to patient preferences, consideration of ability and desire to comply), and interpersonal style (friendliness, respectfulness, discrimination, cultural sensitivity, support). All the domains, except cultural sensitivity, were validated through a survey of 603 ethnically diverse, low-income adults. Confirmation of the framework's usefulness should enable researchers to explore how interpersonal processes might account for observed ethnic and social class differences in health care and health.

Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts.

To identify groups for melanoma prevention and early detection programs, this study explored the hypothesis that survival with cutaneous melanoma is disproportionately lower for persons of lower socioeconomic status. Massachusetts Cancer Registry and Registry of Vital Records and Statistics data (1982 through 1987) on 3288 incident cases and 1023 deaths from cutaneous melanoma were analyzed. Mortality/incidence ratios were calculated and compared, predictors of late stage disease were examined with logistic regression analysis, and a proportional hazards regression analysis that used death registration as the outcome measure for incident cases was performed. Lower socioeconomic status was associated with a higher mortality/incidence ratio after adjustment for age and sex. For education, the mortality/incidence ratio was 0.37 in the lower group vs 0.25 in the higher group (rate ratio = 1.48, 95% confidence interval [CI] = 1.08, 2.03). Late stage disease was independently associated with lower income (rate ratio for lowest vs highest tertile = 1.64, 95% CI = 1.20, 2.25), and melanoma mortality among case patients was associated with lower education (rate ratio = 1.52, 95% CI = 1.09, 213). Melanoma patients of lower socioeconomic status may be more likely to die from their melanoma than patients of higher socioeconomic status. Low- SES communities may be appropriate intervention targets.

New Prevention Research Center Targets Diet, Physical Activity And Smoki Ns For Study Through Community-based Interventions In A Rural Midwest Population

Changing eating, exercise and smoking habits in rural midwest communities is a principal goal of the newly established Prevention Research Center. The Center, a partnership between the Centers for Disease Control and Prevention, the Saint Louis University School of Public Health and the Missouri Department of Health, is funded from 1994 through 1998.The Center pursues its mission - to prevent disease and disability in the rural midwest - through applied research to reduce cardiovascular disease in a high-risk population. This population consists of persons of lower socioeconomic status in a 12-county area of southeast Missouri, total population 217,000.In the major research study, Community-Based Intervention for Healthy Lifestyles, staff train local coalitions to implement interventions targeting fruit and vegetable intake, physical activity and cigarette smoking. Coalitions also mobilize communities to accept policy change related to these interventions.Diet-, exercise- and smoking-related outcome objectives are to increase fruit and vegetable intake to five or more servings per day by 6% (baseline: 20%), to increase physical activity by 8% (baseline: 39%), and to decrease cigarette smoking by 6% (baseline: 29%). Environmental and policy objectives include implementing school lunch policies to decrease fat to less than or equal to 30% total calories, increasing referrals for dietary change, enhancing media coverage of cardiovascular risk issues, building walking trails, and establishing local ordinances prohibiting tobacco sales to minors.The quasi-experimental study design allows us to match at the group level (intervention and comparison county pairings) and analyze at the individual level (personal interviews). Appropriate statistical techniques will be employed. Evaluation methods include phone surveys based on a Behavioral Risk Factor Surveillance System questionnaire, focus groups, a network analysis, level-of-effort analyses, and the FORECAST technique. Preliminary study results are expected in late 1995

Physical Activity, Body Weight, and Adiposity

Overweight is a common problem in the United States, especially among minority women and persons of lower socioeconomic status and lower educational attainment. Moreover, the prevalence of reported inactivity may be highest in these same population subgroups. Both overweight and sedentary behavior are important risk factors for chronic disease morbidity and mortality; however, there is encouraging evidence that moderate to higher levels of physical activity may provide protection from certain chronic diseases, even among persons with established risk factors. Several methodological issues preclude the ability to determine accurately the impact of physical activity on body weight and adiposity. These issues include (a) a low prevalence of higher-intensity physical activity in the general population, (b) measurement error with regard to self-reported activity, especially that of lower-intensity, (c) inappropriate time frame of the physical activity assessment, (d) effect modification by age and gender, and (e) failure to adjust for important statistical confounders. Despite these methodological issues, the inverse association between physical activity and weight has been reported in several cross-sectional epidemiologic studies, which consistently report lower body weight, or more favorable distribution of body fat, with higher categorical levels of self-reported physical activity. Directionality of the physical activity and weight relation cannot be determined from these studies, however, and the few longitudinal epidemiologic studies that have assessed the influence of physical activity on the risk of weight gain report inconclusive results. This is possibly because a one-time assessment of physical activity if not adequate in describing the contribution of habitual physical activity on long-term weight maintenance. Therefore, longitudinal population-based studies with multiple assessments of physical activity over long follow-up periods are necessary to determine this relationship. In any case, the evidence suggests that persons concerned with overweight, or especially the prevention of overweight and obesity, should increase their physical activity. Sociodemographic characteristics such as age, gender, educational level, and weight are associated with physical activity patterns and choices. Therefore, these characteristics should be considered by professionals when implementing physical activity interventions for weight control. Walking is accessible to all segments of the U.S. population. Because walking is convenient, low cost, and safe, and can result in weight loss if done regularly for durations of at least 20-30 min, its relative merits should be stressed in weight reduction and maintenance programs. Furthermore, to reduce the morbidity and mortality associated with overweight, obesity, and sedentary behavior, priority for intervention programs should be directed at persons in the most vulnerable sectors of the population.

Physical activity patterns among adults in Georgia: results from the 1990 Behavioral Risk Factor Surveillance System.

Regular physical activity increases a person's ability to perform daily activities more efficiently, reduces the risk of specific chronic diseases, including coronary artery disease, and lowers death rates in general. The Healthy People 2000 Physical Activity and Fitness Objectives underscored the importance of monitoring and tracking the prevalence of physical activity and fitness in the United States population for the purpose of planning, implementing, and evaluating efforts to improve the public's physical activity habits. This report examines the prevalence of self-reported leisure-time physical activity (LTPA) among southeastern adults aged 18 years and older living in the state of Georgia. Using data from the 1990 Behavioral Risk Factor Surveillance System (BRFSS) surveys from Georgia, we describe the LTPA patterns of Georgia adults aged 18 years and older. A total of 1,723 adults were interviewed during 1990. Results show the following: women are less active than men, blacks are less active than whites, persons of lower socioeconomic status (SES) are less active than those of higher SES, and older adults are less active than younger adults. These results suggest that a more concerted effort needs to be made in promoting physical activity for women, persons of lower SES, and older adults.

National cancer institute's ethnic and low literacy nutrition education project

The term has been defined in the National Literacy Act of 1991 * as individual's ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one's goals, and develop one's knowledge and potential. Illiteracy exists everywhere and can be found in all socioeconomic strata in the United States,I.2 although it is most prevalent among persons oflow socioeconomic status. I-4 As many as 18% (1.5 million people) of New York City's population are functionally illiterate.3 In other large but less urbanized cities, such as Phoenix, Arizona, the situation is proportionally similar. 5 In rural areas where high school completion rates are often below the rates of central cities, illiteracy is also common. American-born whites make up the largest number of illiterate adults; however, illiteracy is proportionally more prevalent among ethnic minority groups, adding to the major social and economic obstacles these groups face. 7 The results of recent research by Weiss et al. 8 suggest that in the United States, as in many nonindustrialized nations, there is a relation between poor literacy skills and poor health. Minorities will comprise an increasing share of America's population in the future; the U.S. Bureau of the Census predicts that by the year 2020, approximately 40% of school-age Americans will be minority children.9 Thus, the health and well-being of minority people is not only a matter of social justice, but of national self-interest as well. This paper provides a brief overview of the National Cancer Institute's Ethnic and Low Literacy Nutrition Education Project, and a presentation of the key insights gained as a result of developing intercultural nutrition education materials for this project.

Prevalence of trachoma among displaced persons in the Sudan: A clinical and sero-epidemiological study

The prevalence of trachoma was determined among displaced persons from the north, west and south of The Sudan who had settled in Angola Village, Omdurman County. Of 616 persons examined, 376 (61%) were found to have clinical signs of active trachoma. Of the 448 children, aged 4 months to 15 years, 55 (12%) had mild, 69 (15%) moderately severe, and 210 (47%) severe disease. The corresponding figures for those aged 16 and older (adults) were 5 (3%), 12 (7%) and 25 (15%), respectively. The prevalence of active trachoma among the children in the village was 75%, being higher among those from southern (86%) Sudan than for those from the northern (64%) and western (66%) regions. The corresponding figures for the adults were 25%, 38%, 13% and 14%. Antibodies to Chlamydia trachomatis were found in the lacrymal fluid of 224 (67%) and in the serum of 272 (81%) of the children tested. A higher (74%) prevalence rate of antibody-positive tears was found in children from the south than from either northern (58%) or western (61%) Sudan. The corresponding percentages of antibody-positive sera were 90%, 72% and 73%. In the adults, antibodies to C. trachomatis were found in tears of 28 (67%). As in the children, the proportion of adults with antibody-positive tears was higher among those from the south (80%) than in those from north or west Sudan (25% and 38%, respectively). This was also true of the prevalence of serum antibodies, which was 93% versus 75% and 75%, respectively. Trachoma is still common in The Sudan among persons of low socio-economic status.(ABSTRACT TRUNCATED AT 250 WORDS)

Educational status and active life expectancy among older blacks and whites.

Persons of low socioeconomic status are known to have reduced life expectancy. In a study of the relation of socioeconomic status to disability-free or active life expectancy among older persons, we analyzed prospectively gathered data on 2219 blacks and 1838 whites who were 65 years of age or older in the Piedmont region of North Carolina. We defined disability as the inability to perform independently one or more basic functional activities such as walking, bathing, dressing, eating, and using the toilet. For subgroups defined by sex, race, and education, statistical models were used to estimate, for persons at each year of age, the probability of transition from not being disabled or being disabled at base line to not being disabled, being disabled, or having died one year later. These transition probabilities were then entered into increment-decrement life tables to generate estimates of total, active, and disabled life expectancy (with total life expectancy equal to active life expectancy plus disabled life expectancy). Sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), although the differences were reduced after we controlled for education. The estimates for 65-year-old black women (total life expectancy, 18.7 years; active life expectancy, 15.9 years) were similar to those for white women. Black men and women 75 years old and older had higher values for total life expectancy and active life expectancy than whites, and the differences were larger after stratification for education. Education had a substantially stronger relation to total life expectancy and active life expectancy than did race. At the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values for those with less education in all the four subgroups defined by sex and race. Overall, the subgroups with longer total life expectancy and active life expectancy also lived more years with a disability. Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy.

Examining HIV-related Knowledge Among Adults in the U.S.

Supplemental AIDS data from the 1987 National Health Interview Survey indicate that adults in the U.S. know the most frequent modes of HIV transmission, but lack a more comprehensive understanding of HIV and AIDS. Elements from a diffusion model were isolated to create a path-analytic framework for examining the effects of population or recipient characteristics and information sources or communication channels on HIV-related knowledge with these data. This multivariate analysis suggests that persons of lower socioeconomic status, older adults, those from racial/ethnic minority groups, those living outside of metropolitan areas, men, and those citing mass media (television or newspapers) as their primary source of information about HIV and AIDS have slightly lower levels of HIV-related knowledge. Decomposition of the effects in the path analysis suggests that use of information sources or channels, as measured by survey data, accounts for little of the observed variation in HIV-related knowledge. The implications of these results for future research and HIV-related education are discussed.

Specialty Roles in Community Health Nursing: A National Survey of Educational Needs

This study identified population groups, health conditions, and employment settings considered appropriate for graduate-level community health nursing (CHN) practice and employment, and described the relative importance of each of these areas as assessed by CHN leaders. According to 588 leaders in CHN service and education, (1) the population groups most in need of graduate-prepared CHNs are the elderly, persons of low socioeconomic status, the homeless, adolescents, and the unemployed; and (2) the health conditions most in need of CHN services are AIDS, pregnancy and prenatal problems, low birth weight and infant mortality, stress-related illness, and Alzheimer's and other chronic diseases of the elderly. Among the many employment settings rated as having a great need for CHNs are state and local health departments and home health agencies. The findings provide the direction and justification for developing specialty options within CHN that correspond to these identified and changing needs. This article provides suggestions and possible alternatives for initiating educational change to prepare graduate-level CHNs for these various specialties and for the settings in which the specialties will be applied.

Sociodemographic Characteristics of Cigarette Smoking Initiation in the United States

Cigarette smoking initiation greatly influences smoking prevalence in the United States. To understand better the initiation of cigarette smoking, we estimated the age-specific incidence of cigarette smoking initiation in relation to race/ethnicity, sex, and educational attainment, using the reported age at smoking onset for 18- to 35-year-old respondents in the 1987 National Health Interview Survey (N = 14764) and the Hispanic Health and Nutrition Examination Survey (N = 3123) conducted during 1982 to 1984. Among white, black, and Hispanic respondents the incidence of smoking initiation increased rapidly after 11 years of age, reaching a peak in groups 17 to 19 years of age, rapidly declining in groups through age 25 years, and gradually declining thereafter. Age-specific smoking initiation rates were generally lower among black than white respondents, similar between white and Hispanic respondents, and appreciably higher among black and Hispanic men than women. Compared with persons who graduated from high school, persons with less than high school education were consistently more likely to start smoking cigarettes during childhood and adolescence. These data indicate that age and educational attainment are the factors most consistently associated with cigarette smoking initiation among all race/ethnic groups in the United States. These data also emphasize the need for smoking-prevention education beginning at an early age, particularly among persons of low socioeconomic status.

Formulation and Evaluation of Home-Made Weaning Mixes Based on Local Foods

One way to prevent protein-energy malnutrition is to provide nutritious weaning foods to infants. In India, several commercial mixes are available, but they are often too expensive for persons of low socio-economic status. To find a more affordable product, four weaning mixes were formulated using local foods and traditional processing techniques. They were evaluated for acceptability by a sample target population of mothers and infants, and for protein, iron, and energy content using established laboratory methods. All the mixes were inexpensive and nutritious, and remained acceptable even after being stored for one month.

Educational level and 5-year all-cause mortality in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group.

Excess mortality in persons of lower socioeconomic status is a finding confirmed in many population studies. Among the nearly 11,000 hypertensive trial participants in the population-based Hypertension Detection and Follow-up Program, lower educational level (an indicator of low socioeconomic status) was associated with a 5-year death rate significantly above that found in those with higher education. This report examines whether this excess was observed uniformly within both treatment groups--stepped care and referred care--or whether the more vigorous antihypertensive program of stepped care was able to reduce the mortality gradient associated with education. In addition, impact on mortality of degree of blood pressure control during the trial was assessed within stepped and referred care groups, taking account also of educational level. Finally, the benefit of stepped care compared with referred care (control group) in reducing mortality was analyzed, controlling for education. Referred care participants with less than a high school education had a 5-year death rate twice as high as those with more than a high school education, whereas no such gradient of mortality was seen in the stepped care group. Level of blood pressure control throughout the trial was better in the stepped than in the referred care group and was significantly (inversely) associated with mortality in the stepped care group, regardless of educational level. In the referred care group as well, the better the control of elevated blood pressure (again, regardless of educational level), the lower the mortality, although this inverse association did not quite reach statistical significance in the referred care group.(ABSTRACT TRUNCATED AT 250 WORDS)

Chancroid or chancroidal ulcers.

1532 cases with genital ulcers were investigated, of whom 610 presented with features suggestive of chancroid; classic, multiple lesions of chancroid were observed in 312, while its other variants, i.e. dwarf, giant and phagedaenic chancroid were also seen. In addition, 162 cases had a conspicuous morphology characterised by a single ulcer which was well-defined, soft, tender, non-indurated and had weakening edges. These were termed chancroidal ulcers. The latter had a longer incubation period of 8-11 days. Absence of lymphadenopathy was prominent in these cases. The male/female ratio was 27/1. Persons of low socio-economic status in the sexually vulnerable age-group were predominantly affected. The prepuce, coronal sulcus and glans penis were the common sites of affliction in males, while the labia minora was frequently involved in females. Due to the limited value of gram-stained smears for the detection of H. ducreyi and lack of good culture media, chancroid and chancroidal ulcers should be differentiated clinically.

Risk Factors in Heatstroke

<h3>To the Editor.—</h3> The recent article by Kilbourne et al inThe Journaladdressed the question of what were the particular factors that predisposed their group of patients to heatstroke. I want to address the conclusion given that a prior history of heatstroke does not place an individual at risk for future episodes. While the specific age range of their population was not given, the "general population" studied seems characteristic (propensity for elderly persons of lower socioeconomic status with chronic illnesses) of prior epidemiologic studies of nonexertional heatstroke. The risk factors for exertional heat stroke take a different epidemiologic twist, affecting young, healthy persons. In 1981, I reported the case of an elderly gentleman who had survived two prior episodes of heatstroke.¹The case was remarkable, if for nothing else than he had survived a catastrophic illness with a mortality rate as high as 70% twice.²In my

Relative importance of mental dysfunction to chronic alcoholics.

Self-perception of chronic alcoholics as determined by the Mental Dullness Scale was not significantly changed by poor performance on the Halstead Categories Test and feedback to that effect. When asked to rank order several detrimental consequences of alcoholism, mental deterioration was near the bottom (significantly less consequential than financial problems). Although mental deterioration and concomitant impaired cognitive functioning is a reality for chronic alcoholics, it is apparently not a salient enough feature of alcoholism to be used as a deterrent with persons of lower socioeconomic status.

PREVALENCE OF ANTIBODY TO HEPATITIS A AND POLIOVIRUSES IN AN UNIMMUNIZED URBAN POPULATION

A large group of sera collected in 1954-1955 from people living in the metropolitan area of Melbourne, Australia, was tested for neutralizing antibody to polioviruses 1,2 and 3 and for antibody to hepatitis A virus by solid phase radioimmunoassay. The age-specific prevalence of antibody to each virus was remarkable similar, being highest in the elderly and in persons of low socioeconomic status. Antibody to each virus was acquired early in life, with more than half the population showing evidence of infection by the age of 15 years.

Seroepidemiologic investigations of human hepatitis caused by A, B, and a possible third virus.

Seroepidemiologic studies were made of normal subjects in populations in the United States and Costa Rica and in family outbreaks of hepatitis in Costa Rica. Hepatitis A affected a majority of children of very young age in Costa Rica, while such experience in persons of high socioeconomic status in the United States did not occur before middle life. Persons of low socioeconomic status (paid plasma donors) and residents and attendants of institutions for the mentally retarded showed a far greater incidence of hepatitis A antibody than did their counterparts in the open community. Hepatitis A and B epidemics occurred in families in Costa Rica with rapid spread to other susceptible members of the group. The disease was clinically apparent in roughly half the cases, whether the responsible agent be hepatitis A or B. Five cases of nonhepatitis A or B (hypothetical hepatitis C) were found and all but one of them were subclinical.

Participation, Political Structure, and Concurrence

Under what circumstances do citizens in a democracy influence their leaders? This paper uses an index of citizen-leader agreement on community problems to examine the effects of political factors on linkage. This index, termed concurrence, was based on parallel questions on community problems asked of citizens, government heads, and other local leaders sampled in sixty-four smaller American communities.Concurrence was significantly higher in communities with high levels of citizen participation, contested elections, partisan ballots, and active political parties. Regression analysis showed that while voting rates had the largest direct impact on concurrence, participation had more impact when salient electoral alternatives were available. Partisan, contested elections also were associated with higher concurrence between leaders and persons of low socioeconomic status. Political factors also affected concurrence rates in both consensual and nonconsensual communities.Alternative explanations for these findings (popular control of leaders, leaders' efforts to influence citizens or manipulate participation) are considered. Since concurrence scores of nonelected local leaders were also higher in participant communities with contested elections, it is suggested that political factors may affect citizen-leader agreement by facilitating communication between leaders and citizens, as well as by aiding electoral accountability.