Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County.

Objective: To examine how relationship commitment among impoverished women is associated with their frequency of unprotected sex. Design: Cross-sectional analyses were conducted on survey data from a probability sample of 445 women initially sampled from shelters and low-income housing in Los Angeles County. Main Outcome Measure: Frequency of unprotected sex in a typical month was derived as the product of 2 items: how often the woman had sex with her partner in a typical month and how often a male condom was used. Results: For both sheltered and housed women, relationship commitment predicted more frequent engagement in unprotected sex with their partner, even after controlling for the type of relationship (primary vs. casual). However, this association could not be accounted for by perceived partner monogamy, ability to refuse unwanted sex, perceived HIV susceptibility, and condom use self-efficacy. Among housed women only, never asking the partner to use a condom partially accounted for more frequent engagement in unprotected sex among women with stronger relationship commitment. Conclusion: Results emphasize the importance of relationship commitment issues in HIV prevention interventions with impoverished women, and the need for a better understanding of relationship commitment and its influence on condom use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deconstructing the monolith: Differences in attitudes about mammography among low-income African American women.

The purpose of this study was to explore how health beliefs may vary within a minority group. In this mixed-method study, 63 low-income African American women engaged in six focus groups discussing beliefs that inhibited or facilitated mammography. Differences in cognitive complexity, self-efficacy, and attributions of causality occurred across neighborhoods despite the geographic proximity and demographic similarity. The attitude change that occurred during the discussion suggested ways to construct effective health interventions. The data suggest (a) that women were similarly knowledgeable about mammography and cancer, (b) knowledge did not correspond with attitudes, (c) attitudes must be addressed before knowledge can be utilized, (d) attitudes are developed and maintained within neighborhood social networks and that stories maintain these attitudes, (e) increasing the discussion among peers should lead to greater attitude change and discussion leads to increased thought, and (f) motivation and follow through are connected to women’s roles within their communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-year outcomes of a randomized clinical trial treating depression in low-income minority women.

This study examines 1-year depressive symptom and functional outcomes of 267 predominantly lowincome, young minority women randomly assigned to antidepressant medication, group or individual cognitive- behavioral therapy (CBT), or community referral. Seventy-six percent assigned to medications received 9 or more weeks of guideline-concordant doses of medications; 36% assigned to psychotherapy received 6 or more CBT sessions. Intent-to-treat, repeated measures analyses revealed that medication (p = .001) and CBT (p = .02) were superior to community referral in lowering depressive symptoms across 1-year follow-up. At Month 12, 50.9% assigned to antidepressants, 56.9% assigned to CBT, and 37.1% assigned to community referral were no longer clinically depressed. These findings suggest that both antidepressant medications and CBT result in clinically significant decreases in depression for low-income minority women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of message framing and ethnic targeting on mammography use among low-income women.

The authors examined the effects that differently framed and targeted health messages have on persuading low-income women to obtain screening mammograms. The authors recruited 752 women over 40 years of age from community health clinics and public housing developments and assigned the women randomly to view videos that were either gain or loss framed and either targeted specifically to their ethnic groups or multicultural. Loss-framed, multicultural messages were most persuasive. The advantage of loss-framed, multicultural messages was especially apparent for Anglo women and Latinas but not for African American women. These effects were stronger after 6 months than after 12 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathway to health: Cluster-randomized trail to increase fruit and vegetable consumption among smokers in public housing.

Objectives: Examine the effectiveness of an intervention to increase fruits and vegetables (FV) consumption among smokers. Design: Cluster-randomized trial of 20 public housing developments; 10 randomly assigned to an FV intervention and 10 to a smoking cessation intervention. Main outcome measures: Usual (past 7 days) and past 30 days change in daily FV intake at 8 weeks and 6 months postbaseline. Results: Greater increases were seen in the FV group. At Week 8 and Month 6, the FV group had consumed 1.58 (p = .001) and 0.78 (p = .04), respectively, more daily FV servings in the past 7 days than the cessation group. At the same time points, the FV group had consumed 3.61 (p = .01) and 3.93 (p = .01), respectively, more FV servings in the past 30 days than the cessation group. Completing more motivational interviewing sessions (p = .02) and trying more recipes (p = .02) led to significantly greater increases at Month 6 among FV participants. Conclusions: Motivational interviewing counseling and lifestyle modification through trying out healthy recipes may be effective in helping a high-risk population increase their FV intake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes and beliefs toward mammography among women using an urban public hospital

Although overall use of mammography is steadily increasing, low-income and minority women consistently have relatively lower screening rates than white, middle-class women. To assess the mammography-seeking behavior of low-income women using an urban public hospital, this study sought to understand why women in this population decide whether or not to obtain a screening mammogram. Two qualitative techniques, elicitation interviews and focus groups, were used to develop an understanding of attitudes, concerns, and barriers of this group relative to mammography. Fear, embarrassment, susceptibility to breast cancer, inconvenience, cost, concerns about efficacy of mammography, fear of acquiring cancer, and scheduling difficulties were identified as important concerns. "People in the news" were the most influential social referents for mammography decision making, followed by physicians, family members, and friends. The insights gained from these women will assist in developing interventions that encourage mammography-seeking behavior by low-income women.     

Variability in mammography use among older women

OBJECTIVE: To determine rates of and explore factors associated with mammography use among older women. DESIGN: Retrospective review of part B (physician) bills submitted to Medicare during 1990. SETTING: Health Care Financing Administration (HCFA) data, including sociodemographic information and part B physician bills for all services delivered to Medicare-eligible women in 1990. PATIENTS/PARTICIPANTS: Women age 65 or older as of January 1, 1990, residing in one of 10 states with part B coverage through December 31, 1990. MEASUREMENTS AND MAIN RESULTS: The outcome was receipt of a mammogram (yes/no). We explored factors associated with mammography use within three age groups: 65 to 74, 75 to 84, and 85+. The factors considered were race, state, median income of ZIP Code of residence (from the 1990 US Census, and used to divide the population into quintiles within each state), and number of primary care visits (0, 1, 2, and 3+). Overall, 15% of women had a mammogram: 20% of women age 65 to 74, 12% of women age 75 to 84, and 4% of women age 85 and older. Mammography use was lowest in Oklahoma and highest in Washington. However, in each state the older the age category, the less the mammography use (e.g., 9% vs 5% vs 2% in Oklahoma and 25% vs 16% vs 5% in Washington for women 65-74, 75-84, and 85+, respectively). Mammography use was lower for black than for white women age 65 to 74 (14% vs 21%, P < .001) and 75 to 84 (9% vs 12%, P < .001). Women in each of these two age groups had lower mammography use if they resided in the lowest income quintile and highest if they resided in the highest income quintile (17% vs 23% 65-74, and 10% vs 13% 75-84, P values < .001). Among the oldest women (those 85+), mammography use was low (4%) and varied minimally by race and income (P = .907 and .003, respectively). In all age groups, mammography use was lowest among women who did not have a primary care visit, was greater among women who had at least one visit, and continued to rise with increasing numbers of visits (all P values < .001). For example, among women age 75 to 84, mammography use increased from 5% to 10%, 14%, and 17% for those with 0, 1, 2, and 3+ visits. CONCLUSIONS: We found that mammography use was less for women who were older, of black race, who did not visit a primary care provider, and who lived in areas with lower median income and certain geographic locations (states). Similar factors influenced mammography use in women age 65 to 74, where there is greater consensus as to who should receive a mammogram, and women age 75 to 84, where there is neither consensus nor data. Surprisingly, neither race nor income had much influence on mammography use among women age 85 or older.     

Normal housing with specialized supports: A psychiatric rehabilitation approach to living in the community.

Presents a conceptual and historical overview of residential services for Ss with psychiatric disability and challenges the appropriateness and effectiveness of the "continuum of services" model. The authors propose that the goal of residential services should be to assist all people with psychiatric disabilities to choose, obtain, and maintain normal housing and that rehabilitation technology is currently available to accomplish this goal. Data indicate that despite high costs, most state mental health systems are continuing to make large scale investments in facility-based residential programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women

Using annual bite-wing radiographs, the incidence and progression of approximal caries (4d-7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1-2 = radiolucency in the enamel up to the enamel-dentin border; 3 = radiolucency with a broken enamel-dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface-years, and the Kaplan-Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface-years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11-12 years had a risk of new approximal enamel lesions (state 0-2) that was 2.5 times greater than that of the group with DMFSappr = 0-1.     

Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial.

Objective: To assess the efficacy of a 6-week cognitive-behavioral intervention in preventing the onset of perinatal depression and reducing depressive symptoms among low-income women in home visitation programs. Method: Sixty-one women who were pregnant or who had a child less than 6 months of age and who were assessed as at risk for perinatal depression were randomized to a 6-week, group-based cognitive-behavioral intervention or usual home visiting services. Study participants were predominately African American, unmarried, and unemployed. Intervention sessions were led by a licensed clinical social worker or clinical psychologist. Home visitors provided 1-on-1 reinforcement of key intervention messages between group sessions. Depressive symptoms were measured with the Beck Depression Inventory–II (Beck, Steer, & Brown, 1996), and major depressive episodes were measured with the Maternal Mood Screener (MMS; Le & Mu?oz, 1998). Outcomes were assessed at baseline and at 1 week and 3 months postintervention. Results: Repeated measures analysis of variance indicated that there was a significant Time × Condition interaction, F(2, 112) = 4.1, p = .02. At 3 months postintervention, 9 of 27 (33%) women receiving usual care reported levels of depressive symptoms that met clinical cutoff for depression on the MMS compared with 3 of 32 (9%) women in the intervention condition, χ2(1, N = 59) = 5.18, p     

The effects of health beliefs on screening mammography utilization among a diverse sample of older women

Screening mammography is particularly effective in detecting breast cancer in elderly women. Yet, although half of all breast cancers are diagnosed in older women, statistics show that women aged 65 and over tend to underutilize screening mammography. Prior research has used the constructs of the Health Belief Model to explore attitudes and beliefs relative to breast cancer screening. Prior studies have also identified health beliefs and concerns relative to screening mammography and race/ethnicity as some of the patient-related predictors of screening mammography utilization among younger women. This study uses the theoretical framework of the Health Belief Model to explore the effects of these variables on utilization in a multiracial, multiethnic, random sample of 1011 women, aged 65 and over. Race/ethnicity, belief that mammograms detect cancer, ease the mind, and provide accurate results; concern over the radiation, pain, and cost associated with receiving a mammogram; and other independent variables were tested as predictors of screening mammography utilization. Regression analysis identified that the belief that having a mammogram eases recipients minds was the most significant predictor of screening mammography utilization. None of the other health beliefs or health concerns were significant predictors. Race/ethnicity had no direct effects on utilization nor was it a confounder in the relationship between health beliefs, concerns and utilization. These results indicate that, along with emphasizing the importance of mammograms in early detection of breast cancer, stressing the reassurance that mammography brings recipients may be an effective health education strategy for elderly women of different racial/ethnic backgrounds.     

Distress, personality, and mammography utilization among women with a family history of breast cancer.

The authors examined the impact of psychological distress and the personality construct of conscientiousness (as measured by the Neuroticism, Extraversion, and Openness—Five Factor Inventory) on mammography utilization among women who were at increased risk for breast cancer. Participants were 200 women who had at least 1 first degree relative with breast cancer. Overall, 80% of the participants had obtained a mammogram in the previous year. Analyses controlling for potential confounders (perceived risk, decisional balance, and physician recommendation for mammography), revealed that distress was negatively associated with mammography utilization among participants who were low in conscientiousness. Distress was not significantly related to mammography utilization among highly conscientious women. The results are discussed in terms of their implications regarding interventions designed to increase mammography utilization in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of a palmtop computer-delivered treatment for smoking relapse prevention among women.

Relapse is the rule rather than the exception among smokers attempting to quit, and compared to men, women may have higher relapse rates. The current study was a randomized clinical trial testing a palmtop computer-delivered treatment (CDT) for smoking relapse prevention among women. The intervention was individualized based on key theoretical constructs that were measured using ecological momentary assessment (EMA). All participants (N = 302) received standard smoking cessation treatment consisting of nicotine replacement therapy and group counseling, and completed EMA procedures for one week after quitting. At the completion of the group counseling sessions and EMA procedures, participants were randomized to either CDT or no further computer-delivered treatment or assessment (EMA-Only). CDT participants received a palmtop computer-delivered relapse prevention treatment for one additional month. CDT did not improve abstinence rates relative to EMA-Only. Process analyses suggested that heavier smokers were more likely to use CDT and that greater use among CDT participants may be associated with more positive outcomes. The rapid pace of technological advances in mobile computer technology and the ubiquity of such devices provide a novel platform for developing new and potentially innovative treatments. However, the current study did not demonstrate the efficacy of such technology in improving treatment outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

AIDS education and outreach to injecting drug users and the community in public housing.

Describes an inner-city outreach program using indigenous workers to reduce the risk of HIV infection with treatment coupons and communitywide education. The program targeted predominantly African-American public housing neighborhoods, where injecting drug users not in treatment and their sexual partners resided. Changes in community participation and attitudes regarding outreach were observed over 2 yrs of program operation in separate samples. The program resulted in increased knowledge about HIV infection and decreased needle-sharing behavior in Year 2; high-risk sexual behavior persisted. Treatment success was limited and complicated by continued use of other drugs, a short-length of stay in treatment, and insufficient cocaine protocols. In addition to AIDS education, outreach workers provided networking and coalition-building opportunities that have enhanced treatment accessibility and created a perception of hope and positive change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of victimization experiences to psychological well-being among homeless women and low-income housed women.

Stressful experiences and their effects on the psychological well-being of 113 homeless women and 116 low-income housed women were investigated. Measures of victimization assessed multiple dimensions of this construct, including criminal victimization, sexual harassment, and sexual abuse. Measures of current daily environmental hassles and quality of family environment while growing up also were included. Additional measures assessed positive and negative interpersonal exchanges, sense of coherence, and overall psychological distress. Regression analyses indicated that victimization experiences were significant predictors of psychological well-being for both samples. Results also highlighted the importance of investigating both the positive and negative dimensions of interpersonal influences as well as internal resources, and suggested that these resources for coping with stress may be differentially perceived and utilized by these groups. These findings also suggest the need for specific preventive and remedial interventions to empower homeless and low-income housed women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using information, motivational enhancement, and skills training to reduce the risk of HIV infection for low-income urban women: A second randomized clinical trial.

This randomized clinical trial evaluated an HIV-risk reduction (HIV-RR) intervention based on the information–motivation–behavioral skills model. At baseline, 102 women (M age?=?29 years; 88% African American) completed a survey regarding HIV-related knowledge, risk perceptions, behavioral intentions, and risk behavior. Participants were then assigned to either the HIV-RR intervention or a health-promotion control group. Postintervention and follow-up data indicated that women in the HIV-RR program enhanced their knowledge and strengthened their risk reduction intentions relative to controls. Moreover, HIV-RR women who expressed "imperfect" intentions also increased their condom use, talked more with partners about condom use and HIV testing, and were more likely to have refused unprotected sex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of responsibility and persuasion: Increasing mammography utilization among women over 40 with an internally oriented message.

197 women over 40 yrs old and not adhering to national guidelines for screening mammography viewed persuasive messages varying in attributional emphasis (internal, external, or information-only). Internal attributions of responsibility for health-promoting behavior were expected to motivate the greatest change in women's attitudes and behaviors in relation to breast cancer and mammography. Attitudes about breast cancer and mammography were measured immediately and 6 mo after the presentation. 12 mo later, women who viewed the internal message were more likely to have obtained a screening mammogram than women assigned to the other 2 conditions. The attributions of responsibility encouraged by the persuasive messages were associated with whether viewing the presentation led to behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. 480 women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cooking fuel smoke and respiratory symptoms among women in low-income areas in Maputo

The association between exposure to air pollution from cooking fuels and health aspects was studied in Maputo. Mozambique. Almost 1200 randomly selected women residing in the suburbs of Maputo were interviewed and 218 were monitored for air pollution. The fuels most commonly used were wood, charcoal, electricity, and liquified petroleum gas (LPG). Wood users were exposed to significantly higher levels of particulate pollution during cooking time (1200 micrograms/m3) than charcoal users (540 micrograms/m3) and users of modern fuels (LPG and electricity) (200-380 micrograms/m3). Wood users were found to have significantly more cough symptoms than other groups. This association remained significant when controlling for a large number of environmental variables. There was no difference in cough symptoms between charcoal users and users of modern fuels. Other respiratory symptoms such as dyspnea, wheezing, and inhalation and exhalation difficulties were not associated with wood use. Reducing wood use would likely improve acute respiratory health effects in wood users and possibly improve the ambient air pollution conditions in Maputo. To reduce the health impact of wood smoke exposure, it appears that the least costly and quickest method would be to encourage charcoal use to a greater extent, although high carbon monoxide levels would have to be addressed. Turning to modern fuels is beyond the means of most these households in the short term and could not be shown to be more effective.