Journal of urban health : bulletin of the New York Academy of Medicine
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The objective of this paper was to determine the influence of place factors on weight gain in a contemporary cohort of children while also adjusting for early life and individual/family social factors. Participants from the Québec Longitudinal Study of Child Development comprised the sample for analysis (n = 1,580). A mixed-effects regression analysis was conducted to determine the longitudinal relationship between these place factors and standardized BMI, from age 4 to 10 years. ⋯ Early life factors and genetic proxies appeared to be important in explaining weight gain in this sample. This study suggests that residential environments may play a role in childhood weight change; however, pathways are likely to be complex and interacting and perhaps not as important as early life factors and genetic proxies. Further work is required to clarify these relationships.
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Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008-2009) conducted in Belo Horizonte City by the Observatory for Urban Health. ⋯ Cronbach's alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.
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Medication adherence is critical for cardiovascular disease prevention and control. Local health departments are well positioned to address adherence issues, however relevant baseline data and a mechanism for monitoring impact of interventions are lacking. We performed a retrospective analysis using New York State Medicaid claims from 2008 to 2009 to describe rates and predictors of adherence among New York City Medicaid participants with dyslipidemia, diabetes, or hypertension. ⋯ Compared with whites, blacks and Hispanics were less likely to be adherent (adjusted odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.65-0.70 and adjusted OR=0.76, 95% CI: 0.73-0.78, respectively), while Asians were as likely. Medication adherence was inadequate and racial disparities were identified in NYC Medicaid participants on stable medication regimens for chronic disease. This study demonstrates a claims-based model that may be used by local health departments to monitor and evaluate efforts to improve adherence and reduce disparities.
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The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. ⋯ However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients' financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child's asthma.
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The purpose of this study was to examine the prevalence of pregnancy as well as multi-level factors (i.e., individual, family, and environment) associated with history of pregnancy among a sample of urban adolescent women seeking psychological services. Data were collected from a total of 264 sexually active, 13-18-year-old, adolescent women who participated in a larger HIV prevention study. Adolescents and one participating parent completed an audio computer-assisted self-interviewing survey. ⋯ This study is among the first to examine multi-level factors associated with pregnancy among adolescent women diagnosed with psychological disorders. Consideration of such factors is crucial both in terms of clinical practice and in the design of pregnancy prevention programs. Collaboration between physicians and mental health providers working with adolescent women is crucial and represents an ideal opportunity to promote parental involvement and access to supportive community resources, including pregnancy prevention programs for this vulnerable population of adolescents.