Knowledge and use of preventive health practices among Korean women in Los Angeles county

BACKGROUND: The aims of this study are to determine (1) knowledge and use of preventive health practices, and (2) the relationship between acculturation and preventive health practices, in Korean women. METHODS: The data came from the 2000 Korean American Health Survey (KAHS), which includes 656 women. The dependent variables included use of pap smears, physical examinations and mammograms, and use and knowledge of self-breast examinations. Independent variables included demographic and acculturation variables. Logistic regression modeling was used to assess the role of acculturation on dependent variables. RESULTS: Some of the acculturation variables significantly predicted preventive practices. Being married (P < 0.0001) and insured (P < 0.05) were significantly associated with receipt of preventive services. A married Korean woman was more likely than an unmarried Korean woman to have a pap smear within 2 years (P < 0.0001), physical exam within 1 year (P < 0.0001), and perform self-breast examinations (P < 0.05). CONCLUSIONS: Factors related to acculturation influence use of preventive health practices by Korean American women, highlighting the need to consider cultural background in developing systems of care.     

Timing of insurance coverage and use of prenatal care among low-income women

OBJECTIVES: This study examined the relationship between timing of insurance coverage and prenatal care among low-income women. METHODS: Timeliness of prenatal care initiation and adequacy of number of visits were studied among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994-1995. RESULTS: Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester. Rates of untimely care were highest (> or =64%) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester; rates were lowest (about 10%) among women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy were at low risk of having too few visits. CONCLUSIONS: Timing of prenatal coverage should be considered in research on the relationship between coverage and care use among low-income women. Earlier studies that relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about lack of coverage as a barrier to prenatal care.     

Providers of primary care to homeless women in Los Angeles County

Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as "major providers"). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.     

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.     

Designing prenatal care messages for low-income Mexican women.

Communication theories and research data were used to design cross-cultural health education messages. A University of California Los Angeles-Universidad Autonoma in Tijuana, Mexico, research team used the methods of ethnographic and survey research to study behaviors, attitudes, and knowledge concerning prenatal care of a sample of pregnant low-income women living in Tijuana. This audience provided information that served as a framework for a series of messages to increase awareness and change prenatal care behaviors. The message design process was guided by persuasion theories that included Petty and Caccioppo''s elaboration likelihood model, McGuire''s persuasion matrix, and Bandura''s social learning theory. The results from the research showed that poor women in Tijuana tend to delay or not seek prenatal care. They were not aware of symptoms that could warn of pregnancy complications. Their responses also revealed pregnant women''s culturally specific beliefs and behaviors regarding pregnancy. After examination of these and other results from the study, prenatal care messages about four topics were identified as the most relevant to communicate to this audience: health services use, the mother''s weight gain, nutrition and anemia, and symptoms of high-risk complications during pregnancy. A poster, a calendar, a brochure, and two radio songs were produced and pretested in focus groups with low-income women in Tijuana. Each medium included one or more messages addressing informational, attitudinal, or behavioral needs, or all three, of the target population.     

Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles

Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.     

Initiation of prenatal care by low-income Hispanic women in Houston.

OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation. CONCLUSIONS: Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.     

Case-control study of lung cancer in Los Angeles county welders

A case-control study of lung cancer in white male welders was undertaken to investigate possible environmental and occupational causes of a 50% excess of lung cancer observed in this occupational group. The subjects were identified from a population-based cancer registry in Los Angeles County. A standardized questionnaire was administered to either subjects or proxy informants of 90 lung cancer cases and 116 non-lung-cancer controls. Significantly increased risks of lung cancer were associated with tobacco smoking (odds ratio 7.6, p less than .005) and shipyard welding with at least a 10-year latency since first exposure (odds ratio 1.7, p less than .05). Although there were elevated risks associated with some specific welding processes, none were statistically significant. Control subjects were more likely to have had exposure to confined-space welding (odds ratio 0.6, 95% CI = 0.3-1.2), and this association was greatest where there had been at least a 20-year latency since first exposure (0.5, 95% CI = 0.3-1.0). We conclude that the excess of lung cancer in this welding population is contributed to by a higher frequency of smoking and probable exposure to asbestos in shipyards. Other factors may be important, but probably because of limited power and reliance on proxy information, this study failed to detect other statistically significant risks.     

Barriers to prenatal care among low-income women in New York City

Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.     

Disparities in access to fresh produce in low-income neighborhoods in Los Angeles

BACKGROUND: Access to fresh produce and other healthy foods differs between poor ethnic and wealthier non-ethnic neighborhoods. Given the need to improve access, emergency food organizations, such as food pantries, can provide assistance. Food pantry clients, many living in poor ethnic neighborhoods, are at highest risk for inadequate intake of fruits and vegetables as emergency food assistance often does not include a supply of fresh produce. This study examines the extent to which food pantry clients live within reasonable walking distance of stores carrying fresh produce, and it proposes a strategy to increase accessibility of produce to those clients. METHODS: Addresses for 3,985 food pantry clients residing in Pomona, California, in 2003 and 84 food stores categorized as selling a "variety of produce" or "limited produce" were geocoded using geographic information systems technology in 2004. A 0.8-km network buffer was used to measure access to stores. Cluster areas with high densities of food pantry clients, or hot spots, were determined. RESULTS: Forty-one percent of Pomona food pantry clients were within walking distance of a store with fresh produce. Eighty-three percent were within walking distance of stores with limited produce, and 13% were not within walking distance of either store type. Seventeen cluster areas of food pantry clients accounted for 48% of clients with no access to a produce store. CONCLUSIONS: Using individual-level data allowed for the identification of significant numbers of food pantry clients with limited access to stores carrying a variety of fresh produce. Identification of the location of high concentrations of food pantry clients provides a potential solution to increase fresh fruit and vegetable access via mobile produce trucks.     

Factors affecting breastfeeding among women of Mexican origin or descent in Los Angeles.

Data on breastfeeding intentions and behavior were collected in prenatal and postpartum interviews as part of a study on first birth among 518 women of Mexican origin or descent in two Los Angeles hospitals. The prenatal intentions of 82 per cent of the women to breastfeed were maintained postpartum in one hospital but dropped sharply in the other. A greater number of hours a day with the baby in the hospital and earlier initiation of breastfeeding were associated with the hospital where prenatal breastfeeding intentions were more likely to be carried out. The intention to work postpartum was associated both with the decision not to breastfeed at all and with shorter intended duration of breastfeeding.     

Improving prenatal care services for low-income African American women and infants

Increasing the level of prenatal care among African American women may be one method of improving the health and well-being of African American women and children. This article identifies factors influencing access to and use of prenatal care and strategies for increasing the use of prenatal care among low-income African American women. Barriers to prenatal care, the strengths and limitations of prenatal care in reducing infant mortality and improving infant outcomes, and the importance of providing more comprehensive prenatal care that addresses both the medical and psychosocial needs of the low-income African American mother and her infant are discussed. Changes in prenatal care services that include the medical and lay communities, public health organizations, public policy organizations, and medical financing institutions are identified.     

Use of mammography screening among older Samoan women in Los Angeles county: a diffusion network approach

Minority migrant populations, such as older Samoan women, are likely to underuse preventive health services, including mammography screening. The purpose of this paper is to explore how informal (lay peers from churches) and formal (health care providers) health communication networks influence mammography screening use among older Samoan women. To do so, we apply diffusion of innovation theory and network analysis to understand how interpersonal networks may affect mammography use in this urban-dwelling, migrant population. The data come from a survey of 260 Samoan women, aged 50 years or older, who attended 39 randomly sampled Samoan churches in Los Angeles County (USA) between 1996 and 1997. Retrospective data, based over a 20-year period from this sample's year of first use of mammography screening, suggest that interpersonal networks may have accounted for the dramatic increase in the rate of adoption within the past 5 years of the survey. Using this information, we categorized women into mutually exclusive stages of mammography use and regressed these stages of mammography use on formal (had a provider referral) and informal (level of connectedness with peers in churches) health communication networks. The results indicated that being well-connected within women's informal, church-based health communication networks increased the likelihood of being in the decision (planned to have) and implementation and confirmation (had a recent mammogram) stages, but having a provider referral for a mammogram (formal networks) only increased the likelihood of being in the latter stages compared to women in the knowledge and persuasion stages. Formal and informal health communication networks influence recent use of mammography screening, but informal networks, in and of themselves, are also influential on future intention to use mammography screening.     

Neighborhood effects on primary care access in Los Angeles

Individual health outcomes differ greatly between neighborhoods, and recent research has begun to examine how neighborhood environment affects individual health. A common hypothesis is that the inequitable distribution of healthcare resources limits access to health care for individuals in disadvantaged neighborhoods, causing poorer long-term health. Yet, research has not examined if neighborhood environment actually affects an individual's ability to access primary care. Data from the Los Angeles Family and Neighborhood Survey suggests there is significant variation between neighborhoods in an individual's ability to access primary care. This neighborhood-level effect is not explained by the composition of individuals living in the neighborhood. Four mechanisms through which neighborhood environment could affect an individual's ability to access primary care are examined: (1) neighborhood information networks, (2) neighborhood health behavior norms, (3) neighborhood social capital and (4) neighborhood healthcare resources. Social capital and healthcare resources significantly predict an individual's primary care access. Since differences in primary care access may explain individual-level health disparities between neighborhoods, policies designed to improve primary care access must account for both individual and neighborhood effects.     

Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women

In the United States, the prevalence of third trimester anemia among low-income pregnant women is 29% and has not improved since the 1980s. Although low adherence has been linked to the ineffectiveness of iron supplementation programs, data regarding adherence to supplementation in low-income women are currently lacking. Hence this study was conducted to better understand the factors associated with adherence to the use of iron-containing prenatal multivitamin/mineral supplements among low-income pregnant women. Adherence to supplement use was assessed by pill counts among 244 pregnant women of 867 women who were initially randomized to receive 1 of 3 prenatal supplements. All women received care at a public prenatal clinic. Maternal characteristics associated with adherence were identified using predictive modeling. Women took 74% of supplements as prescribed. Adherence was higher among non-Hispanic white women than among non-Hispanic black women (79% vs. 72%, P 相似文献   

Situational and financial barriers to prenatal care in a sample of low-income, inner-city women

The relationship between the use of prenatal care and factors that may impede access to care was examined in a sample of low-income, inner-city women. Situational and financial barriers to care were not important correlates of utilization. In unadjusted analyses, only insurance status and employment status were associated with utilization. Of the sociodemographic characteristics studied, only parity was strongly associated with the use of prenatal care. When the apparent associations between utilization and insurance status and utilization and employment were analyzed controlling for parity, the estimated strength and statistical significance of these relationships diminished considerably. Multiparous women who were more likely than primiparous women to be underutilizers were also more likely to be on medical assistance and to be unemployed. These findings suggest that situational and financial barriers are not important correlates of utilization for low-income, adult women living in urban areas where there are accessible clinic facilities and public transportation. Efforts to identify and surmount other kinds of barriers may prove to be a more effective approach to prenatal outreach for women in these circumstances.     

Effective birth control use among women at risk for unintended pregnancy in Los Angeles, California

ContextIdentifying sociodemographic and health-related risk factors associated with more effective versus less effective birth control use can help to identify barriers to effective birth control use and decrease risk for unintended pregnancy.MethodsData used were from the 2007 Los Angeles County Health Survey. More effective birth control use was assessed among women ages 18 to 49, who were at risk for unintended pregnancy, residing in Los Angeles County. The study population consisted of 849 women. Multivariate associations of more effective birth control use with sociodemographic and health factors were assessed in logistic regression models. All analyses used weighted data.ResultsWomen who used a more effective birth control method at last act of coitus were less likely to be Black (odds ratio [OR], 0.33) or Asian/Pacific Islander (OR, 0.49), have less than a high school education (OR, 0.33), be a smoker (OR, 0.52), and have public insurance (OR, 0.47) than women using a less effective birth control method. They were more likely to have received a pap test (OR, 2.66), describe their health as fair or poor (OR, 2.39), and have a household income of 200% to 299% of the federal poverty level (OR, 2.25) than women using a less effective birth control method.ConclusionsSociodemographic factors, some of which underlie cultural diversity, predict the use of more effective birth control methods and should be considered when providing family planning services and preconception health counseling to unique populations.     

Access to care and use of health services by low-income women

Data from the 1997 National Survey of America's Families (NSAF) are used to analyze access to care and use of health care services for low-income women. Three groups of women are examined: those with Medicaid coverage, those with private coverage, and those with no insurance. Findings show that uninsured women faced larger access barriers and utilized fewer services, particularly preventive care services, than women with either public or private coverage. Access and use did not differ greatly between Medicaid and privately covered women. The results suggest that expansions in coverage, either through Medicaid or through private options, could improve access to care for uninsured women.