Vulnerable Populations

Environmental and individual factors affecting menu labeling utilization: a qualitative research study

Environmental and individual factors affecting menu labeling utilization: a qualitative research study
Journal of the Academy of Nutrition and Dietetics. 2013 May;113(5):667-72. doi: 10.1016/j.jand.2012.11.011. Epub 2013 Feb 9.

Jennifer Schindler, Kamila Kiszko, Courtney Abrams, Nadia Islam, Brian Elbel

Obesity is a prominent public health concern that disproportionally affects low-income and minority populations. Recent policies mandating the posting of calories on menus in fast-food chain restaurants have not proven to uniformly influence food choice. This qualitative research study used focus groups to study individual and environmental factors affecting the use of these menu labels among low-income minority populations. Ten focus groups targeting low-income residents (n=105) were held at various community organizations throughout New York City over a 9-month period in 2011. The focus groups were conducted in Spanish, English, or a combination of both languages. In late 2011 and early 2012, transcripts were coded through the process of thematic analysis using Atlas.ti for naturally emerging themes, influences, and determinants of food choice. Few participants used menu labels, despite awareness. The most frequently cited as barriers to menu label use included: price and time constraints, confusion and lack of understanding about caloric values, as well as the priority of preference, hunger, and habitual ordering habits. Based on the individual and external influences on food choice that often take priority over calorie consideration, a modified approach may be necessary to make menu labels more effective and user-friendly.

Access to primary care in Hong Kong, Greater London and New York City

Access to primary care in Hong Kong, Greater London and New York City
Cambridge University Press 2013. Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 95 109, Published online.

Pui Hing Chau, Jean Woo, Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin and Kam Che Chan

We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.

How Microfinance Really Works

How Microfinance Really Works
The Milken Institute Review

Morduch, Jonathan

About half of the world’s adults lack bank accounts. Most of these “unbanked” are deemed too expensive to serve, or not worth the hassle created by banking regulations. But what may be good business from a banker’s perspective isn’t necessarily what’s best for society. The inequalities that persist in financial access reinforce broader inequalities in the distribution of income and wealth. This is the opening for microfinance and also its challenge. Microlending has been sold as a practical means to get capital into the hands of small-scale entrepreneurs who can then earn their way out of poverty. The idea appeals to our impulse to help people help themselves and to our conviction that bottom-up development depends on the embrace of the market. By eschewing governments and traditional charities, the sector promises to sidestep the bureaucracy and inertia that have hobbled other attempts to expand the opportunities of the poor.

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools
Randy Capps and Michael Fix, editors, Young Children of Black Immigrants in America: Changing Flows, Changing Faces. Washington, DC: Migration Policy Institute: 299-331

Doucet, F., Schwartz, A. E., & Debraggio, E.

The child population in the United States is rapidly changing and diversifying — in large part because of immigration. Today, nearly one in four US children under the age of 18 is the child of an immigrant. While research has focused on the largest of these groups (Latinos and Asians), far less academic attention has been paid to the changing Black child population, with the children of Black immigrants representing an increasing share of the US Black child population.

To better understand a unique segment of the child population, chapters in this interdisciplinary volume examine the health, well-being, school readiness, and academic achievement of children in Black immigrant families (most with parents from Africa and the Caribbean).

The volume explores the migration and settlement experiences of Black immigrants to the United States, focusing on contextual factors such as family circumstances, parenting behaviors, social supports, and school climate that influence outcomes during early childhood and the elementary and middle-school years.  Many of its findings hold important policy implications for education, health care, child care, early childhood development, immigrant integration, and refugee assistance.

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)
Revista de Saude Publica, Vol. 46, supp. 1. 10.1590/S0034-89102012005000059

Lima-Costa, M.F.; L.A. Facchini; D.L. Matos, and J. Macinko

OBJECTIVE: To assess the changes in income-related inequalities in health conditions and in the use of health services among elderly Brazilians.

METHODS: Representative samples of the Brazilian population aged 60 years and more were analyzed between 1998 and 2008 (n = 27,872 and 41,198, respectively), derived from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey). The following variables were considered in this study: per capita monthly household income, self-rated health, physical functioning, medical consultations and hospitalizations in the previous 12 months and exclusive use of the Sistema Único de Saúde (Unified Health System). Data analysis was based on estimates of prevalence and prevalence ratios obtained with robust Poisson regression.

RESULTS: In 1998 and 2008, the prevalence of poor self-rated health, mobility limitations and inability to perform activities of daily living (ADLs), adjusted for age and sex, showed strong gradients associated with per capita household income quintiles, with the lowest values being found among those in the lowest income quintile. The prevalence ratios adjusted for age and sex between the lowest quintile (poorest individuals) and highest quintile (richest individuals) of income remained stable for poor self-rated health (PR = 3.12 [95%CI 2.79;3.51] in 1998 and 2.98 [95%CI 2.69;3.29] in 2008), mobility limitations (PR = 1.54 [95%CI 1.44;1.65 and 1.69 [95%CI 1.60;1.78], respectively) and inability to perform ADLs (PR = 1.79 [95%CI 1.52;2.11] and 2.02 [95%CI 1.78;2.29], respectively). There was a reduction in income-related disparities when three or more medical consultations had been made and with the exclusive use of the Unified Health System. Inequalities were not observed for hospitalizations. 

CONCLUSIONS: Despite reductions in income-related inequalities among indicators of use of health services, the magnitude of disparities in health conditions has not decreased. Longitudinal studies are necessary to better understand the persistence of such inequalities among elderly Brazilians.

Banking The World

Banking The World
The MIT Press

(eds.) Cull, Robert, Asli Demirgüç-Kunt and Jonathan Morduch

About 2.5 billion adults, just over half the world’s adult population, lack bank accounts. If we are to realize the goal of extending banking and other financial services to this vast “unbanked” population, we need to consider not only such product innovations as microfinance and mobile banking but also issues of data accuracy, impact assessment, risk mitigation, technology adaptation, financial literacy, and local context. In Banking the World, experts take up these topics, reporting on new research that will guide both policy makers and scholars in a broader push to extend financial markets.

The contributors consider such topics as the complexity of surveying people about their use of financial services; evidence of the impact of financial services on income; the occasional negative effects of financial services on poor households, including disincentives to work and overindebtedness; and tools for improving access such as nontraditional credit scores, financial incentives for banking, and identification technologies that can dramatically reduce loan default rates.

Asthma Hospital Admissions and Ambient Air Pollutant Concentrations in New York City

Asthma Hospital Admissions and Ambient Air Pollutant Concentrations in New York City
Journal of Environmental Protection, Vol. 3 No. 29, 2012, pp. 1102-1116. doi: 10.4236/jep.2012.329129.

C. Restrepo, J. Simonoff, G. Thurston and R. Zimmerman

Air pollution is considered a risk factor for asthma. In this paper, we analyze the association between daily hospital admissions for asthma and ambient air pollution concentrations in four New York City counties. Negative binomial regression is used to model the association between daily asthma hospital admissions and ambient air pollution concentrations. Potential confounding factors such as heat index, day of week, holidays, yearly population changes, and seasonal and long-term trends are controlled for in the models. Nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO) show the most consistent statistically significant associations with daily hospitalizations for asthma during the entire period (1996-2000). The associations are stronger for children (0 - 17 years) than for adults (18 - 64 years). Relative risks (RR) for the inter-quartile range (IQR) of same day 24-hour average pollutant concentration and asthma hospitalizations for children for the four county hospitalization totals were: NO2 (IQR = 0.011 ppm, RR = 1.017, 95% CI = 1.001, 1.034), SO2 (IQR = 0.008 ppm, RR = 1.023, 95% CI = 1.004, 1.042), CO (IQR = 0.232 ppm, RR = 1.014, 95% CI = 1.003, 1.025). In the case of ozone (O3) and particulate matter (PM2.5) statistically significant associations were found for daily one-hour maxima values and children’s asthma hospitalization in models that used lagged values for air pollution concentrations. Five-day weighted average lag models resulted in these estimates: O3 (one-hour maxima) (IQR = 0.025 ppm, RR = 1.049, 95% CI = 1.002, 1.098), PM2.5 (one-hour maxima) (IQR = 16.679 μg/m3, RR = 1.055, 95% CI = 1.008, 1.103). In addition, seasonal variations were also explored for PM2.5 and statistically significant associations with daily hospital admissions for asthma were found during the colder months (November-March) of the year. Important differences in pollution effects were found across pollutants, counties, and age groups. The results for PM2.5 suggest that the composition of PM is important to this health outcome, since the major sources of NYC PM differ between winter and summer months.

Infant Antibiotic Exposures and Early-Life Body Mass

Infant Antibiotic Exposures and Early-Life Body Mass
International Journal of Obesity , (21 August 2012) | doi:10.1038/ijo.2012.132

Trasande, Leonardo, Jan Blustein, Mengling Liu, Elise Corwin, Laura M Cox, Martin J Blaser


To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life.


Longitudinal birth cohort study.

A total of 11 532 children born at greater than or equal to2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991–1992.


Exposures to antibiotics during three different early-life time windows (


Antibiotic exposure during the earliest time window (


Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6–14 months, 15–23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.

Low Cognitive Ability and Poor Skill with Numbers May Prevent Many from Enrolling in Medicare Supplemental Coverage

Low Cognitive Ability and Poor Skill with Numbers May Prevent Many from Enrolling in Medicare Supplemental Coverage
Health Affairs. 2012; 31(8): 1847-1854. doi: 10.1377/hlthaff.2011.1000

Chan, Sewin and Brian Elbel

Because traditional Medicare leaves substantial gaps in coverage, many people obtain supplemental coverage to limit their exposure to out-of-pocket costs. However, some Medicare beneficiaries may not be well equipped to navigate the complex supplemental coverage landscape successfully because of their lower cognitive ability or numeracy—that is, the ability to work with numbers. We found that people in the lower third of the cognitive ability and numeracy distributions were at least eleven percentage points less likely than those in the upper third to enroll in a supplemental Medicare insurance plan. This result means that many Medicare beneficiaries do not have the financial protections and other benefits that would be available to them if they were enrolled in a supplemental insurance plan. Our findings suggest that policy makers may want to consider alternatives tailored to these high-need groups, such as enhanced education and enrollment programs, simpler sets of plan choices, or even some type of automatic enrollment with an option to decline coverage.

Oral health care and smoking cessation practices of interprofessional home care providers for their patients with HIV

Oral health care and smoking cessation practices of interprofessional home care providers for their patients with HIV
Journal of Interprofessional Care, July 2012, Vol. 26, No. 4 , Pages 339-340 (doi:10.3109/13561820.2012.676107)

Van Devanter, N., C..G. Dorsen, P. Messeri, D. Shelley, and A. Person

The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home care providers lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home care providers. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists.


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