Showing papers on "Disadvantaged published in 2014"

Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

Abstract: Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups.

Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis

Abstract: Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies. Data Sources: CINAHL, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, HMIC, MEDLINE, the NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge were searched from inception until June 2012. Study Eligibility Criteria: We included all studies, without language restriction, that met the following two criteria: (1) assess the effect of shared decision-making interventions on disadvantaged groups and/or health inequalities, (2) include at least 50% of people from disadvantaged groups, except if a separate analysis was conducted for this group. Results: We included 19 studies and pooled 10 in a meta-analysis. The meta-analyses showed a moderate positive effect of shared decision-making interventions on disadvantaged patients. The narrative synthesis suggested that, overall, SDM interventions increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict among disadvantaged patients. Further, 7 out of 19 studies compared the intervention's effect between high and low literacy groups. Overall, SDM interventions seemed to benefit disadvantaged groups (e.g. lower literacy) more than those with higher literacy, education and socioeconomic status. Interventions that were tailored to disadvantaged groups' needs appeared most effective. Conclusion: Results indicate that shared decision-making interventions significantly improve outcomes for disadvantaged patients. According to the narrative synthesis, SDM interventions may be more beneficial to disadvantaged groups than higher literacy/socioeconomic status patients. However, given the small sample sizes and variety in the intervention types, study design and quality, those findings should be interpreted with caution.

Educational effectiveness research (EER): a state-of-the-art review

Abstract: Research and scholarship into educational effectiveness research (EER) is comprehensively reviewed from the UK, The Netherlands, the US, Cyprus, Belgium, Sweden, France, Germany, New Zealand, Australia, and other societies, dating from the field’s origins in the 1970s. Issues include its history, methodological and theoretical advances, scientific properties of school effects, processes at school and classroom level behind these effects, the somewhat limited translation of findings into policy and practice across the world, and future directions for research and practice in EER and for all of the discipline more generally. Future research needs are argued to be a further concentration upon teaching/teachers, more longitudinal studies, more work on possible context specificity, exploration of the cross-level transactions between schools and their teachers/classrooms, the adoption of “efficiency” as well as “effectiveness” as outcome measures, and a renewed focus upon the education of the disadvantaged, the original focus of our discipline when it began.

Defining food literacy and its components

Abstract: Food literacy has emerged as a term to describe the everyday practicalities associated with healthy eating. The term is increasingly used in policy, practice, research and by the public; however, there is no shared understanding of its meaning. The purpose of this research was to develop a definition of food literacy which was informed by the identification of its components. This was considered from two perspectives: that of food experts which aimed to reflect the intention of existing policy and investment, and that of individuals, who could be considered experts in the everyday practicalities of food provisioning and consumption. Given that food literacy is likely to be highly contextual, this second study focused on disadvantaged young people living in an urban area who were responsible for feeding themselves. The Expert Study used a Delphi methodology (round one n = 43). The Young People’s Study used semi-structured, life-course interviews (n = 37). Constructivist Grounded Theory was used to analyse results. This included constant comparison of data within and between studies. From this, eleven components of food literacy were identified which fell into the domains of: planning and management; selection; preparation; and eating. These were used to develop a definition for the term “food literacy”.

Multiple Disadvantaged Statuses and Health The Role of Multiple Forms of Discrimination

Abstract: The double disadvantage hypothesis predicts that adults who hold more than one disadvantaged status may experience worse health than their singly disadvantaged and privileged counterparts. Research that has tested this thesis has yielded mixed findings due partly to a failure to examine the role of discrimination. This article uses data from the National Survey of Midlife Development in the United States (N = 2,647) to investigate the relationship between multiple disadvantaged statuses and health, and whether multiple forms of interpersonal discrimination contribute to this association. The results suggest that multiply disadvantaged adults are more likely to experience major depression, poor physical health, and functional limitations than their singly disadvantaged and privileged counterparts. Further, multiple forms of discrimination partially mediate the relationship between multiple stigmatized statuses and health. Taken together, these findings suggest that multiply disadvantaged adults do face a “...

Sustainable tourism, justice and an ethic of care: toward the Just Destination.

Abstract: While a strong knowledge base has developed in sustainable tourism, theoretical links to justice and ethics have been slow to emerge at the destination level, especially about fairness, equity and justice for disadvantaged local groups, including poor, minority and indigenous populations. This paper draws upon, and justifies the use of several key philosophical traditions and social-political perspectives on justice to tackle this issue. A case study illustrates a range of justice issues experienced by local Mayan residents in Quintana Roo, Mexico, related to procedural and distributive justice, fairness and equity in the development and marketing of their natural and cultural heritage for tourism, as well as discriminatory and exclusionary practices toward that ethnic minority. Together, theoretical and empirical insights corroborate the need for a justice-oriented framework that addresses the social and cultural well-being of disadvantaged populations, and attempts to ensure that the poor are better off...

Dilettante or Renaissance Person? How the Order of Job Experiences Affects Hiring in an External Labor Market

Abstract: Social actors who move across categories are typically disadvantaged relative to their more focused peers. Yet candidates who compile experiences across disparate areas can either be appreciated as...

Staying out of Sight? Concentrated Policing and Local Political Action

Abstract: In some urban neighborhoods, encounters with police have become one of the primary points of contact between disadvantaged citizens and their government. Yet extant scholarship has only just begun to explore how criminal justice interventions help to shape the political lives of the urban poor. In this article, we ask: What are the consequences of the increased use of stop-and-frisks (Terry stops) in disadvantaged neighborhoods for communities’ engagement with the state? Relying on a novel measure of local citizen engagement (311 calls for service) and more than one million police stops, we find that it is not concentrated police surveillance per se that matters but, rather, the character of police contact. The concentration of police stops overall is associated with higher levels of community engagement, while at the same time, a high degree of stops that feature searches or the use of force, especially when they do not result in an arrest, have a chilling effect on neighborhood-level outreach to local g...

Academic Preparedness of First-Generation College Students: Different Perspectives.

Abstract: As student populations continue to become more diversified, institutions must understand students’ academic preparedness to better serve them. A significant amount of research and literature focuses on experiences of students whose parents had little or no college education. Although these first-generation students have much in common with other disadvantaged student groups, their situation presents unique conditions and obstacles to their college experience. This research project seeks to focus on the topic of academic preparedness of first-generation students. More specifically, this project builds on previous research on academic preparedness of first-generation students by exploring differences in students’ attitudes about preparedness compared with traditional academic measures. This study investigates whether first-generation student status affects self-assessment of academic preparedness in the same way it affects traditional measures of academic preparedness.

Summer jobs reduce violence among disadvantaged youth

Abstract: Every day, acts of violence injure more than 6000 people in the United States. Despite decades of social science arguing that joblessness among disadvantaged youth is a key cause of violent offending, programs to remedy youth unemployment do not consistently reduce delinquency. This study tests whether summer jobs, which shift focus from remediation to prevention, can reduce crime. In a randomized controlled trial among 1634 disadvantaged high school youth in Chicago, assignment to a summer jobs program decreases violence by 43% over 16 months (3.95 fewer violent-crime arrests per 100 youth). The decline occurs largely after the 8-week intervention ends. The results suggest the promise of using low-cost, well-targeted programs to generate meaningful behavioral change, even with a problem as complex as youth violence.

Developing Dialogic Argumentation Skills: A 3-year Intervention Study

Abstract: Argumentation is increasingly recognized as a fundamental intellectual skill, but evidence suggests that few adolescents or adults are skilled arguers. This article reports on an extended (3-year, twice weekly) intervention designed to afford dense practice in dialogic argumentation to middle-school students from traditionally academically disadvantaged backgrounds, with the goal of supporting development of argumentation skills. Students collaborated with peers who shared their positions on a series of social issues, both in small-group argument-building and reflective activities and in electronic dialogues with a succession of opposing-side peers. Annual assessments of individual argumentative skills on new topics showed students gaining in argumentative discourse skills across all 3 years of the intervention. Continued gains during the 3rd year, however, were concentrated among students who began with the least skill, highlighting the potentially equalizing role of such an intervention.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0–5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Abstract: Background: Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. Methods: Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. Results: Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from −0.29 kg/m 2 to −0.54 kg/m 2 for body mass index (BMI) and −2.9 to −25.6% for the prevalence of overweight/ obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. Conclusion: There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

The Digital Youth Network: Cultivating Digital Media Citizenship in Urban Communities

Abstract: The popular image of the "digital native" -- usually depicted as a technically savvy and digitally empowered teen -- is based on the assumption that all young people are equally equipped to become innovators and entrepreneurs. Yet young people in low-income communities often lack access to the learning opportunities, tools, and collaborators (at school and elsewhere) that help digital natives develop the necessary expertise. This book describes one approach to address this disparity: the Digital Youth Network (DYN), an ambitious project to help economically disadvantaged middle-school students in Chicago develop technical, creative, and analytical skills across a learning ecology that spans school, community, home, and online. The book reports findings from a pioneering mixed-method three-year study of DYN and how it nurtured imaginative production, expertise with digital media tools, and the propensity to share these creative capacities with others. Through DYN, students, despite differing interests and identities -- the gamer, the poet, the activist -- were able to find some aspect of DYN that engaged them individually and connected them to one another. Finally, the authors offer generative suggestions for designers of similar informal learning spaces.

Can Small High Schools of Choice Improve Educational Prospects for Disadvantaged Students

Abstract: This paper provides rigorous evidence (for 12,130 participants in a series of naturally occurring randomized lotteries) that a large-scale high school reform initiative (New York City’s creation of 100+ small high schools of choice between 2002 and 2008) can markedly and consistently increase high school graduation rates (by 9.5 percentage points overall and for many different student subgroups) for a large population of educationally and economically disadvantaged students of color without increasing annual school operating costs. These findings are directly relevant to current debates by policymakers and practitioners about how to improve the educational prospects of disadvantaged students in the United States. C � 2014 by the Association for Public Policy Analysis and Management.

Spatial stigma and health inequality

Abstract: A large body of literature has considered the way that places contribute to the health of their residents. The bulk of this research has considered the numerous risks and resources that are contained within the bounded spaces of neighborhoods and communities. Only recently have scholars begun to consider how these material and social conditions interact with the symbolic dimensions of place to further affect health. In this conceptual paper, we draw on a broad literature in order to develop a conceptual framework that connects negative representations of place, or spatial stigmas, to health. We argue that spatial stigma can affect health through three primary pathways: (1) access to material resources; (2) processes of stress and coping; and (3) processes related to identity formation and identity management. Our model suggests that spatial stigma is likely an important and understudied mechanism through which disadvantaged places contribute to multiple physical and mental health outcomes. Furthermore, by...

Learning to Think Critically: A Visual Art Experiment

Abstract: This article examines whether exposure to the arts has an effect on the ability of students to engage in critical thinking. We conduct a randomized controlled trial involving 3,811 students who were assigned by lottery to participate in a School Visit Program at the newly opened Crystal Bridges Museum of American Art. Students who participated in the School Visit Program demonstrated significantly stronger critical thinking skills when analyzing a new painting. These effects were larger for students from more disadvantaged backgrounds. In light of recent declines in the availability of the arts for disadvantaged populations, our results have important policy implications for efforts to restore and expand access to the arts.

General Practice Management of Type 2 Diabetes: 2014-15

Abstract: Diabetes is a national health priority. The number of people with type 2 diabetes is growing, most likely the result of rising overweight and obesity rates, lifestyle and dietary changes, and an ageing population. Within 20 years, the number of people in Australia with type 2 diabetes may increase from an estimated 870,000 in 2014, to over 2.5 million.1 The most socially disadvantaged Australians are twice as likely to develop diabetes. If left undiagnosed or poorly managed, type 2 diabetes can lead to coronary artery disease (CAD), stroke, kidney failure, limb amputations and blindness. The early identification and optimal management of people with type 2 diabetes is therefore critical. General practice has the central role in type 2 diabetes management across the spectrum, from identifying those at risk right through to caring for patients at the end of life. These guidelines support general practitioners (GPs) and their teams to provide high-quality management by providing up-to-date, evidence-based information tailored for general practice. In the development of the 2014–15 edition of General practice management of type 2 diabetes, the RACGP has focused on factors relevant to current Australian clinical practice. The RACGP has used the skills and knowledge of your general practice peers who have an interest in diabetes management and are members of the RACGP's National Faculty of Specific Interests Diabetes Network. This edition represents 18 years of a successful relationship between the RACGP and Diabetes Australia. We acknowledge the support of the RACGP National Standing Committee – Quality Care, the Medical Education and Scientific Committee of Diabetes Australia, and RACGP staff in the development of these guidelines. We would also like to acknowledge the contribution of the previous editorial panel (Dr Pat Phillips, Dr Peter Harris, Dr Linda Mann and Ms Carole Webster), whose dedication and commitment to previous editions has been instrumental to the success of these guidelines.

Why poor children are more likely to become poor readers: The early years.

Abstract: Gaps in literacy ability between children from different socio-economic backgrounds are evident before formal schooling begins. Low income makes a minor contribution. Socio-economic status exerts its influence on early literacy primarily through its association with other factors. Children from disadvantaged families are less likely to have experiences that encourage the development of fundamental skills for reading acquisition, specifically phonological awareness, vocabulary and oral language. These skills underlie the cognitive processes in the “simple view” of reading – word identification and language comprehension. Low quality early home literacy environments suppress children’s genetic potential, increasing the risk a child will struggle to learn to read. In addition, children from low socio-economic status backgrounds are more likely to have infant health outcomes associated with cognitive impairments, such as preterm birth and low birth weight, and are less likely to attend preschool. The risk fac...

Perceived Barriers to Exercise and Healthy Eating Among Women from Disadvantaged Neighborhoods: Results from a Focus Groups Assessment

Abstract: This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Culture Shock Revisited: The Social and Cultural Contingencies to Class Marginality†

Abstract: Existing explanations of class marginality predict similar social experiences for all lower-income undergraduates. This article extends this literature by presenting data highlighting the cultural and social contingencies that account for differences in experiences of class marginality. The degree of cultural and social dissimilarity between one’s life before and during college helps explain variation in experiences. I contrast the experiences of two groups of lower-income, black undergraduates—the Doubly Disadvantaged and Privileged Poor. Although from comparable disadvantaged households and neighborhoods, they travel along divergent paths to college. Unlike the Doubly Disadvantaged, whose precollege experiences are localized, the Privileged Poor cross social boundaries for school. In college, the Doubly Disadvantaged report negative interactions with peers and professors and adopt isolationist strategies, while the Privileged Poor generally report positive interactions and adopt integrationist strategies. In addition to extending present conceptualizations of class marginality, this study advances our understanding of how and when class and culture matter in stratification processes in college.

A Comprehensive Analysis of Poverty in India

Abstract: This paper offers a comprehensive analysis of poverty in India. It shows that regardless of which of the two official poverty lines the authors use, they see a steady decline in poverty in all states and for all social and religious groups. Accelerated growth between fiscal years 2004–2005 and 2009-2010 also led to an accelerated decline in poverty rates. Moreover, the decline in poverty rates during these years has been sharper for the socially disadvantaged groups relative to upper caste groups so that the authors now observe a narrowing of the gap in the poverty rates between the two sets of social groups. The paper also provides a discussion of the recent controversies in India regarding the choice of poverty lines.

An equal start?: Providing quality early education and care for disadvantaged children

Abstract: interventions, Brazil wrote a new democratic Constitution which also created the Unified Health System (SUS). Its creation led to the adoption of the universal right to health for the first time. This historical paradox is explained, according to the author, because of the role played by the Sanitaristas, an expert community who successfully seized the opportunity opened by the transition, colonized a niche of the state apparatus, and forced the expansion of citizenship by including the SUS in the new Brazilian Constitution. Written by Brazilian scholars working in the country’s most prestigious higher education institutions, the book fills a gap in the specialized literature published in English about policy analysis in Brazil. Students, scholars and policymakers will find in this book a wealth of information, analysis and sources; all critical material to study the field of public policy in contemporary Brazil.

Place-based policies

Abstract: Place-based policies commonly target underperforming areas, such as deteriorating downtown business districts and disadvantaged regions. Principal examples include enterprise zones, European Union Structural Funds, and industrial cluster policies. Place-based policies are rationalized by various hypotheses in urban and labor economics, such as agglomeration economies and spatial mismatch—hypotheses that entail market failures and often predict overlap between poor economic performance and disadvantaged residents. The evidence on enterprise zones is very mixed. We need to know more about what features of enterprise zone policies make them more effective or less effective, who gains and who loses from these policies, and how we can reconcile the existing findings. Some evidence points to positive benefits of infrastructure expenditure and also investment in higher education and university research—likely because of the public-goods nature of these policies. However, to better guide policy, we need to know more about what policies create self-sustaining longer run gains.

Systematic review of parenting interventions in European countries aiming to reduce social inequalities in children’s health and development

Abstract: Early child development influences many aspects of wellbeing, health, competence in literacy and numeracy, criminality, and social and economic participation throughout the life course. Children from disadvantaged groups have less possibilities of achieving full development. By providing a positive start for all children across the social gradient, improved developmental outcomes will be seen during later childhood and throughout their lives. The objective of this systematic review was to identify interventions during early childhood in countries from the World Health Organisation European Region in 1999–2013 which reduced inequalities in children’s health and development. A systematic review was carried out adhering to the PRISMA guidelines. The review examined universal, targeted and proportionate universalism interventions, programs and services using an electronic search strategy in PubMed and the International Bibliography of the Social Sciences [IBSS] databases. A further search was performed in the grey literature. Interventions were included only if they were aimed at children or their parents and had been evaluated. We identified 23 interventions in total: 6 in the PubMed data base, 5 in IBSS and 12 in grey literature. All but 1 intervention-delivered in Sweden-were carried out in the United Kingdom and the Republic of Ireland. These aimed to improve parenting abilities, however, some had additional components such as: day-care provision, improving housing conditions and speech or psychological therapies. Programmes offering intensive support, information and home visits using a psycho-educational approach and aimed at developing parent’s and children’s skills showed more favourable outcomes. These were parenting behaviours, overall children’s health and higher level of fine motor skills and cognitive functioning. Child injuries and abuse were also reduced. Two interventions were universally proportionate and all others were aimed at a specific target population. Interventions with better outcomes and a higher level of evidence combined workshops and educational programmes for both parents and children beginning during early pregnancy and included home visits by specialised staff. Further evaluation and publication of early years interventions should be carried out also within a wider range of countries than just the UK and Ireland.

Academic Risk and Resilience in the Context of Homelessness.

Abstract: Family homelessness in the United States has increased over the past two decades, raising concerns about associated risks for child development. In this article, we describe a translational research program focused on academic risk and resilience in homeless and highly mobile children. We find that although these children share many risk factors with other disadvantaged children, they are higher on an underlying continuum of risk. Additionally, marked variability has been observed among children who experience homelessness, both in risk level and achievement, with many children manifesting resilience. We discuss implications for research and efforts to address disparities in achievement.