U.S. smokers' reactions to graphic warning labels on their own packs were similar to other, more controlled studies. Qualitative findings underscore the need for warning labels that encourage self-referential processing without increasing defensive reactions.
In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010–2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral + tailored print reminder (N=372), or verbal referral + navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services.
This study examined whether unmet basic needs (food, housing, personal and neighborhood safety, money for necessities) and perceived stress affect recall of and response to a tailored print intervention one month later. Participants (N = 372) were adults who had called 2-1-1 Missouri between June 2010 and June 2012. A series of path analyses using Mplus were conducted to explore the relationships among basic needs, perceived stress, number of health referrals received in a tailored intervention, recalling the intervention and contacting a health referral. Participants were mainly women (85%) and African-American (59%) with a mean age of 42.2 years (SD = 13.3; range 19-86); 41% had annual household income <$10 000. Unmet basic needs were positively associated with increased levels of perceived stress, which, in turn, were negatively associated with recalling the intervention and calling any of the health referrals provided. Tailored printed interventions may be less effective in populations with acute unmet basic needs. More broadly, the effectiveness of minimal contact behavioral interventions might be enhanced by simultaneous efforts to address unmet basic needs.
The 2-1-1 information and referral helpline connects economically vulnerable Americans with needed health and social services in their communities. This longitudinal study followed a random sample of 2-1-1 callers in Missouri (n=1,235) to determine the results of the referrals they received. One month after calling 2-1-1, most remembered receiving (93%), tried contacting (91%) and reached (82%) at least one referral they received. Far fewer (36%) received assistance from the referral, ranging from 17% for housing assistance to 67% for food assistance. Callers receiving assistance were much more likely than those not receiving assistance to report at 1-month follow-up that their problem had been resolved (OR=3.0, 95% CI=2.2, 4.1), although this was less true among callers with multiple unmet basic needs. Findings explain how 2-1-1 helps callers resolve problems, but also identifies missed opportunities in the current system. Future research could elucidate how 2-1-1 callers resolve problems and find ways to improve outcomes for the most disadvantaged 2-1-1 callers.
Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g. housing). Callers to 2-1-1 in Missouri (N=1090) with at least one behavioral risk factor or cancer screening need were randomly assigned to one of three health referral interventions: verbal referrals only, verbal referrals + a tailored mailed reminder, or verbal referrals + telephone health navigator. After one month, we assessed whether the non-health problems that prompted the 2-1-1 call had been resolved. Logistic regression estimated effects of having the problem resolved on calling a health referral. Callers were predominantly female (85%) and had a high school education or less (61%); nearly half (47%) had incomes under $10,000. The most common service requests were for utility assistance (35%), home/family problems (23%), and rent/mortgage assistance (12%). At follow-up, 38% of callers reported that all problems prompting their 2-1-1 call had been resolved, and 24% reported calling a health referral. Resolving all problems prompting the 2-1-1 call was associated with a higher odds of contacting a health referral (OR = 1.44, 95% CI 1.02-2.05) compared to people whose problems were not resolved. Multifaceted interventions that help meet non-health-related needs and provide support in reaching health-related goals may promote health in vulnerable populations.
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