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Lowe AT, Maki A, Figueroa C, Venugopal PD. Place-based estimates of cigarette butt litter raise environmental justice concerns in the United States. PLoS One 2024; 19:e0308930. [PMID: 39146265 PMCID: PMC11326580 DOI: 10.1371/journal.pone.0308930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
Littering of cigarette butts is a major environmental challenge. In 2022, ~124 billion cigarette butts were littered in the United States. This litter may pose an environmental justice concern by disproportionately affecting human and environmental health in communities of color or communities of low socioeconomic status. However, the lack of data on the distribution and magnitude of cigarette butt littering prevents an environmental justice analysis and limits the ability to tackle this environmental challenge. We conducted an environmental justice assessment of tobacco product waste, specifically cigarette butts, through spatially-explicit, place-based estimates across the contiguous U.S. We built a bottom-up model by synthesizing census tract-level population and smoking prevalence, state-level cigarette consumption, and published littering data to assess the spatial pattern of cigarette consumption and littering, and its implications for environmental injustice in >71,600 U.S. census tracts. Further, we compared the model output to urbanicity (rural-urban commuting area) and Social-Environmental Risk (SER; CDC Environmental Justice Index). Cigarette butt density was not uniformly distributed across the U.S. and ranged from 0-45.5 butts/m2, with an area-weighted average of 0.019 ± 0.0005 butts/m2. Cigarette butt density was 96 times higher in metropolitan vs. rural areas. Cigarette butt density increased significantly with SER, with 5.6 times more littered cigarette butts, and a steeper response to population density, in census tracts with the highest SER vs. the lowest SER. These results demonstrate the relative influences of location, smoking prevalence, and population density, and show that cigarette butt littering is a potential environmental justice concern in the U.S. This study provides information that may help devise targeted strategies to reduce cigarette butt pollution and prevent disproportionate impacts. The spatial data layer with place-based cigarette consumption and butt density is a tool that can support municipal, state, and federal level policy work and future studies on associations among cigarette butt pollution and environmental health outcomes.
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Affiliation(s)
- Alexander T Lowe
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Alexander Maki
- Division of Population Health Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Carla Figueroa
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - P Dilip Venugopal
- Division of Nonclinical Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
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Martins SS, Segura LE, Marziali ME, Bruzelius E, Levy NS, Gutkind S, Santarin K, Sacks K, Fox A. Higher unemployment benefits are associated with reduced drug overdose mortality in the United States before and during the COVID-19 pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104522. [PMID: 38996642 PMCID: PMC11347091 DOI: 10.1016/j.drugpo.2024.104522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 06/03/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Overdose mortality rates in the United States remain critical to population health. Economic , such as unemployment, are noted risk factors for drug overdoses. The COVID-19 pandemic exacerbated economic hardship; as a result, the US government enacted income protection programs in conjunction with existing unemployment insurance (UI) to dampen COVID-19-related economic consequences. We investigate whether UI, operationalized as the weekly benefit allowance (WBA) replacement rate, is negatively associated with drug-related overdoses. METHODS Data from the pooled 2014-2020 Detailed Restricted Mortality files for all counties from the Centers for Disease Control and Prevention, restricted to people ≥18 years of age, aggregated at the county-quarter level (n = 89,914). We included any fatal drug, opioid, and stimulant overdose. We modeled the association between WBA replacement rate (e.g., a greater proportion of weekly earnings replaced by UI) on each county-level age-adjusted mortality outcome using separate linear regression models during 2014-2020, pre-COVID (2014-2018), and post-COVID (2019-2020). We conducted sensitivity analyses using multi-level linear regression models. RESULTS Results indicated that a more robust WBA replacement rate any drug (Risk Difference [RD]: -0.06, 95 % Confidence Interval [CI]: -0.08, -0.05), opioid (RD: -0.04, 95 % CI: -0.06, -0.03), and stimulant (RD: -0.03, 95 % CI: -0.04, -0.02) across the entire study period (2014-2020). A more robust WBA replacement rate was associated with fewer fatal drug, opioid and stimulant overdoses in the pre-COVID-19 period and on fatal any drug and stimulant overdoses in the COVID-19 period. CONCLUSIONS Findings support the notion that income protection policies, such as robust UI, can have a supportive role in preventing fatal drug overdoses, calling for a broader discussion onthe role of the safety net programs to buffer drug-related harms.
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Affiliation(s)
- Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States.
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Megan E Marziali
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kristen Santarin
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | | | - Ashley Fox
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, SUNY, United States
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Park JS, Polikarpova A, Leibman S, Laurence JM, Smith G, Falk GL, Sandroussi C. The influence of socioeconomic disadvantage on short- and long-term outcomes after oesophagectomy for cancer: an Australian multicentre study. ANZ J Surg 2024. [PMID: 39041601 DOI: 10.1111/ans.19172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/29/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Socioeconomic status (SES) affects outcomes following surgery for various cancers. There are currently no Australian studies that examine the role of socioeconomic disadvantage on outcomes following oesophagectomy for cancer. This study assessed whether SES was associated with short-term perioperative morbidity, long-term survival, and oncological outcomes following oesophagectomy across three tertiary oesophageal cancer centres in Australia. METHODS A retrospective cohort study was performed comprising all patients who underwent oesophagectomy for cancer across three Australian centres. Patients were stratified into SES groups using the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD). Outcomes measured included perioperative complication rates, overall survival, and disease-free survival. RESULTS The study cohort was 462 patients, 205 in the lower SES and 257 in the higher SES groups. The lower SES group presented with more advanced oesophageal cancer stage, a higher rate of T3 (52.6% versus 42.7%, P = 0.038) and N2 disease (19.6% versus 10.5%, P = 0.006), and had a higher rate of readmission within 30 days (11.2% versus 5.4%, P = 0.023). There was no difference in overall survival or disease-free survival between groups. CONCLUSION Lower socioeconomic status was associated with more advanced stage and increased risk of early, unplanned readmission following oesophagectomy, but was not associated with a difference in overall or disease-free survival.
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Affiliation(s)
- Jin-Soo Park
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Aleksandra Polikarpova
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven Leibman
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jerome M Laurence
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Garett Smith
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gregory L Falk
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Charbel Sandroussi
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
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Zhou E, Wu J, Zhou X, Yin Y. Systemic inflammatory biomarkers are novel predictors of all-cause and cardiovascular mortality in individuals with osteoarthritis: a prospective cohort study using data from the NHANES. BMC Public Health 2024; 24:1586. [PMID: 38872115 PMCID: PMC11170786 DOI: 10.1186/s12889-024-19105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Chronic inflammation may contribute to increased mortality risk in individuals with osteoarthritis (OA), but research on the prognostic value of inflammatory biomarkers is limited. We aimed to evaluate the associations of the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) with all-cause and cardiovascular mortality among US adults with OA. METHODS This cohort study included 3545 adults with OA aged ≥ 20 years from the National Health and Nutrition Examination Survey 1999-2020. The SII and SIRI were calculated using complete blood cell count data. Participants were categorized as having a higher or lower SII and SIRI using cutoff points derived by the maximally selected rank statistics method. Cox proportional hazards models, Fine-Gray competing risk regression models and time-dependent receiver operating characteristic (ROC) analysis were used to evaluate the associations between the SII/SIRI and mortality in OA patients. RESULTS Over a median follow-up of 5.08 (3.42-9.92) years, 636 (17.94%) deaths occurred, including 149 (4.20%) cardiovascular deaths. According to multivariable-adjusted models involving demographic, socioeconomic, and health factors, OA patients with a higher SII had a twofold greater risk of all-cause mortality than patients with a lower SII (HR 2.01; 95% CI: 1.50-2.68). Similarly, a higher SIRI was associated with an 86% increased risk of all-cause mortality relative to a lower SIRI (HR 1.86; 95% CI: 1.46-2.38). Similar to the trend found with all-cause mortality, patients with an elevated SII and SIRI had a 88% and 67% increased risk of cardiovascular mortality, respectively, compared to patients with a lower SII (HR 1.88; 95% CI: 1.16-3.03) and SIRI (HR 1.67; 95% CI: 1.14-2.44). Time-dependent ROC curves showed that both the SII and SIRI have moderate and valid performance in predicting short- and long-term mortality in patients with OA. CONCLUSIONS Higher SII and SIRI values were associated with greater all-cause and cardiovascular mortality among US adults with OA.
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Affiliation(s)
- Erye Zhou
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, No.188 Shizi St, Suzhou , Jiangsu, 215006, China
| | - Jian Wu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, No.188 Shizi St, Suzhou , Jiangsu, 215006, China
| | - Xin Zhou
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, No.188 Shizi St, Suzhou , Jiangsu, 215006, China
| | - Yufeng Yin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, No.188 Shizi St, Suzhou , Jiangsu, 215006, China.
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Scotti KB, Rajoria M, Carrera Seoane M, Ross KM, Muenyi S, McVay MA. Exploring potential reach and representativeness of a self-weighing weight gain prevention intervention in adults with overweight and obesity. Clin Obes 2024; 14:e12641. [PMID: 38302264 PMCID: PMC11090748 DOI: 10.1111/cob.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
Most adults with obesity do not enrol in comprehensive weight loss interventions when offered. For these individuals, lower burden self-weighing interventions may offer an acceptable alternative, though data is lacking on the potential for reach and representativeness of such interventions. Health system patients with BMI ≥30 kg/m2 (or 25-30 kg/m2 with an obesity comorbidity) completed a general health survey. During the survey, patients were given information about comprehensive weight loss interventions. If they denied interest or did not enrol in a comprehensive intervention, they were offered enrolment in a low-burden weight gain prevention intervention focused on daily self-weighing using a cellular network-connected in-home scale without any dietary or physical activity prescriptions. Enrolment in this program was documented. Among patients offered the self-weighing intervention (n = 85; 55.3% men; 58.8% White; BMI = 34.2 kg/m2), 44.2% enrolled. Compared to those who did not enrol, enrollers had higher educational attainment (57.1% vs. 42.9% with bachelor's degree p = .02), social anxiety (5.8 vs. 2.8, p < .001), and perceptions of the effectiveness of the self-weighing intervention (25.8 vs. 20.9 on 35, p = .007). The most highly endorsed reason for not enrolling in the self-weighing intervention was that it would make individuals overly focused on weight. A low-intensity weight gain prevention intervention may serve as a viable alternative to comprehensive weight loss interventions for the substantial portion of patients who are at risk for continued weight gain but would otherwise not enrol in a comprehensive intervention. Differential enrolment by education, however, suggests potential for inequitable uptake.
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Affiliation(s)
- Kellie B Scotti
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | | | - Montserrat Carrera Seoane
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Sofia Muenyi
- Department of Community Health and Family Medicine, College of Medicine-Jacksonville, University of Florida Health, Jacksonville, Florida, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
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Cornelison B, Aqel O, Axon DR. Characteristics associated with perceived level of confidence managing diabetes among United States adults with diabetes: A retrospective cross-sectional study. J Family Med Prim Care 2024; 13:2440-2448. [PMID: 39027830 PMCID: PMC11254041 DOI: 10.4103/jfmpc.jfmpc_1025_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/12/2023] [Accepted: 02/02/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives Identifying characteristics associated with patients' confidence managing diabetes may aid the primary care provider in offering diabetes self-management education and support to patients. This analysis assessed the relationship between demographic, health, economic, access to care, satisfaction with care, and healthcare utilization characteristics with patients' confidence managing diabetes. Methods United States adults with diabetes in the 2020 Medical Expenditure Panel Survey were included in this retrospective cross-sectional analysis. Characteristics related statistically to patients' confidence managing diabetes in multivariable logistic regression analysis were reported. Results Among the 1,516 eligible individuals, 76.3% stated they were very confident/confident with their diabetes management. Adults who perceived their health positively (odds ratio 2.3, 95% confidence interval [CI] 1.3-3.9), completed ≥30 min moderate/vigorous exercise five times weekly (odds ratio 1.6, 95% CI 1.0-2.6), had at least one inpatient discharge in 2020 (odds ratio 3.5, 95% CI 1.5-8.1), said it was not difficult to telephone their usual provider (odds ratio 3.3, 95% CI 1.4-7.8), and had no emergency room visits in 2020 (odds ratio 2, 95% CI 1.1-3.3) had higher odds of stating they were very confident or confident with their diabetes management. Conclusion The characteristics associated with being very confident/confident managing diabetes should be considered by primary healthcare physicians and other healthcare professionals when helping patients manage diabetes.
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Affiliation(s)
- Bernadette Cornelison
- Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, The University of Arizona 1295 N Martin Ave, Tucson, AZ 85721, USA
| | - Osama Aqel
- Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, The University of Arizona 1295 N Martin Ave, Tucson, AZ 85721, USA
| | - David R. Axon
- Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, The University of Arizona 1295 N Martin Ave, Tucson, AZ 85721, USA
- Center for Health Outcomes and PharmacoEconomic Research (HOPE Center), R. Ken Coit College of Pharmacy, The University of Arizona 1295 N Martin Ave, Tucson, AZ 85721, USA
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Arthur MN, DeLong RN, Kucera K, Goettsch BP, Schattenkerk J, Bekker S, Drezner JA. Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA. Br J Sports Med 2024; 58:494-499. [PMID: 38413131 DOI: 10.1136/bjsports-2023-107367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To explore the association of socioeconomic deprivation and racialised outcomes in competitive athletes with sudden cardiac arrest (SCA) in the USA. METHODS SCA cases from the National Center for Catastrophic Sports Injury Research (July 2014 to June 2021) were included. We matched Area Deprivation Index (ADI) scores (17 metrics to grade socioeconomic conditions) to the 9-digit zip codes for each athlete's home address. ADI is scored 1-100 with higher scores indicating greater neighbourhood socioeconomic deprivation. Analysis of variance was used to assess differences in mean ADI by racial groups. Tukey post hoc testing was used for pairwise comparisons. RESULTS 391 cases of SCA in competitive athletes (85.4% male; 16.9% collegiate, 68% high school, 10.7% middle school, 4.3% youth) were identified via active surveillance. 79 cases were excluded due to missing data (19 race, 60 ADI). Of 312 cases with complete data, 171 (54.8%) were white, 110 (35.3%) black and 31 (9.9%) other race. The mean ADI was 40.20 (95% CI 36.64, 43.86) in white athletes, 57.88 (95% CI 52.65, 63.11) in black athletes and 40.77 (95% CI 30.69, 50.86) in other race athletes. Mean ADI was higher in black versus white athletes (mean difference 17.68, 95% CI 10.25, 25.12; p=0.0036) and black versus other race athletes (mean difference 17.11, 95% CI 4.74, 29.47; p<0.0001). CONCLUSIONS Black athletes with SCA come from areas with higher neighbourhood socioeconomic deprivation than white or other race athletes with SCA. Our findings suggest that socioeconomic deprivation may be associated with racialised disparities in athletes with SCA.
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Affiliation(s)
- Megan Nicole Arthur
- Family Medicine, Boston University School of Medicine, Cambridge, Massachusetts, USA
| | - Randi N DeLong
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barbara P Goettsch
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Schattenkerk
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | | | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Kamsani SH, Middeldorp ME. Adherence in a fortnight: is this a true reflection of a lifetime? Heart 2024; 110:615-617. [PMID: 38331559 DOI: 10.1136/heartjnl-2023-323800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Suraya H Kamsani
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
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Tang J, Ma Y, Hoogendijk EO, Chen J, Yue J, Wu C. Associations between healthy lifestyle and mortality across different social environments: a study among adults with frailty from the UK Biobank. Eur J Public Health 2024; 34:218-224. [PMID: 38288504 PMCID: PMC10990525 DOI: 10.1093/eurpub/ckae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Among people living with frailty, adherence to a healthy lifestyle may be a low-cost and effective strategy to decrease frailty-induced health risks across different social environments. METHODS We included 15 594 frail participants at baseline from the UK Biobank study. We used four lifestyle factors to create a composite healthy lifestyle score and 17 social factors to construct a polysocial score. We classified the lifestyle score into two levels (unhealthy and healthy) and the polysocial score into three levels (low, intermediate and high). We used Cox regression to determine the association of each lifestyle factor and lifestyle score with all-cause mortality, respectively. We also examined the associations across polysocial score categories. We evaluated the joint association of the lifestyle score and the categorical polysocial score with all-cause mortality. RESULTS During up to 14.41 follow-up years, we documented 3098 all-cause deaths. After multivariable adjustment, we found a significant association between not smoking and adequate physical activity with all-cause mortality across polysocial score categories, respectively. We also found a significant association between a healthy diet and all-cause mortality among frail participants living in an intermediate social environment. A healthy lifestyle was associated with a lower all-cause mortality risk across polysocial score categories, especially among those with a low polysocial score. CONCLUSIONS Adherence to a healthy lifestyle, particularly not smoking, adequate physical activity and a healthy diet, may provide a feasible solution to decreasing mortality risk among frail adults across different social environments, especially for those in the socially disadvantaged group.
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Affiliation(s)
- Junhan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC—location VU University Medical Center, Amsterdam, The Netherlands
| | - Jie Chen
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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Lee MH, Zea R, Garrett JW, Summers RM, Pickhardt PJ. AI-generated CT body composition biomarkers associated with increased mortality risk in socioeconomically disadvantaged individuals. Abdom Radiol (NY) 2024; 49:1330-1340. [PMID: 38280049 DOI: 10.1007/s00261-023-04161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To evaluate the relationship between socioeconomic disadvantage using national area deprivation index (ADI) and CT-based body composition measures derived from fully automated artificial intelligence (AI) tools to identify body composition measures associated with increased risk for all-cause mortality and adverse cardiovascular events. METHODS Fully automated AI body composition tools quantifying abdominal aortic calcium, abdominal fat (visceral [VAT], visceral-to-subcutaneous ratio [VSR]), and muscle attenuation (muscle HU) were applied to non-contrast CT examinations in adults undergoing screening CT colonography (CTC). Patients were partitioned into 5 socioeconomic groups based on the national ADI rank at the census block group level. Pearson correlation analysis was performed to determine the association between national ADI and body composition measures. One-way analysis of variance was used to compare means across groups. Odds ratios (ORs) were generated using high-risk, high specificity (90% specificity) body composition thresholds with the most disadvantaged groups being compared to the least disadvantaged group (ADI < 20). RESULTS 7785 asymptomatic adults (mean age, 57 years; 4361:3424 F:M) underwent screening CTC from April 2004-December 2016. ADI rank data were available in 7644 patients. Median ADI was 31 (IQR 22-43). Aortic calcium, VAT, and VSR had positive correlation with ADI and muscle attenuation had a negative correlation with ADI (all p < .001). Compared with the least disadvantaged group, mean differences for the most disadvantaged group (ADI > 80) were: Aortic calcium (Agatston) = 567, VAT = 27 cm2, VSR = 0.1, and muscle HU = -6 HU (all p < .05). Compared with the least disadvantaged group, the most disadvantaged group had significantly higher odds of having high-risk body composition measures: Aortic calcium OR = 3.8, VAT OR = 2.5, VSR OR = 2.0, and muscle HU OR = 3.1(all p < .001). CONCLUSION Fully automated CT body composition tools show that socioeconomic disadvantage is associated with high-risk body composition measures and can be used to identify individuals at increased risk for all-cause mortality and adverse cardiovascular events.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Ryan Zea
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - John W Garrett
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
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Link BG, García SJ, Firat R, La Scalla S, Phelan JC. Socioeconomic-Status-Based Disrespect, Discrimination, Exclusion, and Shaming: A Potential Source of Health Inequalities? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241232658. [PMID: 38491866 DOI: 10.1177/00221465241232658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.
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Bjerregaard P, Svartá DL, Ottendahl CB, Larsen CVL. Increasing health inequality among Inuit in Greenland from 1993 to 2018: Different patterns for household assets, urbanization and a sociocultural index as indicators of social position. SSM Popul Health 2024; 25:101635. [PMID: 38486800 PMCID: PMC10937147 DOI: 10.1016/j.ssmph.2024.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/05/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Income inequality affects population health and wellbeing negatively. In Greenland, health inequality has been shown to exist among social groups, regionally and according to urbanization, and between Inuit and migrants from Denmark. The purpose of the study was to compare the changes in health inequality from 1993 to 2018 according to three measures of social position, i.e. a socioeconomic measure (household assets), a measure of urbanization and a composite sociocultural index. We hypothesized that social inequality in health increased parallel to the increasing economic inequality in Greenland. The sample was based on four population health surveys conducted among the Inuit in Greenland in 1993, 2005-2010, 2014 and 2018. The total number of interviews was 9024 and the total number of individuals interviewed was 5829, as participants were invited to several surveys as part of a cohort. As statistical measure of social disparity we used the slope index of inequality (SII) adjusted for age and sex. Analyses were performed with daily smoking, suicidal thoughts and obesity as health outcomes. Daily smoking was most prevalent among participants with low social position whereas obesity was most prevalent among participants with high social position. With household assets as indicator of social position, the results showed high and increasing social inequality for both daily smoking and obesity. Social inequality for daily smoking increased over time also for urbanization and the sociocultural index. The hypothesis that social inequality increased over time was thus confirmed for daily smoking and obesity but not for suicidal thoughts. With the results from the present study there is solid evidence to guide prevention and health care towards social equality in health.
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Affiliation(s)
- Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Durita Lyngsø Svartá
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Charlotte Brandstrup Ottendahl
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
- Institute of Health and Nature, University of Greenland, Manutooq 1, 3905 Nuussuaq, Greenland
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Lesand L, Dahlin LB, Rydberg M, Zimmerman M. Effects of socioeconomic status on patient-reported outcome after surgically treated trigger finger: a retrospective national registry-based study. BMJ Open 2023; 13:e077101. [PMID: 38101829 PMCID: PMC11148673 DOI: 10.1136/bmjopen-2023-077101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To investigate if socioeconomic status impacts patient-reported outcomes after a surgically treated trigger finger (TF). DESIGN AND SETTING Data on patients with TF treated with surgery were collected from the Swedish National Quality Registry of Hand Surgery (HAKIR) 2010-2019 with an evaluation of symptoms and disability before surgery and at 3 and 12 months after surgery, using the short version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire.Data from HAKIR and the Swedish National Diabetes Registry (ndr.nu) were combined with socioeconomic data from Statistics Sweden (scb.sc), analysing the impact of marital status, education level, income, occupation, sickness benefits, days of unemployment, social assistance and migrant status on the outcome by a linear regression model. PARTICIPANTS In total, 5477 patients were operated on for primary TF during the study period, of whom 21% had diabetes, with a response rate of 35% preoperatively, 26% at 3 months and 25% at 12 months. RESULTS At all time points, being born in Sweden (preoperatively B-coefficient: -9.74 (95% CI -13.38 to -6.11), 3 months postoperatively -9.80 (95% CI -13.82 to -5.78) and 12 months postoperatively -8.28 (95% CI -12.51 to -4.05); all p<0.001) and high earnings (preoperatively -7.81 (95% CI -11.50 to -4.12), 3 months postoperatively -9.35 (95% CI -13.30 to -5.40) and 12 months postoperatively -10.25 (95% CI -14.37 to -6.13); all p<0.0001) predicted lower QuickDASH scores (ie, fewer symptoms and disability) in the linear regression models. More sick leave during the surgery year predicted higher QuickDASH scores (preoperatively 5.77 (95% CI 3.28 to 8.25; p<0.001), 3 months postoperatively 4.40 (95% CI 1.59 to 7.22; p<0.001) and 12 months postoperatively 4.38 (95% CI 1.35 to 7.40; p=0.005)). No socioeconomic factors impacted the change in QuickDASH score from preoperative to 12 months postoperatively in the fully adjusted model. CONCLUSION Individuals with low earnings, high sick leave the same year as the surgery and those born outside of Sweden reported more symptoms both before and after surgery, but the relative improvement was not affected by socioeconomic factors.
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Affiliation(s)
- Lovisa Lesand
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
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Ibarra-Sanchez AS, Abelsen B, Chen G, Wisløff T. Educational patterns of health behaviors and body mass index: A longitudinal multiple correspondence analysis of a middle-aged general population, 2007-2016. PLoS One 2023; 18:e0295302. [PMID: 38039296 PMCID: PMC10691680 DOI: 10.1371/journal.pone.0295302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/10/2023] [Indexed: 12/03/2023] Open
Abstract
Social differences in body mass index and health behaviors are a major public health challenge. The uneven distribution of unhealthy body mass index and of unhealthy behaviors such as smoking, physical inactivity, and harmful alcohol consumption has been shown to mediate social inequalities in chronic diseases. While differential exposures to these health variables have been investigated, the extent to which they vary over the lifetime in the same population and their relationship with level of education is not well understood. This study examines patterns of body mass index and multiple health behaviors (smoking, physical activity and alcohol consumption), and investigates their association with education level among adults living in Northern Norway. It presents findings from a longitudinal multiple correspondence analysis of the Tromsø Study. Longitudinal data from 8,906 adults aged 32-87 in 2007-2008, with repeated measurements in 2015-2016 were retrieved from the survey's sixth and seventh waves. The findings suggest that most in the study population remained in the same categories of body mass index and the three health behaviors at the follow-up, with a clear educational gradient in healthy patterns. That is, both healthy changes and maintained healthy categories were associated with the highest education levels. Estimating differential exposures to mediators of health inequalities could benefit policy priority setting for tackling inequalities in health.
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Affiliation(s)
| | - Birgit Abelsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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15
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Hjarnaa L, Møller SP, Curtis AB, Becker U, Andersen O, Torvik FA, Tolstrup JS. Alcohol Intake and Academic Performance and Dropout in High School: A Prospective Cohort Study in 65,233 Adolescents. J Adolesc Health 2023; 73:1083-1092. [PMID: 37702649 DOI: 10.1016/j.jadohealth.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE During the teenage years, many adolescents start drinking alcohol, and binge drinking is prevalent. We investigated the relationship between alcohol intake and academic performance. METHODS We conducted a longitudinal cohort study by combining data from the Danish National Youth Study on 65,233 high school students aged 15-20 years, with information on dropout and grade point average. We assessed associations between alcohol intake and academic performance using multilevel Poisson regression and linear regression, accounting for dependency between students from the same school and class. RESULTS The average alcohol intake was 10 drinks per week, and 43.6% engaged in binge drinking 3+ times per month. During follow-up, 9.8% of the boys and 6.7% of the girls dropped out. The incidence rate ratio was higher in never drinkers, frequent binge drinkers, and those with a high weekly alcohol intake as compared to those with a low intake. For example, the incidence rate ratio was 1.47 (95% confidence level: 1.24, 1.76) in girls who drank 21-27 drinks per week and 1.29 (95% confidence level: 1.13, 1.48) in girls who never drank as compared to those who drank <7 drinks per week. Alcohol associated with a lower grade point average over the entire span of intake in a dose-dependent manner, and similarly so in boys and girls. Findings were consistent in strata of socioeconomy and individual academic ambition. DISCUSSION Alcohol intake has implications for academic performance and poses a threat for the prospects of the individual as well as society. Policies and interventions aimed at lowering the intake among high school students are warranted.
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Affiliation(s)
- Louise Hjarnaa
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne Pagh Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Alberte Brix Curtis
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Fartein Ask Torvik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Karlsson ML, Hertzberg-Nyquist K, Saevarsdottir S, Lundberg IE, Demmelmaier I, Pettersson S, Chatzidionysiou K. Evaluation of an individually tailored smoking-cessation intervention for patients with rheumatoid arthritis in an outpatient clinic. Scand J Rheumatol 2023; 52:591-600. [PMID: 36815567 DOI: 10.1080/03009742.2023.2172903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate an individually tailored smoking-cessation intervention delivered in rheumatology care and compare the characteristics of patients who quit smoking with those who did not. METHOD This was an open single-group prospective intervention study over 24 months, with assessments at baseline and at 6, 12, 18, and 24 months. Current smokers with rheumatoid arthritis (RA) were invited to a smoking-cessation programme including behavioural change support, with or without pharmacotherapy. Data on disease activity, medical treatment, and patient-reported outcomes were retrieved from the Swedish Rheumatology Quality Register. The primary outcome was the proportion of patients at month 24 who reported having quit smoking with self-reported 7 day smoking abstinence. RESULTS In total, 99 patients participated in the study. Median age was 58 years (interquartile range 50-64); 69% were female and 88% rheumatoid factor and/or anti-cyclic citrullinated peptide positive. At 24 months, 21% of the patients had quit smoking. At 6, 12, and 18 months, 12%, 12%, and 14% of patients, respectively, had quit smoking. For patients still smoking at 24 months, the median number of cigarettes per day was significantly reduced from 12 to 6 (p ≤ 0.001). Among patients who had quit smoking at 24 months, a smaller proportion reported anxiety at baseline compared to those still smoking (28% vs 58%, p = 0.02). CONCLUSION A smoking-cessation intervention including behavioural change support with or without pharmacotherapy can be helpful for a substantial number of RA patients. Anxiety is associated with lower smoking-cessation success rates.
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Affiliation(s)
- M-L Karlsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | | | - S Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - I Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - S Pettersson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - K Chatzidionysiou
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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Gautam N, Dessie G, Rahman MM, Khanam R. Socioeconomic status and health behavior in children and adolescents: a systematic literature review. Front Public Health 2023; 11:1228632. [PMID: 37915814 PMCID: PMC10616829 DOI: 10.3389/fpubh.2023.1228632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Socioeconomic status affects individuals' health behaviors and contributes to a complex relationship between health and development. Due to this complexity, the relationship between SES and health behaviors is not yet fully understood. This literature review, therefore, aims to assess the association between socioeconomic status and health behaviors in childhood and adolescence. Preferred Reporting for Systematic Review and Meta-Analysis protocol guidelines were used to conduct a systematic literature review. The electronic online databases EBSCO Host, PubMed, Web of Science, and Science Direct were utilized to systematically search published articles. The Joanna Briggs Institute's critical appeal tool was used to assess the quality of included studies. Eligibility criteria such as study context, study participants, study setting, outcome measures, and key findings were used to identify relevant literature that measured the association between socioeconomic status and health behaviors. Out of 2,391 studies, only 46 met the final eligibility criteria and were assessed in this study. Our review found that children and adolescents with low socioeconomic status face an elevated risk of unhealthy behaviors (e.g., early initiation of smoking, high-energy-dense food, low physical activity, and involvement in drug abuse), in contrast to their counterparts. Conversely, children and adolescents from higher socioeconomic backgrounds exhibit a higher prevalence of health-promoting behaviors, such as increased consumption of fruit and vegetables, dairy products, regular breakfast, adherence to a nutritious diet, and engagement in an active lifestyle. The findings of this study underscore the necessity of implementing specific intervention measures aimed at providing assistance to families from disadvantaged socioeconomic backgrounds to mitigate the substantial disparities in health behavior outcomes in children and adolescents.
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Affiliation(s)
- Nirmal Gautam
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Getenet Dessie
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mohammad Mafizur Rahman
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Rasheda Khanam
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
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18
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Peshkovskaya A, Galkin S. Health behavior in Russia during the COVID-19 pandemic. Front Public Health 2023; 11:1276291. [PMID: 37849726 PMCID: PMC10577229 DOI: 10.3389/fpubh.2023.1276291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023] Open
Abstract
In this article, we report results from a nationwide survey on pandemic-related health behavior in Russia. A total of 2,771 respondents aged 18 to 82 were interviewed between January 21 and March 3, 2021. The survey included questions on perceived vulnerability to coronavirus, prevention-related health behavior, readiness for vaccination, and general awareness about COVID-19. Descriptive data showed that 21.2% of respondents reported high vulnerability to the coronavirus, and 25% expressed fear. Moreover, 38.7% of the surveyed individuals reported low trust in vaccination efficacy, and 57.5% were unwilling to take a vaccine, which was much higher than the official data. Based on the evidence obtained, four types of health behavior during the pandemic were constructed. Rational (29.3%) and denying (28.6%) behaviors prevailed in men, while women were found to more likely behave with a vaccine-hesitant demeanor (35.7%). Educational background affected the proportion of respondents with the denying type of health behavior, who were also of younger age. The rational behavioral type was found to be more common among respondents aged above 50 years and prevailed as well among individuals with university degrees. The middle-aged population of Russia was highly compliant with prevention-related health practices; however, vaccine hesitancy was also high among them. Furthermore, health behaviors varied significantly across the Federal Districts of Russia. We are convinced that our results contribute to existing public health practices and may help improve communication campaigns to cause positive health behaviors.
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Affiliation(s)
- Anastasia Peshkovskaya
- Tomsk State University, Tomsk, Russia
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Stanislav Galkin
- Tomsk State University, Tomsk, Russia
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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Palte NK, Adler LSF, Ady JW, Truong H, Rahimi SA, Beckerman WE. Area Deprivation Index is not predictive of worse outcomes after open lower extremity revascularization. J Vasc Surg 2023; 78:1030-1040.e2. [PMID: 37318431 DOI: 10.1016/j.jvs.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Prior research has shown that socioeconomic status (SES) is associated with higher rates of diabetes, peripheral vascular disease, and amputation. We sought to determine whether SES or insurance type increases the risk of mortality, major adverse limb events (MALE), or hospital length of stay (LOS) after open lower extremity revascularization. METHODS We conducted a retrospective analysis of patients who underwent open lower extremity revascularization at a single tertiary care center from January 2011 to March 2017 (n = 542). SES was determined using state Area Deprivation Index (ADI), a validated metric determined by income, education, employment, and housing quality by census block group. Patients undergoing amputation in this same time period (n = 243) were included to compare rates of revascularization to amputation by ADI and insurance status. For patients undergoing revascularization or amputation procedures on both limbs, each limb was treated individually for this analysis. We performed a multivariate analysis of the association between ADI and insurance type with mortality, MALE, and LOS using Cox proportional hazard models, including confounding variables such as age, gender, smoking status, body mass index, hyperlipidemia, hypertension, and diabetes. The cohort with an ADI quintile of 1, meaning least deprived, and the Medicare cohort were used for reference. P values of <.05 were considered statistically significant. RESULTS We included 246 patients undergoing open lower extremity revascularization and 168 patients undergoing amputation. Controlling for age, gender, smoking status, body mass index, hyperlipidemia, hypertension, and diabetes, ADI was not an independent predictor of mortality (P = .838), MALE (P = .094), or hospital LOS (P = .912). Controlling for the same confounders, uninsured status was independently predictive of mortality (P = .033), but not MALE (P = .088) or hospital LOS (P = .125). There was no difference in the distribution of revascularizations or amputations by ADI (P = .628), but there was higher proportion of uninsured patients undergoing amputation compared with revascularization (P < .001). CONCLUSIONS This study suggests that ADI is not associated with an increased risk of mortality or MALE in patients undergoing open lower extremity revascularization, but that uninsured patients are at higher risk of mortality after revascularization. These findings indicate that individuals undergoing open lower extremity revascularization at this single tertiary care teaching hospital received similar care, regardless of their ADI. Further study is warranted to understand the specific barriers that uninsured patients face.
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Affiliation(s)
- Nadia K Palte
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Lily S F Adler
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Justin W Ady
- Department of Surgery, Division of Vascular and Endovascular Therapy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Huong Truong
- Department of Surgery, Division of Vascular and Endovascular Therapy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum A Rahimi
- Department of Surgery, Division of Vascular and Endovascular Therapy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - William E Beckerman
- Department of Surgery, Division of Vascular and Endovascular Therapy, Robert Wood Johnson Medical School, New Brunswick, NJ.
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Surachman A, Tucker-Seeley R, Almeida DM. The association between material-psychological-behavioral framework of financial hardship and markers of inflammation: a cross-sectional study of the Midlife in the United States (MIDUS) Refresher cohort. BMC Public Health 2023; 23:1845. [PMID: 37735377 PMCID: PMC10514981 DOI: 10.1186/s12889-023-16745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Measures of financial hardship have been suggested to supplement traditional indicators of socioeconomic status (SES) to elucidate household economic well-being. This study formally tested the construct validity of financial hardship and examined its association with markers of inflammation. METHODS This study utilized data from the Midlife Development in the United States Refresher Study (MIDUS-R; Age = 23-76, 53.7% female, 71% white). Participants were divided into exploratory factor analysis (EFA; completed SAQs only; N = 2,243) and confirmatory factor analysis sample (CFA; completed SAQs and biomarker assessment; N = 863). Analysis was divided into three steps. First, exploratory factor analysis (EFA) is used to examine if the three-domain factor (material, psychological, and behavioral) is the best fitting model for financial hardship measures. Second, we conducted CFA to test the hypothesized three-factor measurement model of financial hardship. Third, we tested the association between domains and the general latent factor of financial hardship and inflammation (interleukin 6/IL6, c-reactive protein/CRP, and fibrinogen). RESULTS Results from EFA supported the three-domain model of financial hardship. The hypothesized three-domain measurement model fits well in a different sample within MIDUS-R. In the models adjusted for age and sex, higher material hardship was associated with elevated IL6, CRP, and fibrinogen, while higher behavioral hardship was associated with higher CRP. The association between the material domain and IL6 remained significant after adding body mass index, education, and race as additional covariates. The second-order financial hardship measurement model was associated with IL6, CRP, and fibrinogen, adjusted for age, sex, BMI, education, and race. CONCLUSION Explicating the socioeconomic environment to include indicators of financial hardship can help researchers better understand the pathway between SES and the inflammation process, which may help elucidate pathways between SES and age-related chronic diseases associated with inflammation.
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Affiliation(s)
- Agus Surachman
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, 19104, USA.
- College of Nursing and Health Professions, Drexel University, Philadelphia, 19104, USA.
| | | | - David M Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, 16802, USA
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21
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Zhu Y, Stearns SC. Hospital safety-net status and postdischarge outcomes: The impact of socioeconomic status and Medicare post-acute care types. J Eval Clin Pract 2023; 29:955-963. [PMID: 36807665 DOI: 10.1111/jep.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 02/21/2023]
Abstract
AIM To examine the impact of socioeconomic status (SES) and postacute care (PAC) locations on the association between hospital safety-net status and 30-day postdischarge outcomes (readmission, hospice use, or death). METHOD Medicare Current Beneficiary Survey (MCBS) participants during 2006-2011 who were Medicare Fee-for-Service beneficiaries aged 65.5 years or older were included. The associations between hospital safety-net status and 30-day post-discharge outcomes were evaluated by comparing the models with and without PAC and SES adjustments. Safety-net hospital status was defined as being in the top 20% of hospitals ranked by hospital-level percent of total Medicare patient days. SES was measured using individual-level SES (dual eligibility, income, and education) and the Area Deprivation Index (ADI). RESULTS This study identified 13,173 index hospitalizations for 6,825 patients; 1,428 hospitalizations (11.8%) were in safety-net hospitals. The average unadjusted 30-day hospital readmission rate was 22.6% in safety-net hospitals versus 18.8% in nonsafety-net hospitals. Regardless of whether patient SES status was controlled or not, safety-net hospitals had higher estimated probabilities of 30-day readmission (ranging from 0.217 to 0.222 vs. 0.184 to 0.189), and lower probabilities for having neither readmission nor hospice/death (0.750-0.763 vs. 0.780-0.785); for models additionally adjusted for PAC types, safety-net patients had lower rates of hospice use or death (0.019-0.027 vs. 0.030-0.031). CONCLUSIONS The results suggested that safety-net hospitals had lower hospice/death rates but higher readmission rates relative to outcomes at nonsafety-net hospitals. Readmission rate differences were similar regardless of patients' SES status. However, the rate of hospice referral or death rate was related to SES, which suggested that the outcomes were affected by SES and PAC types.
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Affiliation(s)
- Ye Zhu
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sally C Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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22
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Zuniga-Chaves I, Eggers S, Kates AE, Safdar N, Suen G, Malecki KMC. Neighborhood socioeconomic status is associated with low diversity gut microbiomes and multi-drug resistant microorganism colonization. NPJ Biofilms Microbiomes 2023; 9:61. [PMID: 37640705 PMCID: PMC10462741 DOI: 10.1038/s41522-023-00430-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
Social disparities continue to limit universal access to health care, directly impacting both lifespan and quality of life. Concomitantly, the gut microbiome has been associated with downstream health outcomes including the global rise in antibiotic resistance. However, limited evidence exists examining socioeconomic status (SES) associations with gut microbiome composition. To address this, we collected information on the community-level SES, gut microbiota, and other individual cofactors including colonization by multidrug-resistant organisms (MDROs) in an adult cohort from Wisconsin, USA. We found an association between SES and microbial composition that is mediated by food insecurity. Additionally, we observed a higher prevalence of MDROs isolated from individuals with low diversity microbiomes and low neighborhood SES. Our integrated population-based study considers how the interplay of several social and economic factors combine to influence gut microbial composition while providing a framework for developing future interventions to help mitigate the SES health gap.
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Affiliation(s)
- Ibrahim Zuniga-Chaves
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Shoshannah Eggers
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ashley E Kates
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Kristen M C Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Environmental and Occupational Health Sciences, School of Public Health, University of Chicago Illinois, IL, Chicago, USA.
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Liu C, He L, Li Y, Yang A, Zhang K, Luo B. Diabetes risk among US adults with different socioeconomic status and behavioral lifestyles: evidence from the National Health and Nutrition Examination Survey. Front Public Health 2023; 11:1197947. [PMID: 37674682 PMCID: PMC10477368 DOI: 10.3389/fpubh.2023.1197947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Background Diabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups. Methods With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes. Results A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes. Conclusion This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.
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Affiliation(s)
- Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yuanfei Li
- Department of Sociology, University at Albany, State University of New York, Albany, CA, United States
| | - Aimin Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, United States
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
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Kong F, Chen H, Cheng Y. Social Interaction, Survival Stress and Smoking Behavior of Migrant Workers in China-An Empirical Analysis Using CHARLS Data from 2013-2018. Behav Sci (Basel) 2023; 13:680. [PMID: 37622820 PMCID: PMC10451940 DOI: 10.3390/bs13080680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
Smoking is a major public health problem in most countries and usually occurs in marginalized groups. Analyzing the smoking behavior of migrant workers, a marginalized group in China, is of practical significance. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) database from 2013 to 2018, this study examined influence factors of smoking behavior (whether to smoke and smoking frequency) among migrant workers in China through the Heckman two-stage model. The results showed that the smoking rates of migrant workers were positively associated with social activity and a sense of loneliness, while smoking frequency was negatively associated with work stress and life satisfaction. Meanwhile, smoking behavior was associated with the demographic variables such as gender, age, and education level. Gender differences in smoking behavior were particularly notable among Chinese migrant workers. Furthermore, there was regional heterogeneity in smoking behavior among migrant workers. Smoking behavior in the eastern region was mainly influenced by psychological factors of wellbeing, such as social activity and life satisfaction, while it was affected by material conditions such as income in the central-western region. Effective strategies to control tobacco use among migrant workers are proposed in order to promote social integration between urban and rural residents, increase vocational education and training, and strengthen anti-smoking propaganda among migrant workers.
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Affiliation(s)
| | - Huiguang Chen
- College of Public Administration, Nanjing Agricultural University, Nanjing 210095, China; (F.K.); (Y.C.)
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Francis M, Lindrose A, O'Connell S, Tristano RI, McGarvey C, Drury S. The interaction of socioeconomic stress and race on telomere length in children: A systematic review and meta-analysis. SSM Popul Health 2023; 22:101380. [PMID: 37065841 PMCID: PMC10102414 DOI: 10.1016/j.ssmph.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Rationale Proposed mechanisms relating early life exposures to poor health suggest that biologic indicators of risk are observable in childhood. Telomere length (TL) is a biomarker of aging, psychosocial stress, and a range of environmental exposures. In adults, exposure to early life adversity, including low socioeconomic status (SES), is predictive of shorter TL. However, results in pediatric populations have been mixed. Defining the true relation between TL and SES in childhood is expected to enhance the understanding of the biological pathways through which socioeconomic factors influence health across the life span. Objective The aim of this meta-analysis was to systematically review and quantitatively assess the published literature to better understand how SES, race, and TL are related in pediatric populations. Methods Studies in the United States in any pediatric population with any measure of SES were included and identified through the following electronic databases: PubMed, EMBASE, Web of Science, Medline, Socindex, CINAHL, and Psychinfo. Analysis utilized a multi-level random-effects meta-analysis accounting for multiple effect sizes within a study. Results Thirty-two studies were included with a total of 78 effect sizes that were categorized into income-based, education-based, and composite indicators. Only three studies directly tested the relation between SES and TL as the primary study aim. In the full model, there was a significant relation between SES and TL (r = 0.0220 p = 0.0286). Analysis by type of SES categorization identified a significant moderating effect of income on TL (r = 0.0480, 95% CI: 0.0155 to 0.0802, p = 0.0045) but no significant effect for education or composite SES. Conclusions There is an overall association between SES and TL that is predominately due to the association with income-based SES measures implicating income disparities as a key target for efforts to address health inequity across the life span. Identification of associations between family income and biological changes in children that predict life-span health risk provides key data to support public health policies addressing economic inequality in families and presents a unique opportunity to assess the effect of prevention efforts at the biologic level.
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Affiliation(s)
- Mariza Francis
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Alyssa Lindrose
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, LA, USA
| | - Renee I. Tristano
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Cecile McGarvey
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Stacy Drury
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
- Corresponding author. Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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NIEDERDEPPE JEFF, LIU JIAWEI, SPRUILL MIKAELA, LEWIS NEILA, MOORE STEVEN, FOWLER ERIKAFRANKLIN, GOLLUST SARAHE. Strategic Messaging to Promote Policies that Advance Racial Equity: What Do We Know, and What Do We Need to Learn? Milbank Q 2023; 101:349-425. [PMID: 37096590 PMCID: PMC10262382 DOI: 10.1111/1468-0009.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/17/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Many studies have explored the impact of message strategies to build support for policies that advance racial equity, but few studies examine the effects of richer stories of lived experience and detailed accounts of the ways racism is embedded in policy design and implementation. Longer messages framed to emphasize social and structural causes of racial inequity hold significant potential to enhance support for policies to advance racial equity. There is an urgent need to develop, test, and disseminate communication interventions that center perspectives from historically marginalized people and promote policy advocacy, community mobilization, and collective action to advance racial equity. CONTEXT Long-standing racial inequities in health and well-being are shaped by racialized public policies that perpetuate disadvantage among Black, Brown, Indigenous, and people of color. Strategic messaging can accelerate public and policymaker support for public policies that advance population health. We lack a comprehensive understanding of lessons learned from work on policy messaging to advance racial equity and the gaps in knowledge it reveals. METHODS A scoping review of peer-reviewed studies from communication, psychology, political science, sociology, public health, and health policy that have tested how various message strategies influence support and mobilization for racial equity policy domains across a wide variety of social systems. We used keyword database searches, author bibliographic searches, and reviews of reference lists from relevant sources to compile 55 peer-reviewed papers with 80 studies that used experiments to test the effects of one or more message strategies in shaping support for racial equity-related policies, as well as the cognitive/emotional factors that predict their support. FINDINGS Most studies report on the short-term effects of very short message manipulations. Although many of these studies find evidence that reference to race or use of racial cues tend to undermine support for racial equity-related policies, the accumulated body of evidence has generally not explored the effects of richer, more nuanced stories of lived experience and/or detailed historical and contemporary accounts of the ways racism is embedded in public policy design and implementation. A few well-designed studies offer evidence that longer-form messages framed to emphasize social and structural causes of racial inequity can enhance support for policies to advance racial equity, though many questions require further research. CONCLUSIONS We conclude by laying out a research agenda to fill numerous wide gaps in the evidentiary base related to building support for racial equity policy across sectors.
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Kemper M, Zagorski J, Wagner J, Graß JK, Izbicki JR, Melling N, Wolter S, Reeh M. Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center. Cancers (Basel) 2023; 15:2827. [PMID: 37345164 DOI: 10.3390/cancers15102827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
In Germany, socioeconomically deprived citizens more often develop esophageal carcinoma, since typical risk factors follow the social gradient. Therefore, we hypothesized that socioeconomic deprivation might also be associated with advanced tumor stages and comorbidities at the time of surgery. As a consequence, socioeconomic deprivation may be related to postoperative complications and reduced overall survival. Therefore, 310 patients who had undergone esophagectomy for cancer in curative intent between 2012 and 2020 at the University Medical Center Hamburg-Eppendorf (UKE) were included in this study. Socioeconomic status (SES) was estimated using the purchasing power of patients' postal codes as a surrogate parameter. No association was found between SES and tumor stage or comorbidities at the time of surgery. Moreover, SES was neither associated with postoperative complications nor overall survival. In conclusion, socioeconomic inequalities of patients treated at a high-volume center do not affect treatment outcomes.
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Affiliation(s)
- Marius Kemper
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jana Zagorski
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jonas Wagner
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Julia-Kristin Graß
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
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Buhmeida A, Assidi M, Budowle B. Current Healthcare Systems in Light of Hyperendemic NCDs and the COVID-19 Pandemic: Time to Change. Healthcare (Basel) 2023; 11:1382. [PMID: 37239667 PMCID: PMC10218054 DOI: 10.3390/healthcare11101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Despite the significant achievements of current healthcare systems (CHCSs) in curing or treating several acute conditions, there has been far less success coping with noncommunicable diseases (NCDs), which have complex roots and nonconventional transmission vectors. Owing to the impact of the invisible hyperendemic NCDs and the COVID-19 pandemic, the limitations of CHCSs have been exposed. In contrast, the advent of omics-based technologies and big data science has raised global hope of curing or treating NCDs and improving overall healthcare outcomes. However, challenges related to their use and effectiveness must be addressed. Additionally, while such advancements intend to improve quality of life, they can also contribute the ever-increasing health disparity among vulnerable populations, such as low/middle-income populations, poorly educated people, gender-based violence victims, and minority and indigenous peoples, to name a few. Among five health determinants, the contribution of medical care to individual health does not exceed 11%. Therefore, it is time to implement a new well-being-oriented system complementary or parallel to CHCSs that incorporates all five health determinants to tackle NCDs and unforeseen diseases of the future, as well as to promote cost-effective, accessible, and sustainable healthy lifestyle choices that can reduce the current level of healthcare inequity.
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Affiliation(s)
- Abdelbaset Buhmeida
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mourad Assidi
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bruce Budowle
- Department of Forensic Medicine, University of Helsinki, Universitetsgatan 2, 00100 Helsinki, Finland
- Forensic Science Institute, Radford University, Radford, 24142 VA, USA
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Caballero E, Minnis A, Parmar D, Zerofsky M, Comfort M, Raymond-Flesch M. Labeling in a Latinx Community: Public Health Implications for Youth and Role in Community Narratives. RESEARCH SQUARE 2023:rs.3.rs-2626181. [PMID: 36993344 PMCID: PMC10055544 DOI: 10.21203/rs.3.rs-2626181/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Youth of color are disproportionately subjected to negative formal and informal labels by parents, peers, and teachers. This study examined the consequences of such labels on health-protective behaviors, wellbeing, peer networks and school engagement. Methods In-depth interviews were conducted with 39 adolescents and 20 mothers from a predominantly Latinx and immigrant agricultural community in California. Teams of coders completed iterative rounds of thematic coding to identify and refine key themes. Results Dichotomous labeling of "good" and "bad" was pervasive. Youth labeled as "bad" experienced limited educational opportunities, exclusion from peers, and community disengagement. Additionally, preservation of "good kid" labels compromised health protective-behaviors including foregoing contraception. Participants pushed back on negative labeling when it was applied to close family or community acquaintances. Discussion Targeted interventions that foster social belonging and connection rather than exclusion may facilitate health protective behaviors and have positive implications for future trajectories among youth.
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Mutola S, Gómez-Olivé FX, Ng N. The path between socioeconomic inequality and cognitive function: A mediation analysis based on the HAALSI cohort in rural South Africa. Front Public Health 2023; 11:1011439. [PMID: 36992876 PMCID: PMC10040802 DOI: 10.3389/fpubh.2023.1011439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundSocioeconomic position (SEP) strongly predicts late-life cognitive health, yet the pathways between SEP and cognitive function remain unclear. This study assessed whether and to what extent the association between SEP and cognitive function in the adult population in rural South Africa is mediated by some health conditions, behavioral factors, and social capital factors.MethodsIn this cross-sectional study, we used data from the 2014–15 “Health and Aging Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort, including 5,059 adults aged 40+ years from the Agincourt sub-district in Mpumalanga Province, South Africa. SEP, the independent variable, was measured based on ownership of household goods. Cognitive function, the dependent variable, was assessed using questions related to time orientation and immediate and delayed word recall. We used the multiple-mediation analysis on 4125 individuals with complete values on all variables to assess the mediating roles of health conditions (hypertension, diabetes, obesity, and disability), behavioral factors (leisure physical activity, alcohol consumption, and tobacco smoking), and social capital factors (community's willingness to help, trust, sense of safety, and social network contact) in the association between SEP and cognitive function.ResultsCompared to adults in the poorest wealth quintile, those in the richest wealth quintile had better cognition (β = 0.903, p < 0.001). The mediation analysis revealed that health conditions mediated 20.7% of the total effect of SEP on cognitive function. In comparison, 3.3% was mediated by behavioral factors and only 0.7% by social capital factors. In the multiple-mediator model, 17.9% of the effect of SEP on cognitive function was jointly mediated by health conditions, behavioral factors, and social capital factors.ConclusionLow socioeconomic position is a significant factor associated with poor cognitive function among adults aged 40 years and above in South Africa. Health conditions mainly mediate the effects between SEP and cognitive function. Therefore, actions to prevent and control chronic health conditions can serve as the entry point for intervention to prevent poor cognitive function among people with low socioeconomic status.
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Affiliation(s)
- Sianga Mutola
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- *Correspondence: Nawi Ng
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Zheng M, Zhou S, Hur K, Chambers T, O'Dell K, Johns M. Disparities in the prevalence of self-reported dysphagia and treatment among U.S. adults. Am J Otolaryngol 2023; 44:103774. [PMID: 36586319 DOI: 10.1016/j.amjoto.2022.103774] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess sociodemographic differences in the prevalence of self-reported dysphagia and treatment and to identify barriers in access to care. STUDY DESIGN Cross-sectional analysis. SETTING National healthcare survey database. METHODS The 2012 National Health Interview Survey was used to analyze adults who reported a swallowing problem in the prior 12 months. Associations of sociodemographic variables with dysphagia prevalence and treatment as well as access to care were determined by multivariate logistic regression. RESULTS Among 235 million adults in the United States, 9.4 ± 0.3 million (4.0 % ± 0.1 %) adults (mean age 52.1 ± 0.6 years; 60.2 % female) reported swallowing problems, only 19.2 % ± 2.0 % of whom reported receiving treatment or therapy for their swallowing problem. In a multivariate model controlling for sociodemographic factors, female gender, older age, lower income level, public insurance status and unemployment were independently associated with increased odds of reporting dysphagia, while also associated with decreased odds of receiving treatment. Conversely, Black, Hispanic and other racial/ethnic minorities were less likely to report swallowing problems, but among those who did report dysphagia, non-white adults were more likely to receive treatment. Barriers leading to delayed care for women, low-income adults and adults with public or no health insurance included cost, not being able to get an appointment soon enough, limited office hours, inability to get through to an office by phone, lack of transportation, and long office wait times. CONCLUSION Sociodemographic groups at higher risk for dysphagia are less likely to receive treatment. Targeted interventions are needed to address barriers to care. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Melissa Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, SA, United States of America
| | - Sheng Zhou
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Kevin Hur
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Tamara Chambers
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Michael Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America.
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de Courson B, Frankenhuis WE, Nettle D, van Gelder JL. Why is violence high and persistent in deprived communities? A formal model. Proc Biol Sci 2023; 290:20222095. [PMID: 36809805 PMCID: PMC9943638 DOI: 10.1098/rspb.2022.2095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
There is massive variation in rates of violence across time and space. These rates are positively associated with economic deprivation and inequality. They also tend to display a degree of local persistence, or 'enduring neighbourhood effects'. Here, we identify a single mechanism that can produce all three observations. We formalize it in a mathematical model, which specifies how individual-level processes generate the population-level patterns. Our model assumes that agents try to keep their level of resources above a 'desperation threshold', to reflect the intuitive notion that one of people's priorities is to always meet their basic needs. As shown in previous work, being below the threshold makes risky actions, such as property crime, beneficial. We simulate populations with heterogeneous levels of resources. When deprivation or inequality is high, there are more desperate individuals, hence a higher risk of exploitation. It then becomes advantageous to use violence, to send a 'toughness signal' to exploiters. For intermediate levels of poverty, the system is bistable and we observe hysteresis: populations can be violent because they were deprived or unequal in the past, even after conditions improve. We discuss implications of our findings for policy and interventions aimed at reducing violence.
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Affiliation(s)
- Benoît de Courson
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Germany.,Institute for Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Willem E Frankenhuis
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Germany.,Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Daniel Nettle
- Institut Jean Nicod, Département d'études cognitives, École Normale Supérieure, Université PSL, EHESS, CNRS, Paris, France.,Population Health Sciences Institute, Newcastle upon Tyne, Newcastle University, UK
| | - Jean-Louis van Gelder
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Germany.,Institute for Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
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Vilariño-Rico J, Fariña-Casanova X, Martínez-Gallego EL, Hernández-Lahoz I, Rielo-Arias F, Pértega S, Encisa JM, García-Colodro JM, Fernández-Noya J. The Influence of the Socioeconomic Status and the Density of the Population on the Outcome After Peripheral Artery Disease. Ann Vasc Surg 2023; 89:269-279. [PMID: 36404448 DOI: 10.1016/j.avsg.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Low socioeconomic status (SES) and living in a rural environment are associated with poorer health and a higher number of amputations among the population at large. The purpose of this study is to determine the influence of low SES and of the degree of urbanization on the short-term and long-term results of patients after revascularization for peripheral artery disease. METHODS An observational retrospective follow-up study of 770 patients operated on for peripheral artery disease at three university centers in north-western Spain from January 2015 to December 2016. The events studied were Rutherford classification of severity upon admission, direct amputation, amputations in the follow-up period, new revascularization procedures, major adverse cardiovascular events (MACE), and overall mortality. Mean personal income and income of the household associated with the street in which each patient lived and the degree of urbanization in three areas as per Eurostat criteria: densely populated areas, intermediate density areas, and thinly populated areas. Comorbidity, surgical, and follow-up variables were also collected. Descriptive analysis and Cox regression were used. Approval was obtained from the regional ethics committee. RESULTS Median follow-up was 47.5 months. MACE occurred in 21.5% of the series and overall mortality was 47.0%. Living in a thinly populated area is associated with a lower risk of MACE (adjusted subhazard ratio = 0.60; 95% confidence interval [CI]: 0.39-0.91). Overall survival is lower in intermediate density area patients (adjusted Hazard Ratio = 1.46; 95% CI: 1.07-2.00). The third quartile of mean personal and household income is associated with a higher risk of major amputation at follow-up (adjusted Odds Ratio 1.92, 95% CI: 1.05-3.52 and adjusted Odds Ratio 1.93, 95% CI: 1.0.3-3.61, respectively). CONCLUSIONS Patients who live in a densely populated area run a higher risk of MACE. SES is neither associated with worse outcomes after surgery nor with MACE in long-term follow-up.
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Affiliation(s)
- Jorge Vilariño-Rico
- Angiology and Vascular Surgery Service, A Coruña University Hospital Complex, A Coruña, Spain.
| | | | | | | | | | - Sonia Pértega
- Clinical Epidemiology and Biostatistics Unit, A Coruña University Hospital Complex, A Coruña, Spain
| | - José Manuel Encisa
- Angiology and Vascular Surgery Service, Vigo Hospital Complex, Vigo, Spain
| | | | - Jorge Fernández-Noya
- Angiology and Vascular Surgery Service, A Coruña University Hospital Complex, A Coruña, Spain
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Powell W. A socioscientific issues approach to ninth-graders' understanding of COVID-19 on health, wealth, and educational attainments. PLoS One 2023; 18:e0280509. [PMID: 36972262 PMCID: PMC10045461 DOI: 10.1371/journal.pone.0280509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/02/2023] [Indexed: 03/29/2023] Open
Abstract
This study investigated the implementation of a curricular unit of instruction designed to immerse rising ninth-grade students socioscientific issues via data collection and analysis of the relationships between health, wealth, educational attainment, and the impact of the COVID-19 Pandemic on their communities. Twenty-six (n = 26) rising ninth-grade students (14-15 years old; 16 girls, 10 boys) participated in an early college high school program operated by the College Planning Center at a state university in the northeastern United States. The findings of this study demonstrate how ninth-graders enhanced their understanding of the relationships between COVID-19 and community health, wealth, and educational attainments. The students also identified from their research data that communities in Massachusetts that are more educated and with more financial resources were less impacted less by the virus.
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Affiliation(s)
- Wardell Powell
- Department of Education & Social and Behavioral Sciences, Framingham State University, Framingham, MA, United States of America
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Braveman P. Defining Health Equity. J Natl Med Assoc 2022; 114:593-600. [PMID: 36167751 DOI: 10.1016/j.jnma.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Paula Braveman
- Professor of Family and Community Medicine, Founding Director, Center for Health Equity, Department of Family and Community Medicine, University of California, San Francisco.
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Siddiq H, Najand B. Immigration Status, Socioeconomic Status, and Self-Rated Health in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15657. [PMID: 36497731 PMCID: PMC9735665 DOI: 10.3390/ijerph192315657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
The literature has established a protective effect of socioeconomic status (SES) indicators on health. However, at least in the US, these SES indicators tend to generate fewer health gains for marginalized groups including immigrants. As this literature mainly originated in the US, it is necessary to study whether these indicators similarly correlate with the health of foreign-born and native-born individuals in Europe. The current study was based on the Marginalization-related Diminished Returns (MDRs) theory and compared the effects of three SES indicators, namely parental education, own education and income, on self-rated health (SRH) of immigrant and native-born individuals. We used data from the European Social Survey 2020 (ESS 2020). Participants included 14,213 individuals who identified as either native-born (n = 9052) or foreign-born (n = 508). Education, income, and parental education were the independent variables. Self-rated health (SRH) was the outcome. Age and sex were covariates. Linear regression and logistic regression were used for data analysis. Overall, high education, income, and parental education were associated with lower odds of poor SRH. We documented a statistical interaction between immigration status and parental education, indicating a weaker inverse association between parental education and poor SRH for foreign-born than native-born individuals. The links between some but not all SES indicators vary across foreign-born and native-born individuals in Europe. Host countries seem to undervalue the parental educational attainment of foreign-born families. Future research should explore the role of time, period, cohort and country of origin as well as host country and associated policies in equalizing returns of SES indicators on the health of population subgroups. The results are important given that most studies on MDRs are developed in the US, and less is known about Europe. The results are also very important given the growing anti-immigrant sentiment and nationalist movements in Europe and the rest of the world.
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Affiliation(s)
- Hafifa Siddiq
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90095, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
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Yuan S, Tao F, Li Y. The Restorative Effects of Virtual Reality Forests on Elderly Individuals During the COVID-19 Lockdown. J ORGAN END USER COM 2022. [DOI: 10.4018/joeuc.297626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study focuses on the restorative effects of immersive virtual reality (VR) forest experiences on elderly people during the COVID-19 lockdown. A field experiment with 63 elderly participants was conducted in an elderly care institution in China. The results showed that a five-minute VR forest experience with three minutes of subsequent reliving can bring immediate psychological improvements (i.e., increased positive affect, decreased negative affect, and enhanced stress recovery) to elderly individuals. The negative affect decrease and stress recovery enhancement were more obvious among introverted individuals. Furthermore, participating in three VR forest experiences over 3 consecutive days can bring continuous psychological improvements. Moreover, short VR forest experiences were unable to significantly decrease the blood pressure of participants. The effects of three VR experiences over 3 days on blood pressure improvement were also nonsignificant. Additionally, VR forest experiences can increase elderly participants’ intentions to undertake real forest therapy.
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Nichols OI, Fuller-Rowell TE, Robinson AT, Eugene D, Homandberg LK. Neighborhood Socioeconomic Deprivation in Early Childhood Mediates Racial Disparities in Blood Pressure in a College Student Sample. J Youth Adolesc 2022; 51:2146-2160. [PMID: 35852667 PMCID: PMC9744188 DOI: 10.1007/s10964-022-01658-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
The influence of childhood contexts on adult blood pressure is an important yet understudied topic. Using a developmental perspective, this study examines the association between neighborhood socioeconomic disadvantage in early childhood (0-5 yrs), middle childhood (6-12 yrs) and adolescence (13-18 yrs) on subsequent blood pressure in young adulthood. Data were from 263 college students (52% Black; Mage = 19.21 years) and neighborhood socioeconomic disadvantage was measured using a tract-level Area Deprivation Index. Neighborhood disadvantage in early childhood was significantly associated with diastolic blood pressure and explained 22% of the race difference between Black and White adults. The findings are consistent with the notion that early childhood may be a sensitive period for the effects of neighborhood disadvantage on blood pressure.
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Affiliation(s)
- Olivia I Nichols
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA.
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA
| | - Austin T Robinson
- School of Kinesiology, Auburn University, 301 Wire Road, Auburn, AL, 36849, USA
| | - DaJuandra Eugene
- Center for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Lydia K Homandberg
- Sociology Department, Cornell University, 323 Uris Hall, Ithaca, NY, 14853, USA
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Development and Validation of a Health Behaviour Scale: Exploratory Factor Analysis on Data from a Multicentre Study in Female Primary Care Patients. Behav Sci (Basel) 2022; 12:bs12100378. [PMID: 36285947 PMCID: PMC9598194 DOI: 10.3390/bs12100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Health behaviours are the most important proximal determinants of health that can be either promoting or detrimental to the health of individuals. To assess and compare health behaviours in different socioeconomic groups within the population, a comprehensive, valid, reliable, and culturally appropriate measure is needed. This study aimed to develop a health behaviour questionnaire and validate it in a sample of female patients over 45 years of age with cardiovascular disease (CVD). The development procedure encompassed the following stages: literature search and item generation, content validity testing (focus group and expert evaluation), and field testing. A preliminary 38-item Health Behaviour Scale (HBS) was developed and tested in a group of 487 female primary care patients over 45 years of age. An exploratory factor analysis (EFA) yielded a four-factor structure. Factors jointly accounted for 47% of the variance observed. The results confirmed very good internal consistency of the questionnaire. The Cronbach's alpha and McDonald's omega coefficients for the entire scale were 0.82 and 0.84, respectively. The factor and item structure of the final 16-item HBS reflects the specificity of the studied sample. This measure can be a useful tool for primary care practitioners and public health researchers by helping them to develop interventions and strategies to reinforce health-promoting behaviours.
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Activity-related dyspnea in older adults participating in the Canadian Longitudinal Study on Aging. J Gen Intern Med 2022; 37:3302-3309. [PMID: 35819684 PMCID: PMC9550921 DOI: 10.1007/s11606-021-07374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Dyspnea is associated with functional impairment and impaired quality of life. There is limited information on the potential risk factors for dyspnea in an older adult population. OBJECTIVES Among older adults aged 45 to 85 years of age, what sociodemographic, environmental, and disease related factors are correlated with dyspnea? DESIGN We used cross-sectional questionnaire data collected on 28,854 participants of the Canadian Longitudinal Study of Aging (CLSA). Multinomial regression was used to assess the independent effect of individual variables adjusting for the other variables of interest. KEY RESULTS The adjusted odds ratios for dyspnea "walking on flat surfaces" were highest for obesity (OR, 5.71; 95%CI, 4.71-6.93), lung disease (OR, 3.91; 95%CI, 3.41-4.49), and depression (OR, 3.68; 95%CI, 3.15-4.29), and were greater than 2 for lower income, and heart disease. The effect of diabetes remained significant after adjusting for sociodemographics, heart disease and BMI (OR, 1.61; 95%CI, 1.39-1.86). Those with both respiratory disease and depression had a 12.78-fold (95%CI, 10.09-16.19) increased odds of exertional dyspnea, while the corresponding OR for the combination of heart disease and depression was 18.31 (95%CI, 13.4-25.01). CONCLUSIONS In a community sample of older adults, many correlates of dyspnea exist which have significant independent and combined effects. These factors should be considered in the clinical context where dyspnea is out of proportion to the degree of heart and lung disease. Whether or not diabetes may possibly be a risk factor for dyspnea merits further investigation.
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Holoubek SA, MacKinney EC, Khokar AM, Kuchta KM, Winchester DJ, Prinz RA, Moo-Young TA. Treatment Differences for Adrenocortical Carcinoma by Race and Insurance Status. J Surg Res 2022; 280:169-178. [PMID: 35987166 DOI: 10.1016/j.jss.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/19/2022] [Accepted: 05/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION To determine if treatment and clinical outcomes of adrenocortical carcinoma (ACC) vary by race and insurance status. METHODS ACC patients from the National Cancer Database (2004-2017) were reviewed. Race was defined as White versus minority (Black and Hispanic). Insurance types were private (PI) versus other (Medicaid/uninsured/unknown). Metastatic ACC (M-ACC) was defined as distant metastases at the time of diagnosis; nonmetastatic ACC (NM-ACC) patient had no distant disease. RESULTS Of 2351 NM-ACC patients, 83.6% were White and 16.4% minority. There were 1216 M-ACC patients, with 80.3% White and 19.8% minority. Both White NM-ACC and M-ACC patients had more PI (each P < 0.001). PI NM-ACC was associated with a shorter duration from diagnosis to first treatment (14 versus 18 d, P = 0.005). Both NM-ACC and M-ACC with PI were more likely to receive surgery (92.6% versus 86.9%, P = 0.001 and 35.4% versus 27%, P = 0.02) and to receive surgery sooner (13 versus 16 d, P = 0.03). M-ACC with PI were more likely to receive chemotherapy (63.6% versus 54.3%, P = 0.01) and to have lymph nodes examined (14.8% versus 8.6%, P = 0.02). Length of stay postoperatively was shorter for White NM-ACC (6 versus 7 d, P = 0.04) and M-ACC (8 versus 17 d, P = 0.02). For NM-ACC and M-ACC, the 30-d readmission, 90-d mortality, and overall survival were similar by race. A multivariable analysis showed minorities (OR 0.69, 95% confidence interval 0.54-0.88, P = 0.003) and patients without PI (OR 0.75, 95% confidence interval 0.58-0.97, P = 0.03) were less likely to have surgery. However, a multivariable analysis showed survival was similar for White versus minority patients and PI versus other. CONCLUSIONS White NM-ACC or M-ACC and PI were more likely to receive surgery and timely multimodality care. These disparities were not associated with differences in 90-d mortality or overall survival.
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Affiliation(s)
- Simon A Holoubek
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; Augusta University, Otolaryngology Department, Head and Neck Surgery, Augusta, Georgia; University of Wisconsin School of Medicine and Public Health, Division of Endocrine Surgery, Madison, Wisconsin
| | - Erin C MacKinney
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; University of Chicago, Department of Surgery, Chicago, Illinois
| | - Amna M Khokar
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; Department of Surgery, Stroger Cook County Hospital, Chicago, Illinois
| | - Kristine M Kuchta
- Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, Illinois
| | - David J Winchester
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; University of Chicago, Department of Surgery, Chicago, Illinois
| | - Richard A Prinz
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; University of Chicago, Department of Surgery, Chicago, Illinois
| | - Tricia A Moo-Young
- NorthShore University HealthSystem, Department of Surgery, Evanston, Illinois; University of Chicago, Department of Surgery, Chicago, Illinois.
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Hazzard VM, Burnette CB, Hooper L, Larson N, Eisenberg ME, Neumark-Sztainer D. Lifestyle health behavior correlates of intuitive eating in a population-based sample of men and women. Eat Behav 2022; 46:101644. [PMID: 35691254 PMCID: PMC9509702 DOI: 10.1016/j.eatbeh.2022.101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/28/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
The aim of this observational study was to examine how lifestyle health behaviors hypothesized to influence attunement to internal cues (breakfast consumption frequency, physical activity, yoga practice, sleep, and recreational screen time) are cross-sectionally related to intuitive eating (IE). Data from 765 men and 1009 women (Mage = 31.1 ± 1.7 years) who participated in Project EAT-IV (Eating and Activity in Teens and Young Adults) were analyzed with sex-stratified linear regression models adjusted for age, race/ethnicity, socioeconomic background, and parent status. Sociodemographic-adjusted mean levels of each health behavior by sex were generated at low (one standard deviation below the mean), average (at the mean), and high (one standard deviation above the mean) levels of IE to facilitate interpretation of regression results. Among women only, more frequent breakfast consumption (p = .02), more time spent practicing yoga (p = .03), more sleep (p = .004), and less recreational screen time (p = .01) were each significantly associated with higher IE after adjusting for sociodemographic characteristics. Compared to women with low IE, women with high IE reported, on average, eating breakfast 0.3 more days a week, practicing 12 more minutes of yoga per week, getting 12 more minutes of sleep per night, and engaging in 18 fewer minutes of recreational screen time per day. Results suggest that these modifiable health behaviors may be valuable targets for interventions to increase IE among women, though longitudinal research is needed to elucidate the temporality of these associations.
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Affiliation(s)
- Vivienne M. Hazzard
- Department of Psychiatry and Behavioral Health, University of Minnesota Medical School, Minneapolis, MN,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - C. Blair Burnette
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Laura Hooper
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Nicole Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Marla E. Eisenberg
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN,Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN,Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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Nishikitani M, Nakao M, Inoue M, Tsurugano S, Yano E. Associations between Workers' Health and Working Conditions: Would the Physical and Mental Health of Nonregular Employees Improve If Their Income Was Adjusted? MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9070040. [PMID: 35877818 PMCID: PMC9317295 DOI: 10.3390/medicines9070040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
Precarious employment can negatively affect health, but workers may be healthy if they earn enough income. This study uses equivalent disposable income and examines the interaction between income classes and employment types to clarify whether workers’ health improves as the income classes rise. In Japan, nonstandard workers, called nonregular employees, have remained high since 2013. Therefore, using data from the national cross-sectional Comprehensive Survey of Living Conditions 2013, an official survey performed in Japan, we targeted a sample of employees aged 18 to 45 who graduated during the economic recession. Our final sample included 8282 employees (4444 males and 3838 females). The health (general and mental) status indicators used the dichotomized self-rated health and scores of the K6 questionnaires scored in the national survey. The association between income and health was almost proportional. Female workers tended to improve their health as their income class increased; however, this tendency was not observed in male workers, especially nonregular employees. Although the associations were weakened by added income information on the regression models, nonregular employees always showed inferior health to regular employees. The health status of nonregular employees, especially female nonregular employees, is statistically significantly lower than that of regular employees, even when the economic class is similar. In conclusion, improving low incomes for nonregular employees could improve health challenges, but income alone may not result in the same health status for regular and nonregular employees.
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Affiliation(s)
- Mariko Nishikitani
- Medical Information Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
- Correspondence: ; Tel.: +81-92-642-6475
| | - Mutsuhiro Nakao
- Department of Psychosomatic Medicine, International University of Health and Welfare, Chiba 286-8529, Japan;
| | - Mariko Inoue
- Graduate School of Public Health, Teikyo University, Tokyo 173-8605, Japan; (M.I.); (E.Y.)
| | - Shinobu Tsurugano
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka 819-0395, Japan;
| | - Eiji Yano
- Graduate School of Public Health, Teikyo University, Tokyo 173-8605, Japan; (M.I.); (E.Y.)
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Oluyomi AO, Mohammadi KA, El-Serag HB, Thrift AP. Mediating Effects of Neighborhood-Level Socioeconomic Deprivation on the Association Between Race/Ethnicity and Advanced Hepatocellular Carcinoma. Cancer Epidemiol Biomarkers Prev 2022; 31:1402-1409. [PMID: 35314860 DOI: 10.1158/1055-9965.epi-21-1396] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Racial/ethnic minorities are more likely than non-Hispanic whites (NHW) to be diagnosed with advanced stage hepatocellular carcinoma (HCC). We examined the role of neighborhood disadvantage as a mediator of the association between race/ethnicity and HCC stage at diagnosis. METHODS We used data from HCC cases diagnosed in Texas from 2007 to 2015. HCC cases were classified as local versus regional/advanced stage. A mediation model approach was used to estimate the average direct effect, average mediated (indirect) effect, total effect, and proportion mediated by the Area Deprivation Index (ADI), a composite measure of disadvantage. RESULTS 7,622 had local while 6303 had regional/advanced HCC. 46.1% of cases were NHW, 15.0% non-Hispanic Black (NHB), and 38.9% Hispanic. NHBs were less likely than NHWs to be diagnosed with local stage HCC [total effect RR, 0.921; 95% confidence interval (95% CI), 0.898-0.947]; however, only 2.26% of this effect was mediated through ADI. Conversely, Hispanics were more likely than NHWs to be diagnosed with local stage HCC (total effect RR, 1.019; 95% CI, 1.001-1.037) and ADI mediated 12.56% of the effect of race/ethnicity on HCC stage. ADI was not associated with HCC stage and therefore was not a mediator of the association with HCC stage when we compared Hispanics with NHBs. CONCLUSIONS Neighborhood socioeconomic disadvantage may explain/mediate some of the association between race/ethnicity and HCC stage; however, the mediating effect was not uniform across populations. IMPACT For NHBs, other individual and neighborhood level factors, not reflected in the ADI, contribute to their lower likelihood of being diagnosed with local HCC. See related commentary by Lazo et al., p. 1254.
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Affiliation(s)
- Abiodun O Oluyomi
- Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Kusha A Mohammadi
- University of Texas Health Science Center at Houston School of Public Health, Houston, Texas.,Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Aaron P Thrift
- Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Mahmoodi Z, Yazdkhasti M, Rostami M, Ghavidel N. Factors affecting mental health and happiness in the elderly: A structural equation model by gender differences. Brain Behav 2022; 12:e2549. [PMID: 35349774 PMCID: PMC9120719 DOI: 10.1002/brb3.2549] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/16/2022] [Accepted: 02/19/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE There are few studies on the gender differences in mental health, happiness, and their related factors among the older population through the structural equation model (SEM) in Iran. We conducted this study to evaluate the factors affecting mental health and happiness in the elderly using an SEM by gender differences. METHODS A cross-sectional study was conducted on 739 elderly people in 2019 in Karaj, Iran. Sociodemographic, Symptom Checklist-90-Revised (SCL90-R), and the Oxford Happiness Inventory were applied to evaluate the relationships between happiness, mental health, and sociodemographic factors by using statistical path analysis with Lisrel 8.8 and SPSS-17. RESULTS Overall, 55.5% of the participants in the study were female. The SCL90 (p value = .000) and happiness (p value = .000) scores showed significant differences between men and women. Fit indices confirmed the high model fitness, desirability, and logical relationships between the variables according to the conceptual model in both men (X2 = 3.2, df = 1) and women (X2 = 5.4, df = 2) groups. According to the path analysis, among the variables that affected happiness just through the direct path, education had the most positive causal relationship in men (B = .13) and women (B = .16), but mental health problems in men (B = -.33) and women (B = -.26), as well as the distance from home to the healthcare center in men (B = -.13) and women (B = -.11), had the most negative causal relationship with happiness respectively. Age was the only variable that was negatively related to happiness through direct and indirect paths in the women (B = -.188). CONCLUSION We provided an empirical model that illustrates the relationships between happiness, mental health, and related factors in the older population. Gender differences in path analysis showed that age negatively affects the happiness of older women but not men.
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Affiliation(s)
- Zohreh Mahmoodi
- Social Determinants of Health Research CenterAlborz University of Medical SciencesKarajIran
| | - Mansoureh Yazdkhasti
- Non‐communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
- Dietary Supplements & Probiotic Research CenterAlborz University of Medical SciencesKarajIran
| | - Mahnoosh Rostami
- Health Systems Evaluation & EvidenceProvincial Clinical ExcellenceAlberta Health ServicesAlbertaCanada
| | - Nooshin Ghavidel
- Social Determinants of Health Research CenterAlborz University of Medical SciencesKarajIran
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Ortiz CE, Dourron HM, Sweat NW, Garcia-Romeu A, MacCarthy S, Anderson BT, Hendricks PS. Special considerations for evaluating psilocybin-facilitated psychotherapy in vulnerable populations. Neuropharmacology 2022; 214:109127. [DOI: 10.1016/j.neuropharm.2022.109127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002-2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074324. [PMID: 35410005 PMCID: PMC8998590 DOI: 10.3390/ijerph19074324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Background: Neighborhood environmental factors along with individual factors are beginning to make a mark as factors which influence individual health outcomes. The goal of this study is to look at the combined impact of individual and neighborhood socioeconomic status on all-cause mortality in diabetic patients who have just been diagnosed. Methods: The Korean National Health Insurance (2002–2013) was employed in this cohort research, which used a stratified random sample. During the years 2003–2006, a total of 15,882 individuals who were newly diagnosed with diabetes and using oral disease-controlling medication were included in the study. Individual income and neighborhood deprivation index were used to examine the combined effect on all-cause mortality. The frailty model was performed using Cox’s proportional hazard regression. Results: During the study period, 28.3 percent (n = 4493) of the 15,882 eligible individuals died. In a Cox regression analysis after adjusting for all covariates, with advantaged and disadvantaged neighborhoods classified according to individual household income, the adjusted HR for patients living in a disadvantaged area was higher compared to patients living in an advantaged area in patients with middle income, compared to the reference group (a high income within an advantaged neighborhood) (HR, 1.22; 95% CI, 1.09–1.35; HR, 1.13; 95% CI, 1.02–1.25, respectively). The adjusted HR for patients with low income who lived in a disadvantaged location was greater than for patients who lived in an advantaged area (HR, 1.34; 95% CI, 1.18–1.53 vs. HR, 1.28; 95% CI, 1.14–1.49). Conclusions: Individual SES has a greater impact on all-cause mortality among diabetic patients when they live in a low-income neighborhood.
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Noble AJ, Pearson JF, Noble AD, Boden JM, Horwood LJ, Kennedy MA, Osborne AJ. DNA methylation analysis using bisulphite-based amplicon sequencing of individuals exposed to maternal tobacco use during pregnancy, and offspring conduct problems in childhood and adolescence. Reprod Fertil Dev 2022; 34:540-548. [PMID: 35412968 DOI: 10.1071/rd21108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Maternal tobacco smoking during pregnancy is a large driver of health inequalities and a higher prevalence of conduct problem (CP) has been observed in exposed offspring. Further, maternal tobacco use during pregnancy can also alter offspring DNA methylation. However, currently, limited molecular evidence has been found to support this observation. Thus we aim to examine the association between maternal tobacco use in pregnancy and offspring CP, to determine whether offspring CP is mediated by tobacco exposure-induced DNA methylation differences. Understanding the etiology of the association between maternal tobacco use and offspring CP will be crucial in the early identification and treatment of CP in children and adolescents. Here, a sub group of N =96 individuals was sourced from the Christchurch Health and Development Study, a longitudinal birth cohort studied for over 40 years in New Zealand. Whole blood samples underwent bisulphite-based amplicon sequencing at 10 loci known to play a role in neurodevelopment, or which had associations with CP phenotypes. We identified significant (P CYP1A1 , ASH2L and MEF2C in individuals with CP who were exposed to tobacco in utero . We conclude that environmentally-induced DNA methylation differences could play a role in the observed link between maternal tobacco use during pregnancy and childhood/adolescent CP. However, larger sample sizes are needed to produce an adequate amount of power to investigate this interaction further.
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Affiliation(s)
- Alexandra J Noble
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
| | - John F Pearson
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand
| | | | - Joseph M Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - L John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand
| | - Amy J Osborne
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
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Rogers MP, DeSantis AJ, Janjua HM, Kulshrestha S, Kuo PC, Lozonschi L. Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Distressed Socioeconomic Communities. Cureus 2022; 14:e23643. [PMID: 35510019 PMCID: PMC9057310 DOI: 10.7759/cureus.23643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Patients of low socioeconomic status have an increased risk of complications following cardiac surgery. We aimed to identify disparities in patients undergoing aortic valve replacement using the Distressed Communities Index (DCI), a comparative measure of community well-being. The DCI incorporates seven distinct socioeconomic indicators into a single composite score to depict the economic well-being of a community. Methods The Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for Florida and Washington was queried to identify patients undergoing surgical and transcatheter aortic valve replacement (surgical aortic valve replacement [SAVR], transcatheter aortic valve replacement [TAVR]) between 2012-2015. Patients undergoing TAVR and SAVR were propensity-matched and stratified based on the quintile of DCI score. A distressed community was defined as those in quintiles 4 and 5 (at-risk and distressed, respectively); a non-distressed community was defined as those in quintiles 1 and 2 (prosperous and comfortable, respectively). Outcomes following aortic valve replacement were compared across groups in distressed communities. Propensity score matching was used to balance baseline covariates between groups. Results A total of 27,591 patients underwent aortic valve replacement. After propensity matching, 5,331 patients were identified in each TAVR and SAVR group. Distressed TAVR patients had lower rates of postoperative pneumonia (7.6% vs. 3.8%, p<0.001), sepsis (3.6% vs. 1.9%, p<0.05), and cardiac complications (15.4% vs. 7.5%, p<0.001) when compared to highly distressed SAVR patients. When comparing distressed SAVR and TAVR and low distressed SAVR and TAVR groups, no significant difference was found in postoperative outcomes, except distressed TAVR experienced more cases of UTI. Conclusions Highly distressed TAVR patients had lower incidences of postoperative sepsis, pneumonia, and cardiac complications when compared to the highly distressed SAVR cohort. Patients undergoing TAVR in highly distressed communities had an increased incidence of postoperative urinary tract infection. DCI may be a useful adjunct to current risk scoring systems.
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Tatoli R, Lampignano L, Donghia R, Castellana F, Zupo R, Bortone I, De Nucci S, Campanile G, Lofù D, Vimercati L, Lozupone M, De Pergola G, Panza F, Giannelli G, Di Noia T, Boeing H, Sardone R. Dietary Customs and Social Deprivation in an Aging Population From Southern Italy: A Machine Learning Approach. Front Nutr 2022; 9:811076. [PMID: 35340551 PMCID: PMC8942783 DOI: 10.3389/fnut.2022.811076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/10/2022] [Indexed: 12/20/2022] Open
Abstract
Background Diet and social determinants influence the state of human health. In older adults, the presence of social, physical and psychological barriers increases the probability of deprivation. This study investigated the relationship between social deprivation and eating habits in non-institutionalized older adults from Southern Italy, and identified foods and dietary habits associated with social deprivation. Methods We recruited 1,002 subjects, mean age 74 years, from the large population based Salus in Apulia Study. In this cross-sectional study, eating habits and the level of deprivation were assessed with FFQ and DiPCare-Q, respectively. Results Deprived subjects (n = 441) included slightly more females, who were slightly older and with a lower level of education. They consumed less fish (23 vs. 26 g), fruiting vegetables (87 vs. 102 g), nuts (6 vs. 9 g) and less “ready to eat” dishes (29 vs. 33 g). A Random Forest (RF) model was used to identify a dietary pattern associated with social deprivation. This pattern included an increased consumption of low-fat dairy products and white meat, and a decreased consumption of wine, leafy vegetables, seafood/shellfish, processed meat, red meat, dairy products, and eggs. Conclusion The present study showed that social factors also define diet and eating habits. Subjects with higher levels of deprivation consume cheaper and more readily available food.
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Affiliation(s)
- Rossella Tatoli
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Luisa Lampignano
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Rossella Donghia
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Fabio Castellana
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Roberta Zupo
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Ilaria Bortone
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Sara De Nucci
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Giuseppe Campanile
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Domenico Lofù
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, Section of Occupational Medicine B. Ramazzini, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni De Pergola
- Unit of Internal Medicine and Geriatrics, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy.,Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Panza
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Heiner Boeing
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy.,Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Rodolfo Sardone
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
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