Abstract A54: The association of county level characteristics with the incidence of squamous cell carcinoma of the cervix in Hispanic women.

This study examined the factors related to eating behavior using the 2016 Community Health Survey data. The subjects of this study were 228,452 adults aged 19 years and over. The relationships between the general characteristics and breakfast, salt intake level, nutrition labeling recognition, reading, and utilization were investigated. The number of breakfast days was higher in rural areas than in urban areas and higher in women than in men. Those aged older than 70 years had more breakfast-eating days than the other age groups. Those who had a higher income level had fewer breakfast-eating days. The rates of people reducing salt intake were higher in those in urban areas and female subjects than those in rural areas and male subjects. Those who had a higher income level and education level consumed salt less. The rates of salt addition at the table were higher in people in rural areas and male subjects. The rates of adding soy sauce to fried food were higher in male subjects and those in urban areas, younger age, not being married, and with higher income and education levels. The rates of recognizing nutrition labels were higher in those in urban areas, female subjects, those not married, and those with higher income and education levels. The rates of reading nutrition labels were the same as those of recognizing nutrition labels. The use rates of nutrition labels were highest in those in urban areas, female subjects, those aged between 30 and 39, and married subjects and those with higher income and education levels. Therefore, it is necessary to provide nutrition education for rural areas, men, people with low income and education levels so that desirable and balanced health behaviors between the target and regions can be practiced.

Las familias de la crisis en las consultas pediátricas de Atención Primaria: estudio descriptivo observacional

We appreciate the commentary by Fischer & Rehm but would like to respond to several points they raised [1,2]. First, we agree with Fischer & Rehm that individual trajectories of non-medical use of prescription drugs (NMUPD) often begin early, with the majority of NMUPD initiating before 21 years of age. We doubt, however, that the trajectories from early onset of NMUPD to prescription drug use disorders (PDUDs) are associated consistently with socio-economic class or educational status. While we were unable to assess this in the National Epidemiologic Survey on Alcohol Related Conditions (NESARC) because it did not measure socio-economic or educational status at the time of NMUPD onset, previous studies suggest that associations between these variables are complex and vary by prescription drug class [3–5]. For instance, the non-medical use of stimulant medications is more prevalent among those with higher income levels [3,5], while non-medical use of prescription opioids is more prevalent among those from lower income levels [3,4]. Individuals with higher educational levels were more likely to engage in the non-medical use of prescription stimulants than those with lower educational levels, but there were no such differences for the non-medical use of prescription opioids, sedatives or tranquilizers [3]. Secondly, we question whether most non-medical users coming from disadvantaged circumstances are ‘self-medicators’. Being economically disadvantaged or uninsured may limit access to prescription medication but regardless of motivation (self-treatment versus recreational use), there are notable risks for non-medical users who self-treat. For example, ‘self-treaters’ do not receive clinical assessments, medical follow-ups or medical information that accompanies a prescription. Thus, self-treaters may be unaware of contraindications or probable interaction with other drugs. Furthermore, abusable prescription medications can produce physical dependence and withdrawal symptoms upon discontinuation. The odds of past-year PDUDs among those who report past-year NMUPD was considerably higher among individuals with lower income levels than those with higher income levels [6]. We noted the limitations of self-report measures using life-time time-frame and expressed the hope that prospective longitudinal studies will examine the natural history of NMUPD. We agree with Fischer & Rehm that more detailed measures are needed in order to obtain a more complex understanding of NMUPD; advances in our understanding of NMUPD will not be possible until we reconsider the assessment tools that measure NMUPD. Surprisingly, few advances have been made since Hubbard and colleagues showed the limitations of using a single measure to assess NMUPD and advocated decomposing the single NMUPD measure into separate questions 15 years ago [7]. Improvements in measurement of NMUPD and use of prospective longitudinal designs will help to determine if early onset of NMUPD is simply a correlate of PDUDs or a causal risk factor [8] that might represent a target for prevention and intervention.

Introduction: Obesity is a public health crisis in the US. Childhood obesity is associated with multiple comorbidities in the adulthood, including metabolic syndrome, cardiovascular diseases, and premature death. A recent study found that the prevalence of childhood obesity varied according to age and ethnicity. This study aims to evaluate the long-term trends and the underexplored socioeconomic factors associated with childhood obesity.Method: From the US National Health and Nutrition Examination Survey from 1999 to 2018, 35 907 children aged 2–19 with body mass index (BMI) data were included. Prevalence of obesity and severe obesity, defined as BMI ≥95th percentile and ≥120% of 95th percentile of US Centers for Disease Control and Prevention growth charts, respectively. Trends in prevalence of obesity and subgroup analyses according to age group, sex, ethnicity, language used in interview, household education level, and household income level, were analyzed. Data analysis was performed using the R statistical package “survey” (version 3.6.3).Results: The prevalence of obesity and severe obesity increased from 14.7 [95% CI: 12.9–17.0] % to 19.2 [17.2–21.0] % and 3.9 [2.9–5.0] % to 6.1 [4.8–8.0] % in 1999–2018, respectively (p=0.001 and p=0.014 for obesity and severe obesity, respectively). In 2017–8, the prevalence of obesity among children from Spanish-speaking households was 24.4 [22.4–27.0] %, higher than children from English-speaking households (p=0.027). Children from households with high education level and high income level had a lower prevalence of obesity compared to those with low education level and low income level (p=0.003 and p=0.002 for education level and income level, respectively). Compared to girls, boys had higher prevalence of obesity (p=0.002) and severe obesity (p=0.004).Conclusion: The prevalence of childhood obesity in America kept increasing during the period 1999–2018 despite various public health initiatives. The problem is worse in children with lower socioeconomic status, and in children from Spanish-speaking households. Public health interventions are urgently needed to halt the rising trend of childhood obesity, and measures specifically catering to children from Spanish-speaking families should be put in place.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background Family socioeconomic status (SES) impacts childhood health and could influence the effect of school-based health promotion interventions. Purpose This work aims to evaluate the impact of SES on the effects of the SI! Program randomized controlled trials for cardiovascular health promotion in preschoolers carried out in Colombia, Spain, and USA. Specifically, this work analyzed the effect of SES in the change of knowledge, attitudes and habits (KAH) and body mass index z-scores (zBMI) from baseline to immediately after the end of the health promotion intervention. Methods Children completed a KAH questionnaire (from 0 to 80 points) at baseline and immediate post-intervention. Families reported household income and education level through a dedicated questionnaire. Household income was categorized as low or high, and education level as low, intermediate, or high based on local census data. Adjusted baseline scores were calculated and stratified by SES using linear mixed models. The impact of the intervention was assessed by an individual participant-level meta-analysis using a random-effects model (DerSimonian-Laird method). Estimates of the difference between groups were derived from linear mixed models. Results A total of 3839 children were included in the analysis (48.9% girls, 4.0 (SD=0.8) years at baseline). Children of families with high education level and high household income tended to have a higher KAH score at baseline than those with low education level or low income (47.2 points [95%CI: 43.9; 50.5] vs. 45.7 points [95%CI: 42.4; 48.9]; 47.4 points [95%CI: 44.6; 50.2] vs. 45.8 points [95%CI: 43.0; 48.6], respectively) (Fig. 1A). Children from high education level and high income families had a lower zBMI at baseline than those from low education level and low income families (0.23 [95%CI: -0.20; 0.67] vs. 0.47 [95% CI: 0.03; 0.90]; 0.25 [95%CI: -0.15; 0.66] vs. 0.44 [95%CI: 0.04; 0.85], respectively) (Fig. 1B). The mean difference in KAH change between the intervention and control groups was 4.76 points (95%CI: 2.78; 6.74). The effect of the intervention on KAH score change was higher for children of families reporting high income or an intermediate/high education level than for those reporting low income or education level (Fig. 2A). The overall mean difference in zBMI change between groups was -0.06 (95%CI: -0.14; 0.02), and no significant differences were found in relation to SES indicators (Fig. 2B). Conclusions These results suggest that children from a low SES background benefit less from lifestyle interventions than those from high SES families. Health promotion interventions may implement strategies to counteract this effect and, consequently, avoid the potential risk of increasing health inequalities.

Families of the economic crisis in paediatric primary care clinics: Descriptive observational study

Morbidity and mortality from prostate cancer (PCa) are known to vary heavily based on socioeconomic and demographic risk factors. We sought to describe prescreening PSA (prostate-specific antigen) counseling (PPC) rates amongst male-to-female transgender (MtF-TG) patients and non-TG patients using the behavioral risk factor surveillance system (BRFSS). We used the survey data from 2014, 2016, and 2018 BRFSS and included respondents aged 40-79 years who completed the "PCa screening" and "sexual orientation and gender identity" modules. We analyzed differences in age, education level, income level, marital status, and race/ethnicity using Pearson's χ2 tests. The association of PPC with MtF-TG status and other patient characteristics was evaluated using multivariate logistic regression. A total of 175,383 respondents were included, of which 0.3% identified as MtF-TG. Overall, 62.4% of respondents reported undergoing PPC. On univariate analysis, PPC rates were lower among MtF-TG respondents when compared to the non-TG group (58.3% vs. 62.4%, p = 0.03). MtF-TG respondents were also more likely to report lower education level (p < 0.01), lower-income level (p < 0.01), and were less likely to be white (p < 0.01) than non-TG respondents. However, multivariate analysis adjusting for these respondent features demonstrated an association between higher income and higher education levels with increased odds of PPC, but no association was demonstrated between MtF-TG status and PPC rates. PPC rates for the MtF-TG and non-TG populations did not change significantly over time. Although PPC was less frequently reported among MtF-TG respondents than in the non-TG group on univariate analysis, this association was not demonstrated when controlling for confounders, including education and income levels. Instead, on multivariate analysis, low education and income levels were more predictive of PPC rates. Further research is needed to ensure equivalent access to prescreening counseling for patients across the socioeconomic and gender identity spectrum.

Impact of Intimate Partner Violence on Unmet Need for Mental Health Care: Results From the NSDUH

BackgroundThis study examines the socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China.MethodsTwo cross-sectional interviews and health examination surveys were administered in rural Yunnan Province, including 6,350 consenting participants in 2009 and 6,359 consenting participants in 2016 (aged ≥ 35 years). Participant demographics, socioeconomic status (SES), and ethnicity, along with information about hypertension awareness, treatment, and control, were collected using similar questionnaires in the two surveys. The participants’ blood pressure levels were also measured.ResultsFrom 2009 to 2016, the prevalence of hypertension substantially increased from 28.4% to 39.5% (P < 0.01), and awareness and control rose from 42.2 and 25.8% to 53.1 (P < 0.01) and 30.6% (P < 0.05), respectively. Although people with a higher education level also had higher awareness and control rates than the lower education level ones, there were no conspicuous differences in the improvement of awareness and control between publics with different education levels over the 7 years studied. Increases were observed in both rates of awareness and control in people with a high level of income (P < 0.01). However, only the awareness rate increased in participants with a low level of income. Furthermore, the prevalence (P < 0.01) and treatment (P < 0.05) of hypertension were higher in the Han people than in ethnic minorities.ConclusionsIndividual SES has clear associations with trends in the prevalence, awareness, and control of hypertension. Future interventions to improve hypertension prevention and control should be tailored to address individual SES.

To describe the prevalence on overweight and obesity among Chinese elderly aged 60 and above. Data from China Chronic Disease Surveillance in 2010 was gathered and information on 19 882 subjects aged 60 and over was analyzed. Sample was weighted to represent the population of Chinese elderly. The mean and percentiles of BMI, prevalence of overweight and obesity grouped by sex, age, urban and rural areas, geographic location, education level and household income were analyzed. The mean BMI was (23.8 ± 3.6)kg/m² among the Chinese elderly. The overall prevalence of overweight was 32.1% among the Chinese elderly, with 31.0% among males and 33.3% among females (χ² = 15.23, P < 0.05), 38.3% in urban areas and 29.1% in rural areas (χ² = 29.05, P < 0.05). The overall prevalence of obesity was 12.4% among Chinese elderly, with 9.3% among males and 15.3% among females (χ² = 152.75, P < 0.05), 16.5% in urban areas and 10.3% in rural areas (χ² = 20.67, P < 0.05). Compared with those with lower income or lower education level, the prevalence rates of both overweight and obesity were higher in elderly with higher household income or higher education level. According the WHO definitions on overweight and obesity, the prevalence rates of overweight and obesity among Chinese elderly were 29.3% (25 kg/m² ≤ BMI<30 kg/m²) and 5.3% (BMI≥30 kg/m²) , respectively. Approximately, 50% of the Chinese elderly showed abnormal high body mass index. The profiles of body weight among Chinese elderly were characterized by the mean of BMI and the higher prevalence rates of overweight and obesity seen in women than in men, higher in urban than in rural areas, The prevalence rates of overweight and obesity decreased with age but increased with household income and education level.

We studied the influence of levels of income and education on QuickDASH scores. The scores were collected in a random sample of 1376 residents of Norway. The level of income was divided into four bands and level of education into five bands. The mean QuickDASH score for both men and women fell with every increase in education and income level. For women the mean score was 30 for those with the shortest education and 9 for those with the longest (p < 0.001). The corresponding figures for men were 19 and 7 (p < 0.01). The women with the lowest level of income had a mean score of 23, compared with 8 for women with the highest income level (p < 0.001). For men the corresponding mean scores were 20 and 5 (p < 0.001). Analysis of variance showed that age alone accounted for 16% of the variability of the scores among women and 7% among men. When levels of education and income were added to the analysis, these three factors accounted for 21% of the variability among women and 13% among men. We conclude that socioeconomic factors significantly influence QuickDASH scores. 3.

ABSTRACTThe safety of vaccines, access to health care, the level of community's knowledge and the attention of physicians play a critical role in the rate of adult vaccination. This study aims to determine the immunization rate of pneumococcal, influenza and tetanus vaccines among the patients and their knowledge and attitudes in the hospital. The study is a cross-sectional point prevalence survey. The patients who agreed to participate in the study were interviewed using a questionnaire. Patients' gender, occupation, educational status, income level and risk factors (immunosuppressed and over 65 years old) were compared with the knowledge and attitudes about vaccinations. Of the 251 participants, 51.4% were female and 48.6% were male. The self-reported vaccination rate was 3.5% for pneumococcal, 8.6% for influenza and 26.6% for tetanus. Most of the patients have knowledge about influenza vaccination (90.3%). Patients with the high education level have significantly higher knowlege about tetanus vaccination and higher rate of tetanus vaccine compared to those with low education level (p = 0.04; p = 0.006). It was found that those with higher income levels had the more pneumococcal vaccination, more knowledge on tetanus vaccination, and more attitude that tetanus vaccine is necessary compared to those with lower income level (p < 0.05). Patients without risk factors have a higher rate of tetanus vaccination compared to those with risk factors (p < 0.001). It was inferred that the high level of education and income have a positive effect on the patients vaccination rates and their knowledge and attitude.

[Purpose] To determine the correlations of differences in the income level with the presence of metabolic syndrome (MetS), energy intake, and physical activity across Korean elderly populations.[Methods] We obtained data from 2,139 elderly individuals (aged >65 years) based on the Korea National Health and Nutrition Examination Survey (KNHANES) (2016‒2018). We analyzed the levels of physical activity (PA) and energy intake using the survey data. Moreover, we analyzed the differences in energy intake and PA levels according to the income level and MetS.[Results] Compared with the non-MetS group, the MetS group displayed significantly higher levels of waist circumference (p=0.000), triglycerides (p=0.000), systolic blood pressure (p=0.000), diastolic blood pressure (p=0.016), and fasting blood glucose (p=0.000) for both high and low income levels. However, the level of high-density lipoprotein cholesterol was significantly lower in the MetS group than that in the non-MetS group (p=0.000). The level of smoking in non-MetS men was significantly higher than that in MetS men across all participants (p=0.047). Except carbohydrate intake, the total energy intake (p=0.022), fat intake (p=0.009), and protein intake (p=0.005) were significantly lower in the MetS group than those in the non-MetS group for high income levels. We obtained similar results for low income levels. The two-way analysis of variance (ANOVA) did not identify an interaction between the income level and the presence of MetS; however, the total energy, i.e., the level of total energy intake, was significantly lower in participants with low income levels than in those with high income levels. For high income levels, transport PA (p=0.002), vigorous recreational PA (p=0.001), moderate recreational PA (p=0.001), and total PA (p=0.000) were significantly lower in the MetS group than those in the non-MetS group. For low income levels, moderate occupational PA (p=0.012), transport PA (p=0.018), and total PA ((p=0.000) were significantly lower in the MetS group than those in the non-MetS group. The total PA, i.e., the level of energy consumption, was significantly lower in the elderly with low income levels than in those with high income levels.[Conclusion] Regardless of the income level, the elderly with MetS exhibited low levels of energy intake and PA, compared with those without MetS. In addition, regardless of the presence of MetS, the elderly with low income levels exhibited lesser energy intake and PA. These findings implied the need for balanced nutrient intake and increased participation in PA as well as education and program development to prevent MetS in the elderly.

Wetlands provide a wide range of ecosystem services; however, little is known about their perception value or use for improving urban planning and wetland management. This study explores the perception values towards the Los Batros Wetland in Chile, by inhabitants from different neighborhood typologies. A sample of 457 responses evaluated the wetland by applying the Kellert framework of 9 biophilic values using a Public Participation Geographic Information Systems (PPGIS) approach. A spatial autocorrelation analysis with hotspot revealed that the spatial distribution of biophilic values varies by neighborhood typology. Subsequent ANOVA and T-test suggest that such distribution is affected by perceived accessibility and visitation purposes, and is influenced by socio-demographic aspects that vary among neighborhood typology. Inhabitants of the garden city typology located next to the wetland area, whose residents have higher education and income levels and who have easy and moderate access to the wetland, agreed with a diverse type of biophilic values. In the garden city, the ecologistic-scientific value has the higher spatial concentration. In the condominium typology, with similar education and income levels and accessibility, but situated far from the wetland, there was less agreement with biophilic values, and these were more dispersed, i.e. biophilic values are less representative. In this case, the aesthetic value prevails over others. At the north area of the neighborhood unit, where residents had lower education and income levels along with moderate to difficult physical access to the wetland, but they developed horticultural activities alongside the wetland, inhabitants agree with various biophilic values, highlighting its symbolic value. Conversely, biophilic values of people in the favela were not in agreement nor disagreement, regardless they have similar physical access and distance to the wetland as residents in the condominium typology, but have the lowest income and education level. Findings suggest that effective wetlands management requires appreciation of the clusters of values assigned to wetland environments, which in this case relate to neighborhood typologies. These clusters should be considered when planning to restore, protect, and improve urban wetlands.

High prevalence of arterial hypertension in a Brazilian Northeast population of low education and income level, and its association with obesity and metabolic syndrome