Socioeconomic Status Areas Research Articles

Food Insecurity in Broome County and its Effect on Adolescent Academic Performance

Food insecurity is a growing concern among children within the U.S., as the number of households who are food insecure has grown in the wake of the COVID-19 pandemic. Food insecurity in children can lead to a multitude of cognitive complications. My research investigates the relationship between food insecurity and academic performance in elementary schools in Broome County. To uncover how food insecurity and academic performance are linked, interviews were conducted with school staff (teachers, administrators, a food service manager), the area's socioeconomic status was analyzed, standardized testing scores were compiled, and the food offerings in the area were explored. The results indicate that a place with higher food insecurity and higher poverty could result in lower academic performance, as observed through test scores and observations of the school staff. The results could also highlight that an area with lower food insecurity results in higher academic performance. This demonstrates the need to provide supplementary food and expanded free meals for children in schools to maximize their ability to succeed academically. Free meals for students through the National School Lunch Program should be provided into the future and supplementary programs should be accessible to all, not just those in areas with high food insecurity, to ensure schools give their students the resources they need to succeed.

Women in rheumatology in Africa.

Despite the increasing occurrence of rheumatic diseases worldwide, there is poor access to rheumatology services and few rheumatologists to provide these services in many regions of the world. This fact is particularly true in areas of lower socioeconomic status and low-income and middle-income countires. Studies across various countries show a relative shortage of rheumatologists compared with the rising need for the specialty worldwide.1,2

Autonomy and health-related quality of life in adolescents

BackgroundAutonomy is recognized as important for individual well-being and constitutes one dimension in the KIDSCREEN-instrument measuring health related quality of life (HRQoL) in children and adolescents. However, the autonomy questions in KIDSCREEN are restricted to opportunities to influence leisure time activities, which is a form of autonomy as volition. Yet, there are other aspects of autonomy that might be related to adolescent’s HRQoL. The aims of the present study were first to investigate the psychometric properties of a scale measuring autonomy in adolescence from a control perspective (AAC) including its relation to the autonomy dimension in KIDSCREEN, and second; to investigate AACs ability to predict each of the 10 dimensions constituting KIDSCREEN.MethodsStudents (n = 154) aged 15–16 years who were recruited from schools located in both low (two schools) and high (two schools) socioeconomic status (SES) areas in Sweden participated in a cross-sectional study. The adolescents answered a questionnaire including a new 6-item scale measuring perceived autonomy and HRQoL assessed by the KIDSCREEN-52 instrument. A factor analyses was computed to investigate the relation between the items in the AAC scale and the autonomy items in the KIDSCREEN instrument. Hierarchical regression analyses were computed to investigate if the AAC scale predicted HRQoL in any of the 10 dimensions in KIDSCREEN after controlling for gender, SES and the original autonomy scale included in KIDSCREEN.ResultsThe factor analysis showed that all the items from the autonomy scale loaded in one factor and that all the items from the AAC scale loaded in another dimension. The hierarchical regression models showed that the AAC scale uniquely predicted HRQoL in all dimensions of the KIDSCREEN instrument after controlling for gender, SES and the original autonomy scale included in KIDSCREEN-52. A high level of perceived autonomy was associated with a high level of HRQoL for both scales.ConclusionA new scale for measuring autonomy from a control perspective has been presented and shown to differ from autonomy as volition. Both forms of autonomy are positively related to HRQoL in adolescence 15–16 years old.

The Longitudinal Effect of Area Socioeconomic Changes on Obesity: a Longitudinal Cohort Study in the USA from 2003 to 2017.

Despite several dimensions of area socioeconomic status (SES), past literature has been dominated by the use of area socioeconomic position. We examined the longitudinal effect of three area SES measures (i.e., socioeconomic position, inequality, and segregation) on obesity. Using longitudinal data from the Fragile Families & Child Wellbeing Study (N = 1493), we estimated a linear mixed model to examine the effect of three time-varying area SES measures on time-varying measures of objectively measured body mass index z-score (BMIz) from ages 5years to 15years. Findings showed that BMIz increased steadily over time (B = 0.02, 95% CI = 0.02, 0.03). A significant interaction between time and area socioeconomic position indicates that children in areas with higher socioeconomic position had a smaller increase in BMIz than those in low socioeconomic areas (B = - 0.02, 95% CI = - 0.02, - 0.01). A non-linear relationship of area income inequality with BMIz such that BMIz was higher as area income inequality was greater, but the effect diminishes in magnitude with a higher level of area income inequality (linear term: B = 0.07; quadratic term: B = - 0.03). Area income segregation was associated with greater BMIz (B = 0.08, 95% CI = 0.03, 0.12). No time interaction effect was found for area income inequality and segregation. Results highlight a need for community health policy efforts and evidence-based interventions to address childhood obesity issues in low-SES areas.

A comparison of parent-reported and self-reported psychosocial function scores of the PedsQL for children with non-severe burn

BackgroundQuality of life of paediatric patients after burn injury is often assessed through parents who may score differently to their child. Non-severe burns are the most common type of burn injury in Western Australia, however, despite low severity and high survival rates, they can cause long term physical and psychosocial problems which need to be detected early in order to provide patients with optimal holistic care. MethodsDemographic and clinical data were collected from paediatric patients (5–16-year-old) with non-severe burns (<20% total body surface area), and Paediatric quality of life (PedsQL) questionnaires were collected from both the patient and their parent. Two cohorts of patients were assessed: first, those at approximately six months after burn, and second, those more than one-year after burn. Differences between parent-scores and self-scores were analysed using multivariate linear regression to assess the relationship between risk factors and observed differences in PedsQL scores. ResultsParents reported poorer Psychosocial Function (PSF) for younger children (p = 0.01) and for patients from higher socioeconomic status areas (p = 0.05) compared to their children. In the ‘Early Recovery Cohort’, female patients had significantly different scores to their parents (p < 0.01). In the ‘Late Recovery Cohort’, parents rated older patients lower than they rated themselves (p = 0.03). ConclusionAge at burn, socioeconomic status, and female gender may increase the discrepancy in quality-of-life assessments between parents and patients.

The neighbourhood environment and profiles of the metabolic syndrome

BackgroundThere is a dearth of studies on how neighbourhood environmental attributes relate to the metabolic syndrome (MetS) and profiles of MetS components. We examined the associations of interrelated aspects of the neighbourhood environment, including air pollution, with MetS status and profiles of MetS components.MethodsWe used socio-demographic and MetS-related data from 3681 urban adults who participated in the 3rd wave of the Australian Diabetes, Obesity and Lifestyle Study. Neighbourhood environmental attributes included area socio-economic status (SES), population density, street intersection density, non-commercial land use mix, percentages of commercial land, parkland and blue space. Annual average concentrations of NO2 and PM2.5 were estimated using satellite-based land-use regression models. Latent class analysis (LCA) identified homogenous groups (latent classes) of participants based on MetS components data. Participants were then classified into five metabolic profiles according to their MetS-components latent class and MetS status. Generalised additive mixed models were used to estimate relationships of environmental attributes with MetS status and metabolic profiles.ResultsLCA yielded three latent classes, one including only participants without MetS (“Lower probability of MetS components” profile). The other two classes/profiles, consisting of participants with and without MetS, were “Medium-to-high probability of high fasting blood glucose, waist circumference and blood pressure” and “Higher probability of MetS components”. Area SES was the only significant predictor of MetS status: participants from high SES areas were less likely to have MetS. Area SES, percentage of commercial land and NO2 were associated with the odds of membership to healthier metabolic profiles without MetS, while annual average concentration of PM2.5 was associated with unhealthier metabolic profiles with MetS.ConclusionsThis study supports the utility of operationalising MetS as a combination of latent classes of MetS components and MetS status in studies of environmental correlates. Higher socio-economic advantage, good access to commercial services and low air pollution levels appear to independently contribute to different facets of metabolic health. Future research needs to consider conducting longitudinal studies using fine-grained environmental measures that more accurately characterise the neighbourhood environment in relation to behaviours or other mechanisms related to MetS and its components.

Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Study

IntroductionCardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of area-level socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of individual SES has not been investigated previously. AimsTo estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors independent of individual-level SES. MethodsIn this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromsø Study (2015–2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) at the geographical subdivision level. Individual-level SES data and geographical subdivision of Tromsø municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromsø7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. ResultsASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the mediators accounting for 43% of the observed effects. ConclusionsLiving in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.

A Comparison of Area-Level Socioeconomic Status Indices in Colorectal Cancer Care

IntroductionThere are multiple measures of area socioeconomic status (SES) and there is little evidence on the comparative performance of these measures. We hypothesized adding area SES measures improves model ability to predict guideline concordant care and overall survival compared to models with standard clinical and demographic data alone. Materials and methodsWe included patients with colorectal cancer from 2006 to 2015 from the North Carolina Cancer Registry merged with insurance claims data. The primary area SES study variables were the Social Deprivation Index, Distressed Communities Index, Area Deprivation Index, and Social Vulnerability Index. We used multivariable logistic modeling and Cox proportional hazards modeling to assess the adjusted association of each indicator, with guideline concordant care and overall survival, respectively. Model performance of the SES measures was compared to a base model using likelihood ratio testing and area under the curve (AUC) assessments to compare SES indicator models with each other. ResultsWe found that the Area Deprivation Index, Social Vulnerability Index and Social Deprivation Index, but not Distressed Communities Index, were significantly associated with receiving guideline concordant care and significantly improved model fit over the base model on likelihood ratio testing. All models had similar AUCs. With respect to overall survival, we found that all indices were independently and significantly associated with survival and had significantly improved model fit over the base model on likelihood ratio testing. AUC analysis again showed all area SES measures had comparable performance for overall survival at 5 y. ConclusionsThis analysis demonstrates the importance of including these measures in risk adjustment models. However, of the commonly available measures, no one measure stood out as superior to others.

Developing and testing the senior park environment assessment in Korea (SPEAK) audit tool

Given the rapidly aging population in Korea and the critical role of neighborhood parks in the health of seniors, it is essential to understand how park environments impact physical activity in this age group. This study outlines the development and testing of an audit tool, Senior Park Environment Assessment in Korea (SPEAK), to assess park characteristics and culture-specific features that may promote physical activity in Korean seniors. Additionally, it investigated disparities in park quality and characteristics in high- and low socioeconomic status (SES) neighborhoods. The 36-item, single-page audit tool was developed and field-tested in 42 parks in four districts of two Korean cities, purposely selected for their differences in SES. Cohen’s kappa and percent agreement assessed the inter-rater reliability of each item. The Kruskal–Wallis test and a Mann–Whitney test evaluated differences in the percent scores among five domains (Access, Amenities, Safety, Aesthetics, and Recreation) and compared scores between the two SES areas. SPEAK was generally reliable: 72% of the items had over 75% agreement, and 70.4% had kappa coefficients between 0.4 and 1. Access to parks had the lowest scores among the five domains. Results indicated a significant disparity in three domains (Access, Amenities, and Safety) regarding parks between the two SES areas, suggesting that parks in low-SES areas are of lower quality and less safe than high-SES park areas. SPEAK would provide Korean municipalities with a feasible park assessment of factors impacting physical activity in the elderly.

Self-reported lifestyle behaviours in families with an increased risk for type 2 diabetes across six European countries: a cross-sectional analysis from the Feel4Diabetes-study

BackgroundA healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria).MethodsParents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire (eight items questioning age, Body Mass Index, waist circumference, PA, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families’ lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status.ResultsMost Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries.ConclusionsCountries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.

OROPHARYNGEAL SQUAMOUS CELL CARCINOMA: A SERIES OF 152 CASES FROM RIO DE JANEIRO

<h3>Objectives</h3> The aim of the present study was to evaluate the clinicopathologic features of oropharyngeal squamous cell carcinoma (OPSCC) in a population from Rio de Janeiro, Brazil. <h3>Study Design</h3> One hundred fifty-two patients were diagnosed with primary OPSCC in an oral pathology laboratory between 2014 and 2020. Demographic and clinical data were retrospectively collected from the records and all cases were microscopically classified as keratinizing, nonkeratinizing, or nonkeratinizing with maturation. Immunohistochemistry for p16INK4a was performed in 46 cases (30.2%) and the positive ones were submitted to DNA in situ hybridization (ISH) for human papillomavirus (HPV). <h3>Results</h3> There were 29 females and 123 males, with a mean age of 61 years (range, 39-89). Most patients regularly consumed tobacco (69%) and alcohol (50.7%) and lived in low socioeconomic status areas. Most tumors measured more than 2 cm and were located mainly in the soft palate (48%), followed by unspecified oropharynx, tonsil, and base of the tongue. The 3 histologic subtypes were similarly distributed among the cases. Five cases were positive for p16INK4a (10.9%), and of these, 4 were positive for HPV by DNA ISH (8.7%), most of them nonkeratinizing. <h3>Conclusions</h3> HPV prevalence is low in OPSCC cases from this Brazilian population.

Reflecting on teaching in low SES areas during COVID-19: an Australian experience

ABSTRACT School closures and the move to remote learning during the COVID-19 pandemic transformed teaching and learning in Australian schools. Educators experienced personal and professional challenges as they rapidly responded to the needs of their school communities and managed their own emotional reactions. Eleven educators at two Victorian schools in areas of low socioeconomic status discussed in focus groups the impact of school closures and explored their perceptions of responses from leaders and colleagues who supported their wellbeing. While naming the significance of uncertainty, constant change and increased workloads, these educators acted creatively to ensure their students had access to specifically developed learning materials to suit their needs. Educators demonstrated that they could use existing reflective structures that fostered mutual support to sustain their wellbeing and create supportive environments for themselves and their wider school communities in times of crisis, as well as remain open to sometimes-surprising learning opportunities.

‘What's the magic word?’: mapping oral language interventions implemented in prevention and early intervention programmes

ABSTRACT The nationally funded Prevention and Early Intervention (PEI) programme aimed to design, deliver and evaluate interventions to improve a range of outcomes for children growing up in areas of low socio-economic status (SES). A key focus for many PEI programmes was to improve the oral language abilities of children, recognising its important link to a range of literacy, learning, social, emotional and behavioural indicators. This paper reviewed the published reports of PEI and community programmes that implemented oral language interventions for children, parents and practitioners. This mapping exercise demonstrated that the oral language interventions implemented varied extensively and were predominantly evaluated through gathering the perspectives of those receiving the supports. A noticeable gap was the lack of a national evaluation framework of the oral language interventions provided, resulting in difficulties making comparisons, determining impact and contributing to the evidence base of the effectiveness of bespoke interventions designed and delivered. Implications of this mapping exercise are outlined for the future implementation and evaluation of universal and targeted oral language interventions.

Abstract 3630: Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups

Abstract Introduction: Breast cancer survivors have an increased risk of contralateral breast cancer (CBC), among whom minority breast cancer patients are at increased risk of this adverse outcome. Studies evaluating CBC risk by race/ethnicity frequently aggregate Asian/Pacific Islanders (API) into a single group or exclude them. The purpose of this study was to determine the impact of socioeconomic status (SES) on the risk of CBC among subgroups of API breast cancer survivors. Method: We conducted a population-based retrospective cohort study of women ages 18+ years diagnosed with unilateral Stage I-III breast cancer using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2016). Women included in the study received cancer-directed surgery and the primary outcome of interest was asynchronous CBC occurring. SES was classified using the Yost index, a validated time-dependent composite score with the 1st quintile representing the lowest and 5th quintile being the highest SES. API women were categorized into Chinese, Japanese, Filipina, Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other Asian/Pacific Islanders. We determined overall associations between SES and the risk of CBC using Fine and Gray regression models accounting for competing risks comparing API women to Non-Hispanic White (NHW) women. Multivariable adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. Results: From a cohort of 44,362 API female breast cancer patients included, one quarter of the cohort were Filipina (25%), 18% were Chinese, 14% were Japanese, 8% were Indian/Pakistani, and 17% were other API. API women living in the lowest SES areas were more likely to be uninsured or have Medicaid coverage (21% vs. 6%) and have Stage lll first primary breast cancer (14% vs. 10%) compared to API women living in the highest SES areas. Overall, API breast cancer patients as an aggregate group did not have significantly increased risk of CBC compared to NHW patients. In stratified subgroups, risk estimates for CBC were higher among Chinese women (SHR 1.24, 95% CI 1.08-1.41), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Hawaiian women (SHR 1.67, 95% CI 1.37-2.08) when compared to NHW women after adjusting for demographics and baseline clinical characteristics. Lower SES was not associated with increased CBC risk among API women overall. However, the risk of CBC is significantly lower among Chinese and Vietnamese women and higher among Filipina women who lived in areas lower SES quintile compared to women who lived in area with the highest SES quintile when examining impact of SES within API subgroups. Conclusion: Chinese, Filipina, and Hawaiian women have higher risk of CBC when compared to NHW. When disaggregated API women into subgroups, the impact of SES on the risk of CBC differs significantly across API subgroups. Citation Format: Hsiao- Ching Huang, Jenny S. Guadamuz, Kent F. Hoskins, Naomi Y. Ko, Gregory S. Calip. Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3630.

Metabolic risk is associated with sociodemographic characteristics in adolescents from both rural and urban regions from southern Brazil

BackgroundThe prevalence of several cardiovascular metabolic disorders are increasingly cause for concern in adolescents worldwide. Given the complex interrelations between metabolic risk (MR) and sociodemographic variables, the present study aims to examine the association between the presence of MR with sociodemographic characteristics (sex, skin color, residential area, and parental socioeconomic status) in adolescents from Southern Brazil.MethodsCross-sectional study conducted with 1,152 adolescents (507 males) aged between 12 and 17 years. MR was assessed using a continuous score (cMetS; sum of Z-scores of the following variables: waist circumference, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol [HDL-C, inverse], triglycerides [TG], and estimated cardiorespiratory fitness [CRF, inverse]). Poisson regression was used to examine associations between sociodemographic variables with the dichotomized cMetS and separate metabolic variables. The results were expressed with prevalence ratios (PR) and 95% confidence intervals (CI).ResultsThe presence of MR (evaluated by the cMetS) was observed in 8.7% of adolescents. Higher MR was less prevalent among non-white adolescents (PR: 0.96; 95% CI: 0.93; 0.99). Adolescents living in rural areas had a lower prevalence of the following metabolic variables; low HDL-C (PR: 0.95; 95% CI: 0.94; 0.97), elevated TG (PR: 0.95; 95% CI: 0.92; 0.99), elevated glucose (PR: 0.96; 95% CI: 0.95; 0.98), and low CRF levels (PR: 0.88; 95% CI: 0.85; 0.92). Whereas, SBP was higher in those living in rural areas (PR: 1.11; 95% CI: 1.05; 1.17). In girls, there was a higher prevalence of raised TG (PR: 1.06; 95% CI: 1.02; 1.10) and lower levels of CRF (PR: 1.20; 95% CI: 1.16; 1.24), but a lower prevalence of elevated glucose (PR: 0.97; 95% CI: 0.97; 0.99).ConclusionHigher MR prevalence was lower in those self-reporting non-white skin color and selected MR factors were less prevalent in those living in rural areas. The identification of groups at higher MR is important for early prevention and monitoring strategies for both Type 2 diabetes and later cardiovascular disease. Future studies should be conducted to assess the socio-cultural aspects of the relationships between MR and socio-cultural and lifestyle variables.

HPV vaccination coverage: slightly improved two‐dose schedule completion estimates and historical estimates lower on AIR than HPV Register

ObjectiveTo compare Australian Immunisation Register (AIR) human papillomavirus (HPV) vaccination coverage against historical data from the former National HPV Vaccination Program Register and estimate two‐dose vaccination coverage. MethodsCross‐sectional analysis of registry data for adolescent birth cohorts (1998‐2007). Denominator populations were Medicare enrolments (AIR) and ABS estimated resident populations (HPV register). ResultsFor adolescents aged <17 years, AIR coverage estimates were several percentage points lower than HPV register estimates due to a larger Medicare enrolment denominator. Completed course coverage (two or three valid doses) for 15‐year‐old females in 2020 was 81.5% and for males 78.6%, higher than completed course coverage in 15‐year‐olds in 2019 (79.7 and 76.8% respectively). First dose coverage was similar for Indigenous adolescents but course completion was lower, although improving over time. Course completion was slightly lower (3.5‐5.7%) in areas of lowest socioeconomic status and greatest remoteness. ConclusionsCoverage is slightly lower using AIR than HPV register estimates. Moving from three to two doses has slightly improved completion, likely due to the wider dose spacing, but equity gaps remain. Implications for public healthAn ongoing focus on equity in vaccine delivery is needed. Systems, reminders and catch‐up opportunities to ensure course completion remain important.

Adopting and maintaining a healthy lifestyle in low SES families: How the experience of motherhood shapes responses to dietary and physical activity public health guidance

BackgroundPublic health guidance and associated interventions seek to bring about change in diet and physical activity behaviours to improve life expectancy and healthy life expectancy in the population. Low socioeconomic status (SES) groups suffer from reduced life/healthy life expectancy compared with the population as a whole. This in-depth qualitative study, investigates the lives and experiences of mothers with young children living in a low SES area in a London (UK) borough, to understand the context in which current public health guidance on diet and physical activity is received and viewed, and how this understanding could be used to inform the development of public health guidance and interventions for this group.MethodsThe mothers (n = 20), were recruited from a Surestart Centre, Children’s Centres and through the local branch of a national charity. The mothers took part in a series of three in depth interviews over two years (2016–2017). Thematic analysis was used to generate an iterative set of codes informing an understanding of motherhood, diet and physical activity.ResultsMotherhood was found to be a major factor for understanding and interpreting how women in low SES areas respond to public health guidance on diet and physical activity. The mothers were well informed about dietary guidance, considered that provision of healthy food was critical to the mothering role, but found it difficult to implement the guidance in their own lives. In contrast, physical activity was not seen as integral to the mothering role, although it was acknowledged that it played a part in ensuring that the mothers remained healthy enough to fulfil all their duties. Constrained by the ethic of care, and a lack of material and time resources, the mothers prioritised their family’s health above their own. This study, enabled the mothers to articulate ideas for interventions that would be supportive of a healthy lifestyle and of practical application in their busy lives.ConclusionsMothers from this low SES area responded differently to the public health guidance on diet and on physical activity. Whilst providing and modelling a healthy diet was seen as an essential part of the mother’s role, participating in leisure based physical activity was problematic, and unless carefully framed, could be perceived as selfish behaviour, inappropriate for the “good” mother.

Stepping up to the Canadian opioid crisis: a longitudinal analysis of the correlation between socioeconomic status and population rates of opioid-related mortality, hospitalization and emergency department visits (2000-2017).

High levels of income inequality and increased opioid-related harm across Canada bring into question the role of socioeconomic status (SES) in the opioid epidemic. Only a few studies have examined this association, and most of those have analyzed this issue on a provincial level. This study examined the association between opioid-related health outcomes and SES, and investigated rate ratios over time. Administrative databases were used to identify opioid-related mortality, hospitalization and emergency department visits between 2000 and 2017. Patient's postal code was linked to the quintile of median household income at the forward sortation area level. Crude rates and age- and sex-adjusted rates in each quintile were calculated, as well as the adjusted rate ratio of average annual rates between the lowest and highest quintiles. The significance of the time trend of rate ratios for all outcomes was examined using linear regression. A stepped gradient of opioid-related outcomes across all income quintiles emerged from these data. For mortality, hospitalization and emergency department visits, the average annual rate ratio between lowest quintile and highest quintile was 3.8, 4.3 and 4.9, respectively. These ratios were generally stable and consistent over the study period, albeit the opioid-related mortality SES gap decreased gradually (p < 0.01). Area income quintile was found to be highly associated with opioid outcomes. Psychosocial factors (stress, unemployment, housing insecurity) that are typically concentrated in low SES areas may play a significant role in the opioid epidemic. Health policies should address these factors in order to provide effective solutions.

Localised learning: mobilising belonging among mature-aged students in low socio-economic status regional and remote areas

The higher education participation and success rates of students in low socio-economic status (SES), regional, rural, remote, and isolated areas – who often attend university later in life – is a persistent concern in Australia and beyond. This article focuses on mature-aged students in low SES, regional and remote areas in Tasmania, Australia, proposing that universities harness local belonging when providing learning opportunities. It draws on a thematic analysis of 19 semi-structured interviews with current and prospective university students, and community stakeholders. The study identifies time and place-based barriers to studying on campus: students’ commitments outside of university; and geographical, cultural, and financial challenges. However, existing local infrastructure, such as libraries, create opportunities for face-to-face interactions and learning support for students who study online in their regional or remote communities, provided by staff and local volunteers. These barriers and solutions are discussed using the concept of ‘belonging’, framed spatially and culturally. Current literature on regional and remote higher education students tends to emphasise ‘not belonging’ in relation to distant urban or metropolitan spaces. We argue that ‘belonging’ can be fostered in local spaces with local people. Utilising ‘untapped’ local learning support and existing physical spaces mitigates geographical, cultural, and financial challenges, and provides academic and emotional support. We propose a coordinated network of physical study places and local people, including: regional ‘satellite’ campuses; regional study hubs; local public libraries; and schools, where online students can be supported, connected, and engaged in their studies whilst located in regional and remote communities.

Socio-economic disparities in activity-travel behavior adaptation during the COVID-19 pandemic in North Carolina

The COVID-19 pandemic significantly affected human mobility. This study examines the changes in people's activity-travel behavior over 23 months (from Jan 2020 to Nov 2021) and how these changes are associated with the socio-economic status (SES) at the block group level in North Carolina. We identified 5 pandemic stages with different restriction regimes: the pre-pandemic, lockdown, reopening stage, restriction, and complete opening stage. Using the block-group mobility data from SafeGraph, we quantify visits to 8 types of destinations during the 5 stages. We construct regression models with interaction terms between SES and stages and find that visit patterns during the pandemic vary for different types of destinations and SES areas. Specifically, we show that visits to retail stores have a slight decrease for low and medium SES areas, and visits to retail stores and restaurants and bars bounced back immediately after the lockdown for all SES areas. The results suggest that people in low SES areas continued traveling during the pandemic. Transportation planners and policymakers should carefully design the transportation system to satisfy travel needs of those residents. Furthermore, the results also highlight the importance of designing mitigation policies that recognize the immediate recovery of visits to retail locations, restaurants, and bars.