Community Socioeconomic Status Research Articles

Development of a self-report measure to assess sleep satisfaction: Protocol for the Suffolk Sleep Index (SuSI).

Good sleep is essential for health but there is no consensus on how to define and measure people's understanding of good sleep. To date, people's perceptions of a good night's sleep have been, almost exclusively, conceptualized under the lens of sleep quality, which refers to objective characteristics of good sleep, such as such as ease and time needed to fall asleep, hours of sleep, and physical symptoms during sleep and upon awakening. A related, yet different construct, sleep satisfaction, refers to perceived positive affect about one's sleep experience and has, to date, received little attention. This research focuses on sleep satisfaction, rather than sleep quality, and aims to develop a self-report measure to assess sleep satisfaction in an English adult population. As the measure will be developed in Suffolk, England, and its primary intended users are Suffolk community members, it is labelled the Suffolk Sleep Index (SuSI). The SuSI will draw from principles of community-based participatory research, following a seven-phase developmental process comprising literature review, interviews with Suffolk community members, synthesis of literature review and interview findings, pre-testing, pilot-testing, scale evaluation, and refinement. The present research will also investigate indices related to sleep satisfaction, including the community's general health status, lifestyle factors and socio-economic status. The research will add to the limited, yet emerging body of research on perceived sleep satisfaction and its measurement. To our knowledge, a valid and reliable sleep satisfaction self-report measure has not been developed in the United Kingdom previously.

Modeling the Effect of Streetscape Environment on Crime Using Street View Images and Interpretable Machine-Learning Technique.

Street crime is a common social problem that threatens the security of people's lives and property. Understanding the influencing mechanisms of street crime is an essential precondition for formulating crime prevention strategies. Widespread concern has contributed to the development of streetscape environment features as they can significantly affect the occurrence of street crime. Emerging street view images are a low-cost and highly accessible data source. On the other hand, machine-learning models such as XGBoost (eXtreme Gradient Boosting) usually have higher fitting accuracies than those of linear regression models. Therefore, they are popular for modeling the relationships between crime and related impact factors. However, due to the "black box" characteristic, researchers are unable to understand how each variable contributes to the occurrence of crime. Existing research mainly focuses on the independent impacts of streetscape environment features on street crime, but not on the interaction effects between these features and the community socioeconomic conditions and their local variations. In order to address the above limitations, this study first combines street view images, an objective detection network, and a semantic segmentation network to extract a systematic measurement of the streetscape environment. Then, controlling for socioeconomic factors, we adopted the XGBoost model to fit the relationships between streetscape environment features and street crime at the street segment level. Moreover, we used the SHAP (Shapley additive explanation) framework, a post-hoc machine-learning explainer, to explain the results of the XGBoost model. The results demonstrate that, from a global perspective, the number of people on the street, extracted from street view images, has the most significant impact on street property crime among all the street view variables. The local interpretability of the SHAP explainer demonstrates that a particular variable has different effects on street crime at different street segments. The nonlinear associations between streetscape environment features and street crime, as well as the interaction effects of different streetscape environment features are discussed. The positive effect of the number of pedestrians on street crime increases with the length of the street segment and the number of crime generators. The combination of street view images and interpretable machine-learning techniques is helpful in better accurately understanding the complex relationships between the streetscape environment and street crime. Furthermore, the readily comprehensible results can offer a reference for formulating crime prevention strategies.

The effect of building-level socioeconomic status on bystander cardiopulmonary resuscitation: a retrospective cohort study

Abstract Background/Introduction In out-of-hospital cardiac arrest (OHCA), bystander cardiopulmonary resuscitation (BCPR) increases survival [1]. Understanding the social determinants of BCPR receipt can inform the design of public health interventions to increase BCPR. The association of socioeconomic status (SES) with BCPR is generally poorly understood. Purpose We aimed to evaluate the effect of SES on BCPR in OHCA using a building-level SES marker. Methods This was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry, an ongoing long-term prospective registry for OHCA in the Asia-Pacific region, between 2010 to 2018. We categorized patients into low, medium and high Singapore Housing Index (SHI) levels. The SHI, which appraises a residential property value on an ordinal scale of 1 to 7 (low to high), is a building-level marker that has a robust association with income and residence value [2]. The primary outcome was receipt of BCPR. The secondary outcomes were pre-hospital return of spontaneous circulation (ROSC) and survival – defined as survival to 30 days or hospital discharge, whichever occurred first. Results A total of 12,730 OHCA cases were included (Figure 1), the median age was 71 years and 58.9% were male. BCPR rate was 56.7%. OHCA patients in the low SHI tier were the youngest, most likely male, and least likely to have any medical co-morbidities (Table 1). Compared the low SHI category, those in the medium and high SHI categories were more likely to receive BCPR (medium SHI: adjusted odds ratio [aOR] 1.483, 95% CI 1.301–1.691, p<0.01; high SHI: aOR 1.933, 95% CI 1.669–2.240, p<0.01). As a continuous variable, every unit increase in SHI was associated with increased BCPR (aOR 1.142, 95% CI 1.110–1.174, p<0.001). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.789, 95% CI 1.080–2.964) but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). There were no significant differences in the proportion of ROSC across three categories of SHI (p=0.426). When comparing high with low SHI, females had larger increases in BCPR rates compared to males (ratio of OR 1.370, 95% CI 1.012–1.853). There were no significant associations between SHI and BCPR in the subgroups age ≥65 years, witnessed arrest, daytime arrest, and arrests after 2014, and no interaction effects were observed. Conclusions Lower building-level SES was independently associated with lower rate of BCPR. Higher SES was associated with higher 30-day survival on unadjusted analysis but not adjusted analysis, and this study may be under-powered for this outcome. Females were more susceptible to the effect of low SES on lower rate of BCPR, and community CPR training should focus on recognizing OHCA and performing BCPR in women in low SES communities. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council, Clinician Scientist Awards, Singapore (NMRC/CSA/024/2010, NMRC/CSA/0049/2013 and NMRC/CSA-SI/0014/2017) and Ministry of Health, Health Services Research Grant, Singapore (HSRG/0021/2012).

The Influence of Family and Religion on Youth Decisions in Higher Education English Literature Review

The literature review explores the influence of family and religion on youth decisions in higher education. The study examines articles on how parental influence and religion impact the youth’s horizons of actions. The research identified three significant influencers linked to academic performance and college readiness: parental figures, educators and peers. Parental influence has become an emergent factor in enrolling in higher education. Parental guidance and experience can impact willingness to enroll in higher education and highlight the importance of obtaining a college degree. The findings of this study may be used to create resources for parents that did not attend college or those in lower socioeconomic status communities to more readily gain access to college information, which may aid in the enrollment process.

An Analysis of the Readability of Phacoemulsification Online Resources.

Introduction: Cataract is the leading cause of blindness worldwide. Phacoemulsification is now the gold standard for cataract extraction and is greatly needed in low socioeconomic status (SES) communities, rural and older patient populations, and patients with poor vision. This greatly increases the importance of high readability for online resources on this topic. This study aims to assess the readability of online information about phacoemulsification based on readability scores for each resource. Methods: We conducted a retrospective cross-sectional study. The term “phacoemulsification” was searched online, and each website was categorized by type: academic, physician, non-physician, commercial, social media, and unspecified. The readability scores for each website were calculated using six different readability tests and a composite score that reflects reading grade level was obtained. To evaluate the difference between the categories of websites, analysis of variance (ANOVA) testing was used. All test scores were compared with the 6th grade standard recommendation using a one-sample t-test.Results: A total of 20 websites were analyzed. Three websites (3/20; 15%) had a score which is correlated with a 6th grade reading level or below. Seventeen websites had a score correlated with a college reading level or above (17/20; 85%). None of the readability scores had a mean below a 6th grade reading level. No category had an average readability score at or below a 6th grade reading level. None of the mean readability scores resulted in a statistically significant difference across categories. All readability tests had an average score which was significantly different from a 6th grade reading level (p<0.001). Conclusions: This is the first study to focus on the accessibility of online English resources on phacoemulsification and implement multiple standardized readability scores with regards to cataract surgery resources. It provides further overwhelming evidence that online resources on phacoemulsification are too complex for the average patient to understand. Interventions should be implemented to improve readability.

Lessons learned from the "Goodie Box": A message design study developed and evaluated in community settings for cervical cancer prevention.

Despite the availability of free pap testing services, Jamaican women have low human papillomavirus (HPV) screening rates; 16% of women in the Kingston Metropolitan Area have been screened within the prior 3 years. This paper discusses the testing of theory-based messages to increase HPV screening uptake in a low-resource setting, using HPV self-test kits designed for this intervention. A total of 163 Jamaican women, aged 30–65 years, who had not had a pap test in at least 3 years, from two low socioeconomic status communities in Kingston, were enrolled and assigned to one of two versions of an HPV self-test kit, either with or without culturally targeted fear appeal messages. The uptake of screening was high across conditions; 95.6% of participants used the HPV self-test and returned their kits. However, surprising variations were observed in self-test acceptability, explained by differing attitudes toward the message conditions. Based on the results, we recommend four key components to increase HPV screening in low-resource settings: 1) focus on perceived threat in message design, 2) avoid written materials due to literacy concerns, 3) use culturally appropriate interpersonal or community-based channels, and 4) consider alternative solutions (such as a self-test) available at no or low cost to address structural barriers.

Prevalence and predictors of mother and newborn skin-to-skin contact at birth in Papua New Guinea

ObjectiveThis study examined the prevalence and predictors of maternal and newborn skin-to-skin contact at birth in Papua New Guinea.DesignData for the study was extracted from the 2016–18 Papua New Guinea...

How Debate Can Lessen Educational Inequities for Students Across Diverse Socioeconomic Backgrounds

Public schools are failing to provide a sound education for students in low socioeconomic status communities (SES). With the rise of COVID and online schooling, the education quality gap has widened due to disparities in access to resources and funding. With this divide, debate programs can be a viable, inexpensive solution to the education imbalance that is evident across the United States. Debate allows students to use their voice and develop public speaking skills, which support their intellectual ability to become stronger communicators. Public speaking is an invaluable skill that, unfortunately, receives little attention in the public school system. Adding debate to a school’s offerings can lead to great improvements for the students who take part. Debate increases the academic ability of students as they learn to research, do document reading, and present their work to a large audience. Through practice, students develop a greater self-esteem and become disciplined in their work. When adapting and crafting their speech techniques, students learn how to be efficient communicators and develop essential tools to be leaders in the workforce. Although education policy makers may doubt the effectiveness of debate programs in reducing the SES achievement gap, research shows that debate programs can give students in underserved communities the opportunity to develop skills that will support their future success.

S06-4 Exploring correlates of adolescent boys' muscular fitness: a mixed-methods formative study

Abstract Background According to the Elaborated Environmental Stress Hypothesis, anxiety and depression in children are associated with poor motor competence, and these associations may be mediated by social support and self-perceptions. Improving children’s motor competence through school-based physical activity interventions may therefore be a mechanism for promoting positive mental health through psychosocial factors. Co-production provides opportunities to participate in intervention development processes, thereby ensuring that specific needs of stakeholders are targeted. The shared stakeholder ownership of the process provides a context-sensitive basis for acceptable interventions with increased likelihood of them being effectively implemented and resulting in positive outcomes. This presentation describes phase 1 of the Move Well, Feel Good study, which aimed to co-produce and evaluate the feasibility of a primary school physical activity intervention to improve children’s motor competence and mental health. Methods Five primary schools were recruited from a low socioeconomic status community in northwest England. From these schools, stakeholder groups were formed consisting of class teachers, school leaders, physical activity specialists, and children (aged 8-9 years). Stakeholders worked in single and multiple stakeholder groups through a 6-stage process aligned to the Double Diamond Design Approach by employing divergent and convergent thinking processes to discover, define, develop, and deliver a solution to the ‘problems’ of how best to improve children’s motor competence and mental health, and how best to facilitate real-world school context implementation of the intervention. Through this process the child and adult stakeholders worked separately in workshops and engaged in additional learning and consensus activities. The adult stakeholder co-production workshops were informed by the children’s views and current research evidence. Multiple-stakeholder groups worked collaboratively to develop intervention ideas, which were presented, critiqued, and refined in alignment with the TIDieR checklist. Results In the final stage of the process the research team presented the final co-produced interventions back to the stakeholders and a consensus vote was taken to decide which intervention would be implemented in the phase 2 feasibility trial in September 2022. Conclusions School stakeholders’ participation in intervention co-production ensures their ownership of the finalised programme, which may be important for subsequent implementation and engagement.

Assessing the Socio-Economic Impacts of Rural Infrastructure Projects on Community Development

Public construction infrastructure projects have been recognized as one of the fundamental tools in enhancing community socio-economic conditions for community development. The purpose of this study is to empirically investigate the impacts of socio-economic factors on community development of rural regions. Through a questionnaire survey administrated in Pakistan, public construction practitioners’ views were sought and evaluated. Empirical support for the argument originated from the data collected from 213 respondents in Pakistan’s public construction industry. The questionnaire’s data were evaluated employing the partial least square structural equation modeling (PLS-SEM). The study’s findings showed that economic and social factors influence the community development of rural regions. The result obtained from PLS-SEM proposed a more viable method to realize community development and objectives. The study’s results have offered precious lessons for local authorities, policymakers, and project stakeholders to strengthen the drive for achieving community development goals. Strategies supporting community development in rural regions are indispensable for local community development. This study provides empirical confirmation for the understanding and combining the community development concept; it illuminates absent knowledge about community development, especially in rural regions. This is one of the few studies investigating the influencing dimensions of community development in rural regions. To the authors’ best knowledge, this is the first research article providing empirical evidence of the influencing dimensions of community development in rural regions in a developing country.

The Impact of COVID-19 in the Latinx Community.

Description The COVID-19 pandemic has intensified the existing health and social disparities that affect minority groups in the United States (US), including the Latinx community. This situation has been reflected in many aspects of health, including increased morbi-mortality and reduced adherence to medical and scientific recommendations. Limited access to health care, financial challenges, migrant status, and health literacy, or lack thereof, have all hampered the Latinx community's ability to seek aid quickly and to be tested or treated effectively for this disease. This pandemic has shown that the Latinx community's socioeconomic status correlates with greater mortality rates when compared to other ethnic groups, which runs counter to historical norms. Furthermore, morbi-mortality in Latinx people has been disproportionately greater. Beyond the systematic barriers that the Latinx community has had to face to access care during the pandemic, there were also perception barriers that increased the gap and further complicated the situation. Latinxs were more likely to be exposed due to a decreased compliance with physical distancing. When it was suggested to avoid crowds, many people started using delivery services; however, many Latinxs found the cost and requirements of reliable internet to be a barrier to using these services. Currently, COVID-19 vaccines are broadly available in the US but there has been skepticism from marginalized communities, including the Latinx population, about getting vaccinated. Integrating this population into a welcoming healthcare system, safeguarding their immigration and work status, providing more accessible vaccination locations, and promoting health equality and education would all assist to lessen the impact of this illness on the Latinx community.

Community-Engaged Research on Social Capital and Older Adults’ Health: Lessons Learned

Most adults in the United States prefer to age in their own homes and communities. However, many ageing-in-place models rely on expensive external services, negatively affecting access by lower socioeconomic status (SES) and other vulnerable groups. This article documents two pilot projects conducted by a community-academic partnership that examined associations between social capital, ageing in community, and health among older adults. The first project explored the association between social capital and health across community SES levels. The second project explored one type of social capital, timebanking, and its association with health. We highlight here our lessons learned from these community-engaged research (CER) projects: (1) Our partnership needed to improve our study design and data collection by enhancing our recruitment strategies, community site partnerships, survey instrument and data matching, and research team workload allocation issues. (2) We should have validated our instruments for use with older adults who had mild cognitive and visual impairments, acknowledged how community SES differences influenced our data collection, and included more research assistant support during our community meetings. (3) We would have benefited from protocol development for recording and responding to issues raised by participants. Our projects also led us to relational insights, such as reinforcing the need to foster clear communication across team members, involving community advisory boards earlier in the CER process, seeking network input on research strategies to meet older adults’ needs, and developing plans to sustain long-term relationships. We hope these lessons learned are useful to other community-engaged researchers.

Abstract 1445: Influence of neighborhood deprivation on the DNA epigenome in cancerous breast tissue from African American and European American women

Abstract Low socioeconomic status (SES) associates with early onset of chronic diseases and reduced life-expectancy. This relationship is only partly explained by unhealthy behavioral habits and inadequate access to health care. Chronic life stress is more prevalent in low SES communities and has been shown to affect DNA methylation and the immune system. Yet, the biological processes that mediate the impact of SES on health to promote the development of chronic diseases like cancer remain poorly understood. Our study aims to uncover whether DNA methylation is linked to neighborhood socioeconomic deprivation and to a biology that causes inflammation and changes to the immune environment, thereby promoting breast cancer progression and affecting response to therapy. These differences have been characterized in 181 breast tumors (108 African American (AA), 73 European American (EA)). We geocoded the addresses of our participants and linked these data to a Census-level neighborhood deprivation index (NDI). Statistically significant associations between NDI, race and methylation beta values were determined using linear regression followed by Benjamini-Hochbergcorrection. Of the 18 CpG sites that differed between individuals with low and high neighborhood deprivation, 3 were hypermethylated in women with high neighborhood deprivation. We also used methylCIBERSORT to estimate immune subpopulation differences by race group, breast cancer subtype, and ND. For AA women with aggressive triple negative breast cancer, neighborhood deprivation was significantly positively correlated with absolute immune cell scores (p=0.011), including a higher absolute score for endothelial cell expression (p=0.006) and eosinophils (p=0.049). Our findings give insight into how socioeconomic position and neighborhood deprivation may affect cancerous mammary gland biology by altering DNA methylation patterns. Citation Format: Brittany D. Lord, Emily Rossi, Tiffany Dorsey, Maeve Kiely, Ruby Hutchinson, Stefan Ambs. Influence of neighborhood deprivation on the DNA epigenome in cancerous breast tissue from African American and European American women [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 1445.

Explaining racial/ethnic and socioeconomic differences in COVID protective behavior

COVID-19 has had a disproportionate impact on Black, Hispanic, and lower socioeconomic status communities. Using data from the Community, Health and Politics Study (CHAPS 2021), collected in the midst of the pandemic, we examine differences in COVID-19 health promotion behavior (i.e., avoiding large gatherings, mask wearing, and vaccination status) across racial, ethnic, and socioeconomic status subgroups of the population. Moreover, we examine the degree to which observed differences are robust to controls for other health-related disparities, such as access to health insurance, underlying health conditions, personal exposure to COVID-19 (i.e., own diagnoses, knowing persons who have died from COVID-19), and perceived COVID-19 threat. Findings are consistent with arguments proposed by fundamental cause theory and disease stage theory as they indicate fewer differences on the basis of socioeconomic status or race and ethnicity for masking and social distancing, which may be thought of as less effective measures. In contrast, disparities were prominent in vaccination outcomes. Specifically, racial and ethnic minorities, those with lower levels of education, and those with lower incomes had lower odds of vaccination, after controlling for covariates. Private insurance and older age were also associated with higher odds of vaccination. Higher perceived threat of COVID-19 increased the likelihood of all protective behaviors. Our findings suggest that the need for ongoing efforts to increase vaccination uptake in socially disadvantaged communities.

Reasons and suggestions for improving low immunization uptake among children living in low socioeconomic status communities in Northern Alberta, Canada – A qualitative study

ObjectiveUnder-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. MethodsFourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. ResultsBusy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. ConclusionImplementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents.

District-level religious composition and child health in India

BackgroundCommunity characteristics are a significant social determinant of child health. Little is known about the effects of social heterogeneity as a specific factor that might impact health. This paper aims to fill the void in research on the health effects of India’s district-level religious heterogeneity.MethodsWeighted state fixed effects multivariate logistic regression was applied to India’s Third District Level Household Survey (2007–2008). The dependent variables were death of a child under five and indicators of healthcare utilization. The key independent variables were the proportions in the district who were Hindu, Muslim, Christian, Buddhist, and Sikh. The analysis controlled for generic community diversity, household religion, and socioeconomic status. Separate, sub-group analysis focused on Muslims only, Christians only, and Buddhists only.ResultsMultivariate fixed effects models show that a 1% point increase in the proportion of Muslim, Christian, or Buddhist households in a community is associated with respective odds ratios of child death of 1.008, 1.009, and 1.012 of experiencing the death of a child. The impact of a household’s own religious affiliation is statistically insignificant in these models. Higher proportions of Muslims and Christians in a community lower the odds of BCG (a vaccine for childhood tuberculosis) receipt and child healthcare-seeking.ConclusionsHouseholds residing where there are higher levels of religious minorities in India experience worse child survival. These effects are not mediated by the household’s own religious affiliation. There is evidence that health system performance and quality is systematically worse in communities with higher proportions of religious minorities. Our study can help policymakers identify communities where children may be at higher risk based on community heterogeneity and the potential for insufficient collective action. Policymakers might consider flagging these communities for special attention, because social heterogeneity is likely to be of long duration.

The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China

BackgroundThere was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.MethodsUsing data from the China Health and Retirement Longitudinal 2011–2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.ResultsCommunity SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.ConclusionsThis study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

Women\u2019s decision-making capacity and its association with comprehensive knowledge of HIV/AIDS in 23 sub-Saharan African countries

BackgroundGlobally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women’s decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women’s decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women’s decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA.MethodsWe derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women’s decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).ResultsThe pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16–1.25) compared to those who had no decision-making power. Age, women and partner’s level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge.ConclusionsComprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women’s decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.

125 Community Socioeconomic Status Is Associated with Social Participation Outcomes

IntroductionSocioeconomic factors are recognized as important social determinants of health. Data however are sparse describing the relationship between socioeconomic status and long term burn outcomes. This study aims to examine associations between community-level socioeconomic status and social participation outcomes in burn survivors.MethodsData was obtained from the Life Impact Burn Recovery Evaluation (LIBRE) Journey study that assesses longitudinal social participation outcomes of community dwelling burn survivors. Subjects were linked to the Distressed Communities Index (DCI), which combines seven indicators into a metric that depicts community economic well-being. Participants were categorized by time since burn (< 5, 5-15, ≥15 years). Linear regression models examined associations between DCI (zip code and county levels) and LIBRE domain scores (Family & Friends, Social Interactions, Social Activities, Work & Employment).ResultsThe study included 314 burn survivors, (mean age 44.1 years; 61.0% female; 48.6% married; 82.8% white). The population was distributed among the time since injury categories (< 5: 35.8%, 5-15: 27.5%, ≥15: 36.7%). Approximately 18% of subjects were categorized in the “at risk” or “distressed” DCI categories. For survivors less than five years from burn, a DCI score increase of 1 standard deviation (worse socioeconomic status) at the zip code level was associated with decreased Family & Friends and Social Activity scores of 2.6 (p=.01) and 2.0 points (p=0.04), respectively (small effect sizes). This relationship was even stronger when controlling for sociodemographic factors. In regression analysis, survivors within the first five years from injury living in “at risk” or “distressed” communities showed worse Family & Friend scores by 6.5 points compared to those living in “prosperous” communities, even after adjusting for age, gender, race, ethnicity, education, and marital status (p=0.04; moderate effect size). There were no significant associations between DCI and LIBRE domain scores for survivors assessed beyond 5 years from injury.ConclusionsSocial participation outcomes were worse in burn survivors who lived in socioeconomically disadvantaged neighborhoods. Burn survivors who face socioeconomic challenges may need additional support to address social disparities to improve outcomes.

The association between community-level socioeconomic status and cognitive function among Chinese middle-aged and older adults: a study based on the China Health and Retirement Longitudinal Study (CHARLS)

BackgroundAlthough numerous studies focused on the relationship between area socioeconomic status (SES) and health, only a few of them investigated how community-level SES was linked to late-life cognitive function as well as the potential pathways underlying this association, and very few of them focused on the context of China. This study examined how community-level SES was linked to cognitive function and the potential pathways underlying this association among middle-aged and older adults in China.MethodsData was drawn from the waves 1–4 of China Health and Retirement Longitudinal Study. We measured cognitive function with the components of the Telephone Interview of Cognitive Status battery. Community-level SES was derived from a sum of z scores of the percentage of the illiterate and the per-capita net income status within communities. We adopted two-level hierarchical linear regression models to explore the associations between community-level SES and cognitive function. A multilevel mediation analysis with structural equation modeling was undertaken to disaggregate the direct and indirect pathways of the associations.ResultsHigher community-level SES was associated with better cognitive function (β = 0.562, 95% CI = 0.390, 0.734), and this significant association was only present in rural participants, not in urban participants. Furthermore, we discovered the mediating effects of outdoor exercise facilities within communities (β = 0.023, 95% CI = 0.000, 0.056) and individual-level SES (β = 0.108, 95% CI = 0.057, 0.156) to explain the relationship between community SES and cognitive function.ConclusionsThese findings highlight the importance of community environmental interventions in maintaining individuals’ cognitive health in China, especially for older adults. Our results provided solid empirical evidence for reducing mental health inequalities in China, and suggested that developing an aging-friendly environment and properly distributing community resources are important to improve cognitive function of older adults.