High School Completion Research Articles

Pathways into Computing Fields by Florida’s Community College Students: An Intersectional Descriptive Analysis

ABSTRACT While it is well understood that gender and racial stratification in computing fields continues to exist, we too often approach this workforce problem from a deficit perspective and look to typical sites (where status quo norms are reproduced) to investigate potential solutions. Using an intersectional descriptive analysis on state administrative data on Florida state colleges, we prioritize centering the academic journeys of Asian, Black, Indigenous, Latina/e/o/x, and Multiracial community college women and men, addressing the often-overlooked effects of holding multiple marginalized identities in quantitative research. Analytic results from this study suggest that women of color completed high school computing courses significantly less often than men. Further, our findings reveal that these disparities in high school computing coursetaking were even greater among those who enrolled in Advanced Placement Computer Science. Employing an intersectional approach enabled this study to dive into these and other nuanced effects. Implications offer directions for future research, practice, and policy that may enhance efforts to broaden participation in computing in high school and among community college students.

Parental separation penalties among university students in Italy

AbstractThis paper addresses the long-standing question of whether parental separation shapes offspring school performance drawing on retrospective data from a group of university students in Italy, a country that has historically had very low separation rates yet has experienced an important rise in family dissolution over the last two decades. Using survey data from 1st-year enrollees in undergraduate courses in Economics and Statistics at two points in time (2000 and 2017), we explore whether the association between parental separation and children’s school performance (i) is observed both at the level of middle school (MS) and high school (HS); (ii) varies according to the age at which students experienced separation, and (iii) varies by parental socio-economic status (SES). Our results suggest that students whose parents separated before MS completion score on average 2 points less on the end-of-middle-school exam relative to students whose parents did not separate or separated after MS completion. Similarly, students whose parents separated before HS completion score 1 point less on the end-of-high-school exam relative to their counterpart. As such, we document a parental separation penalty both at the level of MS and HS, yet lower by half when separation occurs later in students’ life course. Moreover, for HS grade parental separation is associated with more negative consequences when students experience it at very young ages (0–5), while for MS grade heterogeneity by age is less clear-cut. Such penalties are concentrated among children of low-educated mothers, particularly for HS, providing support to the “compensatory advantage” hypothesis predicting smaller penalties for children of high-SES parents. Overall, findings from this study corroborate existing evidence suggesting that the consequences of parental separation vary depending on a combination of social background and the “selectivity” of the educational outcome considered.

Our Health Counts Toronto: Commercial tobacco use among Indigenous peoples in Toronto.

Fueled by the commercial tobacco industry, commercial tobacco use continues to be the leading preventable cause of premature death in Canada, with opportunities to improve health outcomes. The objective of this research was to work with Indigenous partners to generate Indigenous population prevalence estimates of commercial tobacco use in Toronto, and examine the association between smoking and sociodemographic, cultural, resiliency, and social variables. Respondent-driven sampling (RDS) was used to generate prevalence estimates of commercial tobacco use and potentially associated sociodemographic, cultural, resiliency, and social connection variables for Indigenous adults living in Toronto. Statistical analysis examined associations between smoking and variables theorized to be predictors of tobacco use. The findings indicated that 36.3% (95%CI 28.2-44.5) of the Indigenous population in Toronto do not smoke, and 63.6% (95%CI 55.5-71.7) reported smoking. Univariate analysis of demographic, social, and cultural variables found age and employment to be statistically significantly different between adults who smoked and adults who did not smoke. Indigenous adults who were above the before-tax low-income cut-off (LICO) were more likely to smoke compared to those who were below the before-tax LICO. Indigenous adults who completed high school were more likely to smoke compared to those who did not complete high school, similarly to those who were unemployed compared to those who were employed. However, those who were not in the labour force (student or retired) were less likely to smoke compared to those who were employed. These effects remained after adjustment for age, gender, and LICO. Indigenous adults with stable housing were 20% less likely to smoke compared to those experiencing homelessness. Adults who had at least one close friend or family member to confide in were more likely to smoke compared to those who did not have any close friends or family members. Indigenous adults were more likely to smoke if they participated in Indigenous ceremony compared to those who did not participate. The Indigenous population in Toronto continues to experience smoking prevalence nearly four times greater thanthat in the general population. This highlights the need for accurate population data to inform programs and policies and address the social determinants of health.

Knowledge, attitude, and practice regarding Sarcopenia in maintenance hemodialysis patients in Northeastern China.

Sarcopenia is a severe complication affecting patients receiving hemodialysis (HD) treatment over an extended period of time. This cross-sectional study assessed knowledge, attitude, and practice (KAP) towards sarcopenia among maintenance HD patients in Northeastern China between 13 December 2023 and 13 January 2024. A total of 752 questionnaires were collected. Multivariate logistic regression showed that completed high school or vocational secondary school, college or bachelor's degree, and maintenance HD lasting ≥ 11 years were independently associated with proactive practice. The Structural equation modeling (SEM) showed that knowledge directly affected attitude and practice. Moreover, attitude directly affects practice. Maintenance HD patients showed inadequate knowledge, positive attitude, and proactive practice towards sarcopenia. Healthcare providers should focus on educational campaigns to increase patient awareness of sarcopenia, its risk factors, and preventive measures.

Implementasi Latihan Batuk Efektif Dalam Upaya Pembersihan Jalan Nafas Pada Pasien Pasca Anestesi Umum Di Ruang Pemulihan

Introduction: Common side effects of general anesthesia, particularly when administered by inhalation, include sore throat, coughing, and hoarseness after surgery. An effective cough is an attempt to alleviate sore throat, cough, and hoarseness in individuals who have had general anesthesia. In order to keep the lungs clean, it is important to cough properly so that secretions may be removed swiftly and efficiently. Objective: At Jatiwinangun Surgical Specialty Hospital, we aim to teach our patients how to cough effectively so that they can reopen their airways following general anesthesia. Method: After one round of general anesthesia, 30 participants will undergo effective coughing activities as part of this activity's methodology. One technique to evaluate a cougher's ability to clear their airways is with the use of a checklist and an observation sheet for airway clearing. This method takes into account the cougher's breathing rate, the noises they make when coughing, the strength of their breathing muscles, and how easily they clear their airways. Result: Ten participants (or 33.3% of the total) fell within the 26–35 age bracket, while nineteen (or 63.3% of the total) were female, fourteen (or 46.7% of the total) had only completed high school, and ten (or 33.3% of the total) were housewives. At least 21 participants (70.0%) had more knowledge regarding how to effectively apply cough training after receiving good-quality education, whereas 6 participants (20.0%) had adequate knowledge and 3 participants (10.0%) had less. After undergoing general anesthesia, 24 subjects (80.0%) had effective coughing abilities, whereas 6 people (20%) shown less competence. When it came time to observe airway clearance, the results showed that 93.3% of participants breathed normally, 83.3% did not make any extra ronchi breath sounds, 90.0% did not use any additional breathing muscles, and 80.0% of participants had no trouble clearing their airways. Conclusion: From the results of PkM it can be concluded that effective cough training can clear the airway in patients after general anesthesia.

Adolescent risk behaviours are associated with educational attainment in early adulthood: results from the Raine Study cohort

BackgroundHigher educational attainment is important for economic wellbeing and associated with better health and longevity. Previous research focused on intelligence, socioeconomic status and mental health or individual risk behaviours as predictors of educational attainment, but the role of multiple domains of adolescent risk behaviours is less clear. This study examined the association between multiple domains of risk behaviour in adolescence and educational attainment by 22 years-of-age.MethodsYoung people (Generation 2, Gen2) and their parents (Generation 1, Gen1) participating in the Raine Study completed questionnaires at years 1, 5, 8, 10 (Gen1 only), 14, 17 (both) and 22 (Gen2 only). The Raine Study is an ongoing longitudinal study initiated in Perth, Western Australia, between 1989 and 1991. The 1,102 Gen2 participants who responded to questions about highest educational attainment were included in this study. The association between Gen2 self-reported risk behaviours (including age at commencement of drinking alcohol, smoking, sexual intercourse and drug use) and educational attainment (defined as self-reported years of completed high school: ≤10, 11, 12 or tertiary education (> 12)) at year 22, after adjusting for mother’s age and combined parental education level, participant sex, and family income, educational performance and adolescent mental health, was explored using ordinal regression models and presented as odds ratios (OR) with 95% confidence intervals (CI).ResultsOrdinal models suggested that never smoking or starting older than 18 compared with smoking before age 15 (OR 2.02, 95%CI: 1.28–2.14); first drinking alcohol between 15 and 17 years compared with younger than 15 (OR 1.52, 95%CI: 1.08–2.14); and, first sexual intercourse aged ≥ 18 years compared with under 15 (OR 1.67, 95%CI: 1.08–2.57) were associated with higher levels of educational attainment at 22-year follow-up. Additionally, lower (“better”) behavioural scores increased the odds of higher levels of attainment.ConclusionsAbsence of health risk behaviours at a younger age or later commencement was associated with higher educational attainment. Evidence-based interventions that address the societal influences underpinning risk behaviours in adolescents may support longer school retention.

Cannabis Use During Adolescence and Young Adulthood and Academic Achievement

Cannabis use during adolescence and young adulthood may affect academic achievement; however, the magnitude of association remains unclear. To conduct a systematic review evaluating the association between cannabis use and academic performance. CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, Scopus, and Web of Science from inception to November 10, 2023. Observational studies examining the association of cannabis use with academic outcomes were selected. The literature search identified 17 622 unique citations. Pairs of reviewers independently assessed risk of bias and extracted data. Both random-effects models and fixed-effects models were used for meta-analyses, and the Grading of Recommendations Assessment, Development, and Evaluation approach was applied to evaluate the certainty of evidence for each outcome. Data were analyzed from April 6 to May 25, 2024. School grades, school dropout, school absenteeism, grade retention, high school completion, university enrollment, postsecondary degree attainment, and unemployment. Sixty-three studies including 438 329 individuals proved eligible for analysis. Moderate-certainty evidence showed cannabis use during adolescence and young adulthood was probably associated with lower school grades (odds ratio [OR], 0.61 [95% CI, 0.52-0.71] for grade B and above); less likelihood of high school completion (OR, 0.50 [95% CI, 0.33-0.76]), university enrollment (OR, 0.72 [95% CI, 0.60-0.87]), and postsecondary degree attainment (OR, 0.69 [95% CI, 0.62-0.77]); and increased school dropout rate (OR, 2.19 [95% CI, 1.73-2.78]) and school absenteeism (OR, 2.31 [95% CI, 1.76-3.03]). Absolute risk effects ranged from 7% to 14%. Low-certainty evidence suggested that cannabis use may be associated with increased unemployment (OR, 1.50 [95% CI, 1.15-1.96]), with an absolute risk increase of 9%. Subgroup analyses with moderate credibility showed worse academic outcomes for frequent cannabis users and for students who began cannabis use earlier. Cannabis use during adolescence and young adulthood was probably associated with increases in school absenteeism and dropout; reduced likelihood of obtaining high academic grades, graduating high school, enrolling in university, and postsecondary degree attainment; and perhaps increased unemployment. Further research is needed to identify interventions and policies that mitigate upstream and downstream factors associated with early cannabis exposure.

Ready, Set, Launch Baseline Academic Outcomes for Students Participating in Dual Enrollment for Equitable Completion Partnerships Compared to Their Peers, 2015 – 2020

The opportunity to complete college coursework during high school has been associated with positive secondary and postsecondary academic outcomes. Students who complete these courses report inspiration to complete high school, new knowledge and skills related to persisting, confidence, and an increased readiness to succeed in postsecondary coursework. Numerous studies have highlighted how dual enrollment access and success for historically underrepresented students on college campuses is necessary and, in some cases, fruitful in increasing equitable representation, access to, and success in postsecondary education. This study presents the high school and college outcomes for students participating in dual enrollment programming offered by ten California K12 and community college partnerships compared to a group of non-dually enrolled peers. Findings suggest that before the launch of a three-year initiative, first-generation, African American/Black, and Hispanic/Latina/o/x students from these selected partnerships who complete college coursework were more likely to graduate high school, have higher high school GPAs, and were more likely to persist, even during the COVID-19 pandemic, and succeed in their first-year college coursework.

Spatio-temporal modeling to identify factors associated with stunting in Indonesia using a Modified Generalized Lasso

This study investigates the factors associated with stunting prevalence in Indonesia, utilizing a generalized lasso framework with modified penalty matrices to accommodate spatio-temporal data structures. Novel approaches are introduced to construct the penalty matrices, with particular focus on defining neighborhood structures. The proposed method is applied to data from 34 Indonesian provinces, covering the years 2019 to 2023. The primary outcome is stunting prevalence, modeled against nine predictor variables: poverty, exclusive breastfeeding, low birth weight (LBW), high school completion, access to proper sanitation, unmet health service needs, Gross Domestic Product (GDP), calorie consumption, and protein consumption. A total of nine spatio-temporal models were compared, including a modified generalized lasso with three distinct penalty matrices for each two tuning selection methods and a generalized ridge regression with three penalty matrices. Results indicate that the generalized lasso model with a 3-nearest neighbor adjacency matrix outperformed the alternatives. Temporal variations were observed in the effects of exclusive breastfeeding, LBW, high school completion, and unmet health service needs. Positive associations with stunting prevalence were identified for poverty, exclusive breastfeeding, LBW, and unmet health service needs, while negative associations were found for high school completion rates, access to proper sanitation, GDP, calorie intake, and protein consumption. The strongest associations were observed in parts of Sumatra, Sulawesi, and Jakarta. These findings suggest that government interventions aimed at improving education, healthcare access, and poverty reduction may help alleviate stunting in Indonesia, particularly in regions with the greatest need.

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Abstract A148: Perceptions of lung cancer screening among Native American patients: The Tribally Engaged Approaches to Lung Screening (TEALS) study

Abstract Introduction: Uptake of lung cancer screening (LCS) with low dose computed tomography is poor nationwide. The U.S. Native American (NA) population has a high prevalence of smoking and lung cancer mortality but low rates of LCS completion. Awareness and perceptions of LCS among NA men and women have rarely been studied. Methods: Using a community-engaged research approach in partnership with the Choctaw Nation Health Services Authority in Oklahoma, the “Tribally Engaged Approaches to Lung Screening” study developed and implemented a cluster-randomized controlled trial of a coordinated LCS program. In 2022, NA men and women eligible for LCS from six tribal health clinics completed a baseline survey prior to being referred for LCS. Surveys included demographic characteristics, smoking history, use of cancer preventive services, beliefs regarding personal risk of lung cancer, and perceptions toward LCS. Findings: Among 210 participants (57% women, 43% men), mean age was 63 years; 50% reported annual household income below $25,000, 83% completed high school or equivalent, with 40% having some college education. The median pack years of smoking was 46 years. The proportion of participants who currently smoke was 72%. Current cigarette users were slightly younger than former users (median age 61 vs 64 years, respectively) and similarly had lower maximum estimates of pack-years of use (median, 44 vs 52). Most (93%) had more than one primary care visit within the past 12 months, and 76% completed an annual physical or wellness visit in the past year. Overall, 73% had completed colonoscopy and, among women, 80% had a mammogram. Only 62% had heard about LCS. However, 74% agreed with the statement “It is likely that I will get lung cancer sometime in my lifetime”. More than 90% of participants agreed that LCS would help with each of the following: early detection, chances of dying from lung cancer, reduce personal worry about lung cancer, reduce their family’s worries, improve planning for the future and peace of mind. However, 44% worried that LCS would find “something wrong”, 15% endorsed that they would rather not know if they had any lung problems, and 10% were afraid the scan would damage their lungs. About 20% worried about being a social outcast or being blamed for having smoked. Regarding potential barriers, 32% felt that cost would be a problem, 28% felt they did not have the time, and 17% that transportation would be a problem. Overall,14% reported bad experiences with healthcare or a provider, and 8% did not trust the healthcare system. Regarding LCS, 28% felt they did not know enough about the test, 11% felt they were too old to benefit from LCS, and 8% felt LCS was not worth the effort. Conclusions: Perceptions of the potential benefits from LCS were overall favorable in this sample of NA adults. However, up to 30% perceived significant barriers to LCS uptake. Greater awareness of LCS and mitigation of barriers to LCS would help to reduce the marked disparities in lung cancer mortality among NA patients. Citation Format: Dorothy A. Rhoades, Cara Vaught, Ann Chou, Kathleen Dwyer, Mark P Doescher, Michele Gibson, Zsolt Nagykaldi. Perceptions of lung cancer screening among Native American patients: The Tribally Engaged Approaches to Lung Screening (TEALS) study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A148.

Abstract A151: Examining the influence of health insurance, socioeconomic factors, and rurality on breast cancer screening behaviors in Ohio

Abstract Background: Among Ohio women, breast cancer (BC) is the most common cancer and the second leading cause of cancer death. Inequalities in BC screening are associated with poverty, social injustice, environmental factors, as well as late-state diagnosis, treatment delays, and mortality. The main objective of this study is to examine how BC screening rates differ by rurality and socioeconomic status. Methods: The Ohio State University Comprehensive Cancer Center conducted a population health assessment survey of Ohioans. The Community Initiative Towards Improving Equity and Health Statues (CITIES) project included two waves of data collection 2017-2018 (Wave 1) and 2023-2024 (Wave 2). Participants self-reported various sociodemographic factors (i.e., race, ethnicity, education level, marital status, and insurance coverage), health insurance status, geographic setting, and BC screening adherence. Adherence with BC screening guidelines was defined as having a mammogram every 2 years after age 50. Baseline demographic characteristics were described using counts and percentages stratified by geographic setting. Adherence with BC screening guidelines was summarized with counts and percentages. The relationship between education, marital status[EP1] , insurance status, rurality, and BC screening adherence were assessed with chi-square tests. Results: A total of 300 women were included in this study. Most women (n=210, 70%) resided in urban counties, while 30% (n=90) lived in rural counties. Among rural residents, 96.7% were White, whereas urban residents were 37.6% White, 35.2% African American, 11.9% Hispanic, 9.1% Somali, and 6.2% Asian. Health care coverage was held by 97.8% of rural and 87.6% of urban residents. Over 67.8% of rural residents and over 65.3% of urban residents had at least some post-high school education. Most rural residents (68.7%) were married, compared to 46.7% of urban residents. Among rural residents, 78.9% (n=71) were within mammogram guidelines. Of the women residing in urban areas, 73.8% (n=155) were within mammogram guidelines and 26.2% (n=55) were not. Individuals with health insurance were over 4 times as likely to adhere to BC screening guidelines than those without health insurance (OR: 4.54, p<0.0001). High school graduates were nearly 5 times as likely to adhere to BC screening guidelines compared to those who did not complete high school (OR: 4.88, p<0.0001). White women were twice as likely to be adherent to BC screening guidelines compared to non-White women (OR: 2.07, p=0.007). Marital status (p=0.219) and rurality (p=0.350) were not significantly associated with adherence to BC screening guidelines. Conclusion: Understanding access to cancer care by education, health insurance status, and race, and how these factors influence BC screening is crucial for knowing the challenges that Ohioans may face in BC care. These findings may lead to future development of interventions targeted at population needs, as identified in this study, and improve equity in BC screening access and BC outcomes. Citation Format: Ruvarashe P. Rumano, Chloe M. Hery, Mohamed I Elsaid, Chasity Washington,, Cecilia R. Degraffinreid,, Electra D. Paskett. Examining the influence of health insurance, socioeconomic factors, and rurality on breast cancer screening behaviors in Ohio [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A151.

Abstract B142: The impact of financial toxicity as a barrier to access and participation in early phase clinical trials for underrepresented populations using the COST–FACIT tool

Abstract Background: ASCO has reaffirmed critical role of early phase (EP) clinical trials (CT) in cancer research and treatment that patients (pts) may achieve improvement in quality of life, experience psychological and direct medical benefits. Disparities in access and participation to CT exist and are more profoundly seen in EP CT with challenge of engaging underrepresented populations (UP) in EP CT which are often complex and only available at larger cancer centers in metropolitan areas. NCI’s Create Access to Targeted Cancer Therapy for Underserved Populations (CATCH-UP.2020) helped bring EP CT to UP. To determine the impact of financial toxicity (FT) as a barrier specific to EP CT participation of UP, the validated COST-FACIT tool was used to survey cancer pts undergoing treatment at the University of Kansas Cancer Center. Methods: This study was approved by our Institutional Review Board (Study 00150640). During routine scheduled visits, pts completed COST-FACIT survey on touch screen tablet. A list of validated questions on EP CT awareness, access, and willingness to participate were included in the survey. Pts responded to 12-item COST-FACIT questionnaire describing the relationship between financial stress and treatments (scale 0 to 4). The score was computed using responses captured from COST-FACIT. Based on literature, scores <26 were determined to be higher FT. Two-sided Fisher's Exact Tests were used to test for a significant association at an alpha level of 0.05. UP included racial and ethnic minorities, low socioeconomic status, low education, and rural. Results: Of 108 pts, 101 completed surveys. 45% identified as female and 55% as male. 11.2% 18–35 years (yrs) of age, 13.9% 36 –50 yrs, 24% 51–65 yrs and 54% >65 yrs. 62.4% were white, 17.8% black, and 19.8% others (Asian or Native American). 8.9% completed <12th grade, 23.8% completed high school, 29.7% have some college experience, 22% completed college and 16% have master’s/doctoral degree. COST-FACIT mean score was 25.7 (SD 10.4, r^2 of 0.48) showing significant financial stress. 46% of pts had scores <26. Pts 18-35 yrs (p=0.02), 36–65 yrs (p=0.00), had yearly incomes of >150,000 (p=0.02) or unaware of their yearly income (p=0.05) were more likely to have significant FT. Pts with < 12th grade (14.89%) or some college experiences (34.09%) were likely to have significant FT. Pts identifying as Asian or Native American were more likely to experience FT than white or black. Conclusion: Almost half of our pts suffer from significant FT creating disparities in EP CT access and participation. Data suggest ages 35-65 yrs, low levels of education, and races other than white and black experience higher levels of FT that is a barrier to EP CT participation. These data support our ongoing efforts to bring innovative EP CT to everyone including the VA and our other outreach partners with higher concentrations of UP. Data on rural and health professional shortage areas will be reported during the meeting. This project was supported in part by The University of Kansas Cancer Center P30CA168524. Citation Format: Kamiyah Hicks, Anusha Chidharla, Dinesh Pal Mudaranthakam, Hope Krebil, Issa Espinoza, Asuka Suzuki, Sam Pepper, Angelica Allen, Jill Hamilton - Reeves, Debra Sullivan, Anna Arthur, Saqib Abbasi, Anup Kasi, Rahul Parikh, Elizabeth Wulff - Burchfield, Al - Ola Abdallah, Lori Barbosa, Erin Carroll, Jennifer Heins, Tara Lin, Gary Doolittle, Weijing Sun, Joaquina Baranda. The impact of financial toxicity as a barrier to access and participation in early phase clinical trials for underrepresented populations using the COST–FACIT tool [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B142.

Using Administrative Data to Identify Factors Associated with Healthy Development After Experiencing Household Challenge Adversity in Early Childhood

This study aimed to identify factors associated with healthy development after experiencing household challenge adversity in early childhood. A cohort of 42,505 children born in Manitoba, Canada was created using linkable health, social, and education administrative data. Children were divided into 5 groups according to whether they experienced adversity between birth and four years of age in the following categories: 1) having a parent diagnosed with a mental health disorder, 2) having a parent diagnosed with a substance use disorder, 3) having a parent who received income assistance for at least 2 months, 4) experiencing at least one of the 3 adversities, and 5) having none of the adversities listed. For each group, multiple linear regression models were computed to determine the association of the independent variables (age, sex, birth order, team parenting, neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, not having a major illness, residential stability, program participation, and connectedness to health care services) on child development, represented by their Early Development Instrument scores. In each group, factors associated with healthy development included at minimum: older age, being female, being firstborn, team parenting, higher neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, and not having a major illness. Several of these factors are associated with increased access to material resources. As such, policies that facilitate the delivery of resources to lower-income families and neighbourhoods with lower socioeconomic status could translate into improved developmental outcomes for children.

Change in sexual and reproductive health knowledge among young women using the conversational agent “Nthabi” in Lesotho: a clinical trial

BackgroundYoung women worldwide face problems like unwanted pregnancy and sexually transmitted infections. Providing sexual and reproductive health education to young women in low- and middle-income countries is a priority. It is unknown if using digital health interventions to deliver health education is effective in resource-constrained settings.MethodsWe conducted an interventional trial among young women in the low–middle-income country of Lesotho to test the impact of the conversational agent system (“Nthabi”) designed to deliver sexual and reproductive health information on either a smartphone or tablet for up to 6 weeks. We measured participant’s knowledge before and after the discussion of family planning, folic acid use, and healthy eating. The main outcome measure was a change in knowledge among participants in these three topic areas. The number of correct pre- and post-test responses was compared using generalized linear models that directly estimated the proportions and percentages of correct responses.ResultsWe recruited 172 young women (mean age 22.5 years, 91% unmarried, 69% completed high school, 23% unemployed, 66% students) to use Nthabi on a mobile phone (11.6%) or loaned tablet device (88.4%). The mean number of interactions with Nthabi was 8.6. Family planning was chosen to be discussed by 82 of the 172 participants (52.2%), and of those, 49 (31.2%) completed the content on this topic, and 26 (16.6) completed the post-test. For the 11 questions about family planning, the total percent of correct responses increased from 85.5% (796 total responses) on the pre-test to 89.9% (320 responses) on the post-test (p = 0.0233). Folic acid use was chosen to be discussed by 74 (47.1%) of 172 participants, and of those, 27 (17.7%) completed the content on this topic, and all 27 (17.7%) completed the post-test. For the 5 questions about folic acid use, the total percent of correct responses was 45.3% (181 total responses) on the pre-test and 71.6% (111 responses) on the post-test (p < 0.0001).ConclusionsThe Nthabi conversational agent system increased knowledge of family planning methods and folic acid use among young women in Lesotho. Digital health interventions like Nthabi have the potential to offer new ways to deliver reproductive health information.Trial registrationClinicalTrials.gov registration April 20, 2020; ID: NCT04354168.

Health-related quality of life in Indonesian hypertension outpatients in Western, Central, and Eastern Indonesia measured with the Bahasa Indonesia version of EQ-5D-5L

ObjectiveTo report EuroQol-5D (EQ-5D) index scores in Indonesian hypertensive (HT) outpatients and to determine the association between index scores and socio-demographic characteristics and clinical conditions.MethodSociodemographic data was obtained through interviews, and clinical data were obtained from healthcare databases and physicians. Participants from healthcare facilities in the Western, Central, and Eastern parts of Indonesia (primary and secondary healthcare). Chi-square and forest plots were used to calculate index scores and multiple ordinal regression to investigate sociodemographic and clinical variables that significantly affect the index score.Results1239 participants (Western: 358; Central: 451; and Eastern: 430), and the index score was 0.83. Participants in primary care (Western and Eastern) had the best scores, at 0.85 and 0.90 compared to those in the Central (0.83). These factors were shown to be significantly associated with lower EQ-5D index scores: (i) lived in the Central part of Indonesia, (ii) treated in a secondary care, (iii) older than 60, (iv) had only completed junior high school, (v) unemployed, (vi) three or more comorbidities, (vii) took more than one type of HT medication, (viii) ate very little or no vegetables in daily lives, and (ix) accompanied by a caregiver.ConclusionThe EQ-5D index score can be used in health and economic assessment. According to index scores by participants in Central Indonesia, it would be beneficial to investigate and carry out more appropriate intervention strategies together with health promotion campaigns focused on healthy living. Overall, participants were more likely to report problems in the pain dimension.

Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality

It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US. To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US. This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024. A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate. The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied. Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] β = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = -0.002 [-0.003 to -0.001]), rurality (median [IQR] β = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] β = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] β = -0.18 [-0.35 to 0.07]). In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

Relationship between social determinants of health and hospitalizations and costs in patients with major depressive disorder.

The relationship of patient characteristics and social determinants of health (SDOH) with hospitalizations and costs in patients with major depressive disorder (MDD) has not been assessed using real-world data. To identify factors associated with higher hospitalizations and costs in patients with MDD. A retrospective observational study identified patients aged 18 years and older newly diagnosed with MDD between July 1, 2016, and December 31, 2018. SDOH were linked to patients at the "near-neighborhood" level. Multivariable models assessed association of patient characteristics with hospitalizations (incidence rate ratios [95% CI]) and costs (cost ratios [95% CI]). Of 1,958,532 patients with MDD, 49.6% had Commercial and 50.4% Medicaid insurance; mean ages were similar (43.9; 43.4) with more female patients (67.6%; 70.5%). MDD patients with Commercial insurance had a mean household income of $75,044; 53.2% were married; 76.5% owned their home; 64.4% completed high school or less; and 2.8% had limited English-language proficiency (LEP). Patients covered by Medicaid had a household income of $46,708; 68.1% lived alone with 41.6% married; 54.6% owned their home; more than 4-in-5 patients (80.8%) completed high school or less, and 6.3% had LEP. Nearly one-third of Medicaid insured patients with MDD had at least 1 hospitalization (29.6%) with a mean length of stay 6.8 days; total health care costs were $21,467 annually. Commercially insured patients with MDD had 14.7% hospitalization rates with a length of stay of 5.9 days; total costs were $14,531. Multivariable models show female patients are less likely (Commercial 0.87; Medicaid 0.80; P < 0.05), and patients with more comorbidities are more likely to be hospitalized (Commercial 1.33; Medicaid 1.27; P < 0.05). All treatment classes relative to antidepressants only increased likelihood of hospitalizations-particularly antipsychotic+antianxiety use (Commercial 2.99; Medicaid 2.29)-and costs (Commercial 2.32; Medicaid 2.00) (all P < 0.05). Household income was inversely associated with hospitalizations for both insured populations. LEP reduced the likelihood of hospitalizations by more than 70% among Medicaid patients (0.27, P < 0.05) and was associated with higher costs for Commercial (2.01) but lower costs for Medicaid (0.37) (P < 0.05). Living in areas with no shortage of mental health practitioners was associated with higher hospitalizations and costs. We identified patient characteristics associated with higher rates of hospitalizations and costs in patients with MDD in 2 insured populations. Female sex, higher comorbidities, and living in areas with no shortage of mental health practitioners were associated with higher hospitalizations and costs, whereas income was inversely associated with hospitalizations. The findings suggest disparities in access to care related to income, LEP, and availability of mental health practitioners that should be addressed to assure equitable care for patients with MDD.

Hepatitis B prevalence and risk factors among adults living with HIV in South Africa: a clinic-based cohort study

BackgroundPeople living with HIV (PLHIV) may have concurrent Hepatitis B Virus (HBV) infection, and certain antiretroviral therapies are recommended for HBV-HIV co-infected individuals. Routine screening for Hepatitis B virus may influence management of antiretroviral therapy for PLHIV, but risk factors for co-infection have not been well defined. The objective of this study was to identify risk factors for HBV infection among PLHIV in South Africa.MethodsWe conducted a cross-sectional analysis of a prospective, clinic-based cohort study of adults seeking HIV testing from 2013–2017 in Umlazi township, South Africa. Patients newly diagnosed with HIV were enrolled and subsequently tested for Hepatitis B surface antigen positive (HBsAg +). We used a Poisson linear regression model to assess which factors, pertaining to sociodemographic status, medical history, clinical symptoms, mental health were associated with HBV.ResultsAmong 3,105 PLHIV participants in South Africa, 6% were positive for HBV. Males had a higher HBV prevalence (10.4%) than females (5.2%). Within the HBV-positive group, the mean age was 33.2 years, with 38.3% females and 43.9% having completed high school or higher. About 39.9% reported alcohol use, 24.7% had a smoking history, and 8.3% reported substance use in the past year. Older participants born before 1995, when routine infant HBV vaccination was introduced, were more likely to have HBV. In multivariable analyses, smoking history increased HBV risk in females (aPR = 2.58; 95% CI 1.47–2.52), while alcohol use decreased HBV risk in males (aPR = 0.36; 95% CI 0.19–0.70).ConclusionsIn a South African cohort, roughly one in 16 PLHIV had HBV co-infection, and this rate was higher in males. The most prominent risk factors for HBV infection in PLHIV were alcohol use, higher income, and smoking history, which may help inform targeted treatment and prevention strategies. Creating HBV-specific screening and prevention strategies for PLHIV may be useful for reducing HBV infections.

Disparities in Liver Transplant Outcomes: Race/Ethnicity and Individual- and Neighborhood-Level Socioeconomic Status.

Race/ethnicity and individual-level socioeconomic status (SES) may contribute to health disparities in liver transplant (LT) outcomes. The socioeconomic conditions of a neighborhood may either mitigate or exacerbate these health disparities. This retrospective study investigated the relationship between race/ethnicity, individual- and neighborhood-level SES, and LT outcomes, and whether neighborhood-level SES modified the relationship between individual factors and LT outcomes. Adult individuals who underwent LT between 2010 and 2019 (n = 55,688) were identified from the United Network for Organ Sharing database. Primary exposures were race/ethnicity, education, primary insurance type, and the Social Deprivation Index (SDI) scores. Education and primary insurance type were used as proxies for individual-level SES, while SDI scores were used as a proxy for neighborhood-level SES. The primary outcome was time to occurrence of graft failure or mortality. Cox proportional hazard models were used to examine the associations between the exposures and outcomes. LT recipients who were Black (hazard ratio [HR]: 1.27, p < .0001), completed high school or less (HR: 1.06, p = .002), and had public insurance (HR: 1.14, p < .0001) had a higher rate of graft failure or mortality than those who were White, completed more than high school, and had private insurance, respectively. The SDI scores were not significantly associated with LT outcomes when adjusting for individual factors (HR: 1.02, p = .45) and did not modify the associations between individual factors and LT outcomes. Findings of this study suggest that disparities based on individual factors were not modified by neighborhood-level SES. Tailored interventions targeting the unique needs associated with race/ethnicity and individual-level SES are needed to optimize LT outcomes.