Consequences Of Disparities Research Articles

Inheritance Feuds in the Ur-Pabilsaĝa Archive from Old Babylonian Nippur

The study of an inheritance division is usually limited by its isolated recording, which leads to an incomplete interpretation of the division’s influence on the status and/or financial position of the family members involved. Inheritance divisions found in the so-called Ur-Pabilsaĝa Archive from Old Babylonian Nippur not only enable inclusive interpretations of the divisions’ influence on the status and/or financial position of the family members involved but also reveal their social and financial networking with two other families. The influence of Nippur’s interrelated social institutions restricted the family members in securing beneficial allocations of their inheritances due to conflicting needs and the consequences of economic disparity. Consequently, family feuds developed. The circumstances and events described in the recordings undermined the advantages that could have been gained from the social and financial networking between the interconnected families.

Gender Equity in Academic Medicine: Why Should We Care?

Gender disparity exists generally in academia and specifically in research and education among academic medical specialists. Reasons for this disparity include overt and unconscious biases that result in women getting fewer opportunities to lead, receiving less compensation, being excluded from networking channels in which privileged positions are discussed, and facing bias in research, including in the peer review grant process. The recent spotlight on these disparities in other sectors pushes us to focus attention on the causes and consequences of gender disparity in academic medicine and to advocate for structural changes to ensure gender equity in academic departments of hospitals and universities.

Understanding Social and Cultural Contexts of Alcohol Misuse in Mexican-Origin Hispanic Men.

Evidence suggests that Hispanic and non-Hispanic White men (NHW) have comparable prevalence rates of alcohol use. However, Hispanic men consistently have higher prevalence rates of alcohol misuse compared with NHW men. Consequently, Hispanic men experience disproportionate levels of adverse health consequences of alcohol misuse when compared with NHW men. The aim of this study was to explore Hispanic male perspectives and opinions regarding alcohol use patterns that may lead to disparate rates of alcohol misuse in Hispanic males. Demographic data were collected with questionnaires. Twenty semistructured one-on-one interviews were completed in English and Spanish with Mexican-origin Hispanic men (age: 44.6 ± 11.3 years). A thematic analysis was conducted using a hybrid deductive-inductive strategy with an a priori codebook supplemented with iterative analysis of transcripts. Results suggest that alcohol misuse patterns in Hispanic males are influenced by an interaction between alcohol-related social norms and learned expressions of masculinity; a lack of knowledge of the alcohol-related health risks that further perpetuate the normalization of alcohol misuse; and expressions of masculinity and adaptive coping that lead to alcohol misuse as an escape from life stressors. Given the rapid expansion of the Hispanic population in the United States, and the disparate consequences of alcohol misuse in this population, it is imperative to consider the complex and often compounded impact of sociocultural norms and the social context on misuse-related behaviors. Viable prevention and treatment strategies should be addressed thought multicomponent, community-level strategies that more comprehensively address the complexities of alcohol misuse in this population.

Immunometabolic Alterations by HPV Infection: New Dimensions to Head and Neck Cancer Disparity.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer, with high morbidity and mortality. Racial disparity in HNSCC is observed between African Americans (AAs) and whites, effecting both overall and 5-year survival, with worse prognosis for AAs. In addition to socio-economic status and demographic factors, many epidemiological studies have also identified factors including coexisting human papillomavirus (HPV) infection, primary tumor location, and a variety of somatic mutations that contribute to the prognostic incongruities in HNSCC patients among AAs and whites. Recent research also suggests HPV-induced dysregulation of tumor metabolism and immune microenvironment as the major regulators of HNSCC patient prognosis. Outcomes of several preclinical and clinical studies on targeted therapeutics warrant the need to elucidate the inherent mechanistic and population-based disparities underlying patient responses. This review systematically reports the underlying reasons for inconsistency in disease prognosis and therapy responses among HNSCC patients from different racial populations. The focus of this review is twofold: aside from discussing the causes of racial disparity, we also seek to identify the consequences of such disparity in terms of HPV infection and its associated mutational, metabolic, and immune landscapes. Considering the clinical impact of differential patient outcomes among AA and white populations, understanding the underlying cause of this disparity may pave the way for novel precision therapy for HNSCC.

Are U.S. adults reporting less sleep?: Findings from sleep duration trends in the National Health Interview Survey, 2004-2017.

To document trends in self-reported sleep duration for the noninstitutionalized U.S. civilian population from 2004 to 2017 and examine how sleep trends vary by race/ethnicity. We use data from the National Health Interview Survey (NHIS) for U.S. noninstitutionalized adults aged 18-84 from 2004 to 2017 (N = 398 382). NHIS respondents were asked how much they slept in a 24-hour period on average, which we categorized as ≤6 hr (short sleep), 7-8 hr (adequate sleep), and ≥9 hr (long sleep). We used multinomial logistic regression models to examine trends in self-reported sleep duration and assess race/ethnic differences in these trends. Our models statistically adjusted for demographic, socioeconomic, familial, behavioral, and health covariates. The prevalence of short sleep duration was relatively stable from 2004 to 2012. However, results from multinomial logistic regression models indicated that there was an increasing trend toward short sleep beginning in 2013 (b: 0.09, 95% CI: 0.05-0.14) that continued through 2017 (b: 0.18, 95% CI: 0.13-0.23). This trend was significantly more pronounced among Hispanics and non-Hispanic blacks, which resulted in widening racial/ethnic differences in reports of short sleep. Recent increases in reports of short sleep are concerning as short sleep has been linked with a number of adverse health outcomes in the population. Moreover, growing race/ethnic disparities in short sleep may have consequences for racial and ethnic health disparities.

Privacy, Reputation, and Control: Public Figure Privacy Law in Twenty-First Century China

Privacy law, as it regulates the nonconsensual disclosure of personal life, is instrumental to how reputation in human society becomes created, destroyed, and redistributed. In the contemporary Chinese society, as in elsewhere, privacy protection, and the lack thereof, have played an important role in the making of the “haves” and “have-nots” in the society’s reputation landscape. This Article makes a first systematic effort towards accounting for China’s contemporary legal regime that regulates its public figure privacy problems. Through examining leading court cases and relevant regulatory practices, this Article demonstrates that the Chinese privacy regime in the twenty-first century, as embedded in the Party-state’s restrictive information regulation apparatus, differs in significant ways from the corresponding Western paradigms in terms of its operational structure, cultural logic, and political dynamics. Overall, China’s status-based regime is highly protective of government officials until the Party-state purges them from the official ranks. It is also often laissez-faire with respect to privacy of famous individuals outside of the government system, but with notable exceptions for those enjoying an exalted status in the realm of high culture. Furthermore, it can be conspicuously hostile towards ordinary citizens who aspire for the limelight. The impact such public figure privacy regime may have had on China’s reputation landscape is conceivably regressive. As this Article explains, underlying such regime is a lasting, albeit evolving, cultural tradition that tends to associate privacy protection with a hierarchical system of moral outlook. Notwithstanding the importance of culture, this Article further argues that China’s privacy regulation must also be understood as embedded in the country’s political context. As the status-based privacy regime produces disparate reputational consequences, it provides the ruling Party-state with a lever to incentivize and control a diverse network of elites, whom the Party-state considers as agents for upholding its political and moral authority and implementing its social control agenda. China’s privacy regime in the new millennium may thus be understood as having stemmed from an intricate political process as the Party-state strategically responds to rising challenges from increasingly powerful and competing market and social forces over the production of information, fame, and influence.

Integrating morphology and invivo skeletal mobility with digital models to infer function in brittle star arms.

Brittle stars (Phylum Echinodermata, Class Ophiuroidea) have evolved rapid locomotion employing muscle and skeletal elements within their (usually) five arms to apply forces in a manner analogous to that of vertebrates. Inferring the inner workings of the arm has been difficult as the skeleton is internal and many of the ossicles are sub-millimeter in size. Advances in 3D visualization and technology have made the study of movement in ophiuroids possible. We developed six virtual 3D skeletal models to demonstrate the potential range of motion of the main arm ossicles, known as vertebrae, and six virtual 3D skeletal models of non-vertebral ossicles. These models revealed the joint center and relative position of the arm ossicles during near-maximal range of motion. The models also provide a platform for the comparative evaluation of functional capabilities between disparate ophiuroid arm morphologies. We made observations on specimens of Ophioderma brevispina and Ophiothrix angulata. As these two taxa exemplify two major morphological categories of ophiuroid vertebrae, they provide a basis for an initial assessment of the functional consequences of these disparate vertebral morphologies. These models suggest potential differences in the structure of the intervertebral articulations in these two species, implying disparities in arm flexion mechanics. We also evaluated the differences in the range of motion between segments in the proximal and distal halves of the arm length in a specimen of O.brevispina, and found that the morphology of vertebrae in the distal portion of the arm allows for higher mobility than in the proximal portion. Our models of non-vertebral ossicles show that they rotate further in the direction of movement than the vertebrae themselves in order to accommodate arm flexion. These findings raise doubts over previous hypotheses regarding the functional consequences of ophiuroid arm disparity. Our study demonstrates the value of integrating experimental data and visualization of articulated structures when making functional interpretations instead of relying on observations of vertebral or segmental morphology alone. This methodological framework can be applied to other ophiuroid taxa to enable comparative functional analyses. It will also facilitate biomechanical analyses of other invertebrate groups to illuminate how appendage or locomotor function evolved.

Accelerated vortex dynamics across the magnetic 3D-to-2D crossover in disordered superconductors

Disorder can have remarkably disparate consequences in superconductors, driving superconductor–insulator transitions in ultrathin films by localizing electron pairs and boosting the supercurrent carrying capacity of thick films by localizing vortices (magnetic flux lines). Though the electronic 3D-to-2D crossover at material thicknesses d ~ ξ (coherence length) is well studied, a similarly consequential magnetic crossover at d ~ Lc (pinning length) that should drastically alter material properties remains largely underexamined. According to collective pinning theory, vortex segments of length Lc bend to adjust to energy wells provided by point defects. Consequently, if d truncates Lc, a change from elastic to rigid vortex dynamics should increase the rate of thermally activated vortex motion S. Here, we characterize the dependence of S on sample thickness in Nb and cuprate films. The results for Nb are consistent with collective pinning theory, whereas creep in the cuprate is strongly influenced by sparse large precipitates. We leverage the sensitivity of S to d to determine the generally unknown scale Lc, establishing a new route for extracting pinning lengths in heterogeneously disordered materials.

Abstract C82: Breast density notification in a racially diverse and immigrant sample of women: Evidence for social disparities in awareness, knowledge, and follow-up

Abstract As mandated by legislation in 31 states, clinical mammographic breast density (MBD) information is currently disclosed to women identified as having heterogeneously or extremely dense breasts on routine mammograms (Breast Imaging-Reporting and Data System [BI-RADS] density categories of C/D, hereafter referred to as high MBD). The New York State legislation, enacted in 2013, informs women about the lower sensitivity of mammography and increased breast cancer risk associated with having dense breasts and advises them to seek risk assessment and additional screening; women with low MBD (BI-RADS density categories of A/B) do not receive density information. The legally mandated MBD information provided to women is ambiguous and written at a high literacy level. Additionally, any follow-up actions on this information taken by women require personal resources, including high educational attainment, health insurance coverage, and access to regular health care provider versed in breast cancer risk assessment and screening guidelines. We investigated the impact of this legislation on women's awareness of MBD, knowledge of its effect on breast cancer risk and detection, and communication with health care providers in a predominately Hispanic and foreign-born sample of 466 women, recruited from a mammography clinic in the Northern Manhattan community of New York City (age range: 40-60 years; 79% Hispanic, 12% African American; 81% foreign-born; 26% less than high school education). Overall 88% of the sample had obtained a prior mammogram since 2013 and 31% had heard about MBD. Awareness of MBD did not differ by risk factors for breast cancer (e.g., family history of breast cancer, breast biopsy, parity-related factors) or psychological factors related to breast cancer screening (breast cancer risk perception and worry). Non-Hispanic white women were significantly more likely to have heard of MBD (81%) than non-Hispanic African American (54%), and Hispanic women (13%). In multivariable logistic regression models, odds of MBD awareness were significantly lower in women who were Hispanic (OR=0.1, 95% CI: 0.04, 0.3 relative to white women), foreign-born (OR=0.3, 95% CI: 0.2, 0.6 relative to U.S.-born), or had lower educational attainment (e.g., OR=0.3, 95% CI: 0.2-0.7 for high school or less vs. college or higher degree). Women with personal high MBD were twice as likely as women with low MBD to be aware of MBD, but adjusting for personal MBD did not substantially alter the associations of race/ethnicity, education, and nativity with MBD awareness. In women who reported awareness of MBD, 47% and 76%, respectively, were able to correctly identify the higher risk and masking potential associated with high MBD, and 31% reported following on MBD information with their health care providers. Racial/ethnic and educational differences in knowledge of MBD impact and health care provider communication were smaller and less consistent. In conclusion, awareness of MBD remains low in women from racial/ethnic minority and lower socioeconomic backgrounds, even in a regularly screened population. These findings underscore the importance of understanding and averting potential unintended disparate consequences of breast density notification. Citation Format: Parisa Tehranifar, Carmen B. Rodriguez, Mariangela Agovino, Karen M. Schmitt. Breast density notification in a racially diverse and immigrant sample of women: Evidence for social disparities in awareness, knowledge, and follow-up [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C82.

Inequality rules: Resource distribution and the evolution of dominance- and prestige-based leadership

Ballooning levels of societal inequality have led to a resurgence of interest in the economic causes and consequences of wealth disparity. What has drawn less attention in the scientific literature is how different levels of resource inequality influence what types of individuals emerge as leaders. In the current paper we take a distal approach to understanding the psychological consequences of inequality and the associated implications for leadership. We describe how the distribution of resources in contrasting animal and small-scale human societies incentivizes dominance-oriented versus prestige-oriented leadership strategies, and we use this framework to tease out a number of implications for modern organizational environments. In particular, we suggest that higher levels of inequality attract and favor dominance-oriented rather than prestige-oriented leaders, and that inequality incentivizes leaders to favor their own self-interest over the interests of the organizations they lead. We describe the features of modern organizations that might facilitate the emergence of dominance-oriented leadership and discuss the downstream consequences for organizations. Finally, we explore the contextual and cultural moderators of inequality's relationship with leader/follower dynamics.

Regional Disparities of the Social Innovation Potential in the Visegrad Countries: Causes and Consequences

Abstract The international literature is paying significant and increasing attention to the analysis of the regions’ innovation potential, and its active contribution to economic growth and competitiveness. Beside the classical, technical innovation, also the social innovation is getting even more emphasis. It can solve as alternative basically in the case of the peripheral territories. The convergence of peripheries is a stressed priority in the European Union. The territorial disparities are resulting in significant social and political problems also in the case of the Visegrad countries’ regions. The authors in their research represent a possible method for the measurement of regional (NUTS-2) level social innovation potential on the example of the Visegrad countries, and they also analyse the causes and consequences of disparities. The applied complex social innovation index can be calculated as a result of three pillars (economic, social, culture and attitude), and several components. As a result of the created patterns can be concluded that compared to the economic indicators, the disadvantage of the peripheries is not so significant in the case of the social innovation index, because of the complex character of the index. In the second part of the research, the authors analyse and evaluate also the methods, which can be adequate for increasing the social innovation potential.

Resource allocations and disparities in the Brazilian health care system: insights from organ transplantation services

BackgroundTo date, few studies have assessed how Brazil’s universal healthcare system’s (SUS, Sistema Único de Saúde) systemic, infrastructural, and geographical challenges affect individuals’ abilities to access organ transplantation services and receive quality treatment.DiscussionIn this article we evaluated the existing literature to examine the impact that SUS has had on an increasingly important healthcare sector: organ transplantation services. We assess how equity challenges within the transplantation system can be explained by wider problems within SUS. Findings suggest stark disparities in access to transplantation services both within and across Brazil’s regions. We found that these regional differences are partially due to logistical challenges, especially in loosely populated areas but are also a consequence of disparities in resource allocations within SUS and under-capacitated health care facilities affecting transplantation services.SummaryWe suggest that Brazil needs to improve its health outcome measurement system for organ transplantations and epidemiological surveillance, to gain more comprehensive and comparable data. Finally, we recommend policy strategies to reduce barriers to access to transplantation services by increasing transplantation service coverage in some areas and investing in emerging technologies.

Results of an Arctic Council survey on water and sanitation services in the Arctic

ABSTRACTAs part of a project endorsed by the Arctic Council’s Sustainable Development Working Group (SDWG), a survey was conducted to describe the current status of water, sanitation and hygiene (WASH) services in the Arctic region. The English language internet-based survey was open from April to September, 2016 and drew 142 respondents from seven Arctic nations. Respondents provided information on access to WASH services, notification requirements for water-related infectious diseases, and examples of environmental- or climate-change related events that impact the provision of WASH services. Many remote Arctic and sub-Arctic residents lack WASH services, and these disparities are often not reflected in national summary data. Environmental changes impacting WASH services were reported by respondents in every Arctic nation. Participants at an international conference co-sponsored by SDWG reviewed these results and provided suggestions for next steps to improve health of Arctic residents through improved access to water and sanitation services. Suggestions included ongoing reporting on WASH service availability in underserved populations to measure progress towards UN Sustainable Development Goal #6; evaluations of the health and economic consequences of disparities in WASH services; and Arctic-specific forums to share innovations in WASH technology, improved management and operations, and adaptation strategies for environmental or climate change.

Cervical fractures of femoral bone in eldery patients: epidimeology and causative fractures (literature review)

Оccurrence, prevalence and treatment of femoral neck fractures among the elderly and senile were analyzed. The structure of a contingent of patients with fractures of the indicated localization is considered. It is shown that 95 % of people the older age group, femoral neck fractures fractures arise due to low-energy injury. However, there is a clear tendency to increase the number of injuries on the background of osteoporosis in the age group of 40–60 years. Geographical differences in frequency of of the proximal femur fracture occurrence on different continents, as well as between different regions which is determined in a certain way by the genetic environmental factors. For example, it is proved the influence of the amount of sunlight on the frequency of fractures often occur in the winter due to vitamin D deficiency and a decrease in neuromuscular coordination. It is shown that female sex is a risk factor for proximal femur fractures: the ratio of a woman/man aged 60– 69 is 9:2. Wherein women have an absolute number of fractures constantly grows with age. Among other reasons that can lead to the emergence of proximal femur fractures are called: a decrease in bone mineral density, a prolonged glucocorticoids administration, low body weight, smoking, alcohol abuse In Ukraine, there is no official statistics on the prevalence of proximal femur fractures, data on the state of medical services to assist such patients are disparate, the medical and social consequences of treatment outcomes by various methods are practically not analyzed. The results of epidemiological studies may become the foundation for the development of a scientifically sound regional program for the prevention and treatment of proximal femur fractures.

An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education.

Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.

Acculturation and health: the moderating role of socio-cultural context.

Acculturation represents an important construct for elucidating the determinants and consequences of health disparities in minority populations. However, the processes and mechanisms underlying acculturation's effects on health are largely undetermined and warrant further study. We integrate concepts from anthropology and statistics to describe the role of sociocultural context as a putative modifier of the relationship between acculturation and health. Sociocultural context may influence the extent to which exposure to host culture leads to internalization of host cultural orientation, and may influence the extent to which acculturation leads to stress and adoption of unhealthy behaviors. We focus on specific aspects of sociocultural context: (1) neighborhood ethno-cultural composition; (2) discrimination; (3) discrepancy between origin and host environments; (4) discrepancy between heritage and host cultures; (5) origin group, host group, and individual attitudes towards assimilation; (6) variation in targets of assimilation within host community; (7) public policy and resources; (8) migration selection bias. We review and synthesize evidence for these moderation effects among first- and later-generation immigrants, refugees, and indigenous populations. Furthermore, we propose best-practices data-collection and statistical-analysis methods for this purpose, in order to improve our understanding of the complex, multilevel aspects of the relationship between acculturation and health.

Lung Adenocarcinoma Survival in EGFR-Mutated African-Caribbean Patients: A Multicenter Study in the French West Indies.

Lung cancer is the leading cause of cancer-related death worldwide. Shorter survival has been repeatedly reported for patients of African ancestry. Multivariate analysis demonstrated that this gap could be a consequence of socio-economic disparities instead of genetic specificities. However, those results were obtained in a pre-targeted therapies era and the effect of tyrosine kinase inhibitors targeting EGFR are not known in this population. In this French West Indies study, we report overall survival (OS) in a frequently mutated population treated for lung adenocarcinoma within an equal-access healthcare system. Clinical, demographic, survival, and treatment data have been retrospectively assessed for all patients diagnosed with lung adenocarcinoma in the islands of Martinique and Guadeloupe between 2013 and 2015. Two hundred and forty-one patients (82% African-Caribbean) were included. EGFR mutations were detected in 37% of all tumor specimens and were associated with non-smoker status in multivariate analysis. Median OS was 16.2months. For patients with advanced disease, median OS was 11.5months, depending on EGFR mutation (23 vs. 8.3months for non-mutated patients, p=0.0012). There was no difference in survival according to ethnicity or island. In multivariate analysis, performance status (PS) and EGFR mutation were the only independent prognostic factors. Despite a higher frequency of EGFR mutations in African-Caribbean patients, ethnicity was not an independent factor of OS in lung adenocarcinoma. Lower initial PS in this mainly non-smoking African-Caribbean population may explain the absence of a difference in OS.

Recession, resilience, local labour markets: wealthier is better?

Economic expansion and recession have shaped the long-term evolution of local economic systems, exemplifying causes and consequences of territorial disparities and alimenting the debate on regional resilience. The present study investigates changes (2004–2013) in the spatial structure of two labour market indicators in Italy (participation and unemployment rates) during the most recent expansion and recession waves, so as to identify socioeconomic and territorial factors influencing short-term performances of local labour markets. Specialization in advanced industry (such as precision mechanics) is one of the most important factors associated to low employment losses during recession in Italy. Our results offers a contribution to the debate on regional resilience by reconnecting it to the more general issue of spatial disparities. We aim to shed light on the impact of institutional change and external shocks on the evolutionary path of local economic systems.

Attention-deficit hyperactivity disorder medication use: factors involved in prescribing, safety aspects and outcomes

While treatment of patients with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal approach that combines medication with specific psychological interventions, pharmacotherapy alone is generally considered an essential and cost-effective element. This paper aims to comprehensively and critically review factors involved in prescribing and medication use in individuals diagnosed with ADHD, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications. A comprehensive and systematic literature search of PubMed/MEDLINE database was conducted to identify studies published in peer-reviewed journals until 1 August 2016. Children, adolescents and adults often encounter significant difficulties in the process of accessing specialist assessment and treatment for ADHD as a consequence of disparities in service organization and available treatment provision. Despite the well-established efficacy and overall safety profile, ADHD medications are not exempt from adverse events. The cardiovascular safety of pharmacotherapies used for treating individuals with ADHD has raised particular concerns; however there is little evidence of serious cardiovascular adverse events, including no serious corrected QT (QTc) abnormalities associated with stimulants, atomoxetine or α2-adrenergic receptor agonists. Although the abuse of prescription stimulant drugs, particularly, short-acting stimulants is a prevalent and growing problem, nonmedical use of prescription stimulants within the clinical context is very limited. In addition, nonstimulant ADHD medications lack any reinforcing effects and consequently any abuse potential.

CAUSATIVE FACTORS OF SOCIAL INEQUALITY AND ITS IMPACT ON COMMUNITY HEALTH: A NEIGHBOURHOOD LEVEL STUDY IN MIDNAPORE MUNICIPAL AREA, WEST BENGAL, INDIA

Abstract. Health is socio-demographic construct of population. In an urban area social, economic and political systems simultaneously operate within a geographically defined space in which the urban dwellers accommodate and act as key player. As such the physical and social factors virtually affect the community health as a consequence of disparity in accessing health. Health disparities in smaller towns of the developing world have drawn serious attention as they are poorly suffering from the problems of ‘urban penalty’. This paper deals with statistical clustering of neighbourhoods on the basis of quality of life, social deprivation and multiple suffering quantified as the variables derived from measurable parameters. Neighbourhoods inequality has been mapped as per the score received by each neighbourhood in respect to the above three variables. Principal Component Analysis (PCA) has also been employed for grouping the neighbourhoods in social terms. Then it has been tried to examine relationship between health attainment and social status of the neighbourhoods. The study shows that status of health does not merely depend on socio-demographic and political factors but availability of healthcare facilities, health related behaviour, health perception and awareness have played significant roles. The findings of the study may be helpful for setting planning strategies most important of which would be inclusion of local people in catering health services.