Low Socioeconomic Status Families Research Articles

The impact of disability-related deprivation on employment opportunity at the neighborhood level: does family socioeconomic status matter?

Difficulties in attaining employment significantly contribute to socioeconomic poverty among individuals with disabilities. However, our understanding of how socioeconomic deprivation experienced by individuals and families with disabilities influences employment opportunities remains incomplete. This study aims to explore the relationship between index of disability-related multiple deprivation (IDMD) and employment opportunities (EMPO), while also investigating the role of family socioeconomic status (FSES) in shaping this relation. This study explores the heterogeneous effects of IDMD, FSES, and the interaction between IDMD*FSES on EMPO among four disabled population groups categorized by IDMD and FSES. Results reveal that IDMD has a significant negative impact on EMPO, suggesting that persons with disabilities are confronted with a poverty trap resulting from the relationship between IDMD and EMPO. Furthermore, FSES demonstrates an effective moderating role in the IDMD-EMPO relationship, with the greatest impact observed among disabled population groups characterized by high IDMD and low FSES. The findings suggest that family-level support is crucial for vulnerable groups of disabled individuals to overcome the poverty trap, surpassing the reliance on individual-level assistance alone. This study supports a paradigm shift in comprehending disability-related deprivation by acknowledging its association with families, thereby presenting opportunities to enhance the welfare of people with disabilities.

Evaluating the Readability and Quality of Online Patient Education Materials for Pediatric ACL Tears.

As the rate of anterior cruciate ligament (ACL) tears increases in children, the internet has become a major source of information and education. In the United States, the average adult reads at about an eighth grade level. The National Institutes of Health recommends that patient education materials do not exceed a sixth-grade reading level. Therefore, the most accessed resources on the internet should be created with this in mind. The purpose of this study is to assess the readability and quality of online patient resources for pediatric ACL tears. Google was queried using the term "Pediatric ACL Tear" on May 26, 2022. The most popular sites were identified through page one of a Google search. All content was evaluated to assure information was directed toward patients. To determine reading difficulty, the most widely accepted readability tests: Flesch Reading Ease Index, Flesch-Kincaid Grade Level, and Gunning Fog Index were calculated through plain text in Microsoft Word and URL in online readability checker Readable.io. The average grade level for all resources was above the recommended reading level based on both Microsoft Word and Readable.io calculations. Each source exceeded the NIH recommendation by 2.6 grade levels on average (Mean grade level readability was 8.6 ± 1.9). Four of the 6 sites were above the average US reading level, exceeding the eighth grade by an average of 1.5 grade levels. All 6 sites analyzed had a mean DISCERN score of 61.9, meeting the 'good quality' criteria. The most readily available online materials for Pediatric ACL tears were of 'good quality' but above both the NIH-recommended readability level and the average US adult reading level. With the increasing need for treatment of ACL tears in pediatric and adolescent patients and greater internet accessibility in these populations, it is important to consider the readability of these resources in support of increased health literacy and improved outcomes. It is important for physicians treating young patients with ACL tears to be aware of all sources of information and support, including content shared online as these platforms are increasingly utilized, especially by patients and families of lower socioeconomic status.

Mathematics learning gap during pandemic among early adolescents: Roles of own aspiration and parental involvement

The Covid-19 Pandemic has affected school learning broadly, and particularly for students from low socioeconomic status families. The present study aimed to quantify the heterogeneous learning loss in mathematical learning due to the pandemic, and more importantly, to understand whether parents' involvement or adolescents' aspiration is more responsible for the learning gap. Using the Propensity Score Matching method, 678 adolescents aged 10–15 in China were selected from the 2016 and 2020 China Family Panel Study database (339 for each year) and controlled for demographic variables, educational aspirations, family socioeconomic status (SES) and parental involvement. The results showed that during the pandemic, (1) learning loss in mathematical reasoning skill was about 12 % among Chinese adolescents, and the loss was more significant for low SES adolescents (20 %) than high SES adolescents (8 %); and (2) adolescents' educational aspiration directly mediated the association between SES and mathematical reasoning skill, whereas parents' involvement in academics only had an indirect effect through aspiration. Findings implies that facilitating adolescents' educational aspiration can be a more effective strategy to buffer the pandemic-induced mathematics learning loss. Thus, parents, especially those from low SES families, are advised to facilitate adolescents' aspiration than simply involving in adolescents' learning.

Commentary: Cognitive stimulation and executive functions in the prevention and treatment of childhood disorders - reflection on Phillips etal., 2023.

The study by Phillips etal. (Journal of Child Psychology and Psychiatry, 2023) shows that preschool executive functions (EF) are a transdiagnostic mechanism through which deprivation increases the risk for psychopathology in adolescence. In addition, deprivation appeared to be a key mechanism through which economic adversity (i.e., lower income-to-needs ratio and maternal education) undermines EF and increases the risk for psychopathology in adolescence. In this commentary, implications for early prevention and treatment of childhood disorders are discussed. In view of optimal EF development attention is needed to cognitive and social stimulation both in: (a) selective prevention targeting preschool children at high risk for childhood disorders due to low socioeconomic status; (b) indicated prevention targeting preschool children with minimal but detectable symptoms from low socioeconomic status families; and (c) treatment targeting preschool children with a clinical disorder from low socioeconomic status families.

The predictive role of early childhood dysregulation profile on the parallel growth trajectories of reading and math performance across elementary and middle school

This study examined the heterogeneity in the co-developmental trajectories of reading and math performance (i.e., parallel changes in the initial scores and growth patterns) and identified the number, size and shape of the co-developmental trajectory across elementary and middle schools. In addition, this investigation focused on how an early childhood dysregulation profile (DP; indexed by a high co-occurrence of emotional, behavior, and attention problems) was associated with distinct co-developmental trajectories of reading and math performance. Specifically, we examined whether early childhood DP level can predict (a) membership assignment into each distinct co-development group and (b) variability in initial scores and changes in growth with each distinct co-development group. Participants were 784 academically at-risk students (47 % girls) predominantly from low socioeconomic status families who were recruited in first grade (Mean age = 6.57 years) and followed annually through the final year of middle school (ninth grade). Results revealed two distinct co-developmental trajectories of reading and math performance, including (a) a lower initial reading (higher increasing) and higher initial math (lower increasing) class (85.3 %) and (b) a lower initial math (higher increasing) and higher initial reading (lower increasing) class (14.7 %). Our results provided evidence for the compensatory pattern of co-developmental trajectories, indicating initial lower skills grow at a faster rate than the initial high. Further, early childhood DP was not associated with the membership assignment for these two distinct classes, which means that regardless of children’s early DP level, they have equal chances to be assigned to each of the classes. However, children with higher parent and teacher-reported DP in first grade demonstrated lower initial scores and a slower improvement rate in both classes after controlling for kindergarten literacy skills, gender, ethnicity, intelligence, socioeconomic status, and grade retention. Our study findings demonstrated (a) substantial heterogeneity in the co-developmental trajectories of reading and math performance across elementary and middle school ages; and (b) the importance of promoting self-regulation beginning in early childhood, especially for academically at-risk children in families facing economic challenges.

A patient-driven registry on Behçet's disease: the AIDA for patients pilot project.

This paper describes the creation and preliminary results of a patient-driven registry for the collection of patient-reported outcomes (PROs) and patient-reported experiences (PREs) in Behçet's disease (BD). The project was coordinated by the University of Siena and the Italian patient advocacy organization SIMBA (Associazione Italiana Sindrome e Malattia di Behçet), in the context of the AIDA (AutoInflammatory Diseases Alliance) Network programme. Quality of life, fatigue, socioeconomic impact of the disease and therapeutic adherence were selected as core domains to include in the registry. Respondents were reached via SIMBA communication channels in 167 cases (83.5%) and the AIDA Network affiliated clinical centers in 33 cases (16.5%). The median value of the Behçet's Disease Quality of Life (BDQoL) score was 14 (IQR 11, range 0-30), indicating a medium quality of life, and the median Global Fatigue Index (GFI) was 38.7 (IQR 10.9, range 1-50), expressing a significant level of fatigue. The mean Beliefs about Medicines Questionnaire (BMQ) necessity-concern differential was 0.9 ± 1.1 (range - 1.8-4), showing that the registry participants prioritized necessity belief over concerns to a limited extent. As for the socioeconomic impact of BD, in 104 out of 187 cases (55.6%), patients had to pay from their own pocket for medical exams required to reach the diagnosis. The low family socioeconomic status (p < 0.001), the presence of any major organ involvement (p < 0.031), the presence of gastro-intestinal (p < 0.001), neurological (p = 0.012) and musculoskeletal (p = 0.022) symptoms, recurrent fever (p = 0.002), and headache (p < 0.001) were associated to a higher number of accesses to the healthcare system. Multiple linear regression showed that the BDQoL score could significantly predict the global socioeconomic impact of BD (F = 14.519, OR 1.162 [CI 0.557-1.766], p < 0.001). Preliminary results from the AIDA for Patients BD registry were consistent with data available in the literature, confirming that PROs and PREs could be easily provided by the patient remotely to integrate physician-driven registries with complementary and reliable information.

COVID-19 and bilingual children's home language environment: Digital media, socioeconomic status, and language status.

Input is considered crucial in bilingual children's language development. This is especially true for bilingual children's mother tongue language learning given its common reduction in input opportunities due to the dominance of one language within society, as seen in countries and regions from Wales to Singapore. Previous studies tend to focus on the quantity and quality of conventional active communication and resources (e.g., speaking and reading with parents) on bilingual children's language development, and substantially, fewer studies have explored this topic from the perspective of digital media. However, the COVID-19 pandemic has accentuated the critical role of digital media in various aspects of life, including bilingual children's home language environment. Thus, to holistically understand bilingual children's daily language input patterns, it is imperative to explore both their conventional and digital media input resources. The current study focuses on English-Mandarin bilingual children in Singapore and would like to explore (1) whether their conventional and digital media language environments have been affected by the COVID-19 pandemic and (2) whether the societal status of a language and familial socioeconomic status (SES) would affect bilingual children's conventional and digital media input. Survey data from 162 parents of English-Mandarin bilingual preschoolers (3 to 6 years old) were used to explore the two research questions. Two online parental questionnaires were employed for data collection. One-way repeated-measures MANOVA and path models were used to address the questions. The results indicated that input patterns from nuclear family members had not been affected by COVID-19; however, the amount and frequency of conventional and digital media materials and activities increased significantly since COVID-19. Higher-SES families possessed more conventional materials and conducted conventional activities more often, while lower-SES families possessed more digital media materials. Both conventional and digital media materials and activities were richer in English than in Mandarin. Higher-SES families perceived digital media usage for learning to be of less importance than lower-SES families. The implications for early bilingual learning following COVID-19 are discussed.

The impact of low socioeconomic statusand primary health care access on emergency department presentations in young children in regional Queensland.

The purpose of this study was to empirically evaluate if children from low socio-economic status (SES) families in regional southeast Queensland utilise acute care services for low acuity health care rather than utilising primary health services. A retrospective audit of children under the age of 5 years presented at a regional hospital emergency department (ED) over a 12-month period. Medical records were examined for presenting problem, Australasian triage category, care outcomes, whether the child's parent/guardian held an Australian concession/health care card (AC/HCC) and accessed child health services or a general medical practitioner (GP). Eight hundred and eighty-eight children who had not reached their fifth birthday presented to ED between 1 June 2019 and 31 May 2020, with a total of 1691 presentations. Most children were bought to the ED by their parents with semi-urgent health concerns and were discharged home following medical review. Holding an AC/HCC was a significant predictor for hospital presentation. Holding an AC/HCC was not associated with access to child health services. However, accessing child health services resulted in a small but significant increase in hospital presentations. The AC/HCC may be an important proxy to identify low SES individuals. These card holders tended to use acute services more frequently than those who did not qualify for an AC/HCC. Furthermore, families that engage with primary care services such as child health also accessed acute care services more frequently. The results indicate accessing primary health-care services does not ameliorate the use of acute care services.

Does Socioeconomic Status Affect Mental Well-being Among Children with Asthma in Kosovo?

The aim of this study was to investigate the relationship between mental well-being – as assessed by the SDQ among children with asthma in Kosovo and SES. Methods and Results: For this cross-sectional observational study, data were collected from five regions of Kosovo, public and private institutions, public hospitals and primary healthcare facilities in each area, a tertiary level hospital, and two private immunology clinics in the capital city. The survey included 161 Kosovar children (mean age of 11.1±2.7 years) with asthma, aged 7-16 years, and their caregivers. The survey questionnaires used were those of the American Academy of Pediatrics: The Children's Health Survey for Asthma (CHSA), the parent and child version (CHSA-C), and the Strengths and Difficulties Questionnaire (SDQ). SDQ showed conspicuous (borderline or abnormal) results in 25.1% of children. None of the scales of the SDQ, except prosocial behavior, showed statistically significant differences across SES categories. Prosocial behavior scores increased significantly with increasing SES. Conclusion: Children with asthma from lower SES families in Kosovo have more social contact problems but do not show reduced mental well-being nor more conduct problems.

The impact of an interaction-based classroom program on executive function development in low-SES preschoolers: first support for effectiveness

Studies have shown that children from a low socioeconomic status (SES) family are likely to have lower academic scores, indicating an SES-achievement gap. This inequality already starts in preschool and persists throughout children’s lives. Since executive functions (EFs) have been put forward as contributing factors in this SES-achievement gap, it is crucial to target early EF development to remediate the adverse effects of poverty. In this quasi-experimental study, a classroom program delivered by teachers (i.e., “Put your EF glasses on”) was implemented to strengthen preschoolers’ EFs, consistent with the idea that well-developed EFs can foster school readiness and prevent school failure. The program aimed to boost children’s EFs through high-quality teacher-child interactions, EF-supporting activities (e.g., games), and a supportive classroom structure. Teachers (n = 24) and children (n = 224, Mage = 52.61 months) from 8 Belgian schools participated in this quasi-experimental pilot study and were divided into experimental and control groups. Teachers in the experimental group carried out the program (receiving materials and coaching to support implementation), whereas teachers in the control group practiced teaching as usual. Before and after the program, all teachers filled out the BRIEF-P, a questionnaire about daily executive problems in preschool children. We compared the effect of the classroom program in low-SES versus middle-to-high-SES children on EF problem scores. Results revealed that all low-SES children started with significantly higher EF problems (total problem score, working memory, inhibition, and planning and organizing) scores than middle-to-high-SES children. A positive effect of the program was found among low-SES children. More specifically, EF problems (total problem score, working memory, shifting, and planning and organizing) remained stable over time in the low-SES group in the experimental group, but there was no program effect on emotional control and inhibition. In the control group, these EF problems increased for low-SES children, expanding the gap between low and middle-to-high-SES children. There were no program effects for middle-to-high-SES children. These results show that a teacher-mediated classroom program can support EF development, especially in preschoolers at sociodemographic risk.

Self-assessment: The role of the social environment

This study presents evidence on the role of the social environment in shaping the accuracy of self-assessment. We introduce a new measurement tool to elicit children’s accuracy of self-assessment. We use this tool to show that children from high SES families are more accurate in their self-assessment, compared to children from low SES families. We then exploit exogenous variation of participation in a mentoring program designed to enrich the social environment of children. The mentoring program has a causal positive effect on the accuracy of self-assessments and is most effective for children whose parents provide few interactive activities.

Social gradient in use of health services and health-related quality of life of children with attention-deficit/hyperactivity disorder: A systematic review.

ADHD (attention-deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health-related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes. The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer-reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists. 25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well-being. Children with ADHD from low SES families had lower HRQoL than children from high SES families. This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD.

Neuroticism and Adolescent Problematic Mobile Social Media Use: A Moderated Mediation Model

Although previous studies have confirmed the influence of neuroticism on problematic mobile social media use, mechanisms underlying this relation have not been well-understood. The present study investigated the mediating effect of self-control, as well as the moderating role of family socioeconomic status (FSES). A total of 1146 adolescents’ data (Mage = 16.11, SDage = 0.97, 498 boys) were collected. Participants completed questionnaires about neuroticism, self-control, problematic mobile social media use, and FSES. The moderated mediation analysis showed that self-control mediated the positive association between neuroticism and problematic mobile social media use. In addition, FSES moderated the negative relation between self-control and problematic mobile social media use. Specifically, compared with adolescents in low FSES, the association between self-control and problematic mobile social media use was stronger for adolescents in high FSES. This study advanced our understanding of the development of problematic mobile social media use by revealing the potential mechanism between adolescent neuroticism and problematic mobile social media use.

Structural Inequities in the Kin Safety Net: Mapping the Three-Generational Network throughout Early Adulthood1.

Research in the intergenerational transmission of socioeconomic status (SES) consistently shows that the SES of one generation benefits the next. Demographic processes shape the kin structures that serve as conduits for the transmission of SES. Few studies have examined these trends together to describe experiences in evolving kin structures throughout the life course and across generations. This article applies demographic techniques to fertility, marital, and mortality data from three generations in the Panel Survey of Income Dynamics to simulate the amount of time young adults would spend within consequential kin structures. High-SES adults spend more years of their young adulthood in advantageous kin structures with greater potential for kin support and capital accumulation, while low-SES adults spend a larger portion of their young adulthoods as single parents, sandwiched between widowed parents and children, and as adult orphans. The kin network inequities have grown since the 1980s, driven by lagging mortality improvements and increasing single parenthood among low-SES families.

Socioeconomic disparities in adolescent anxiety and depression in Finland have not increased during the COVID-19 pandemic.

The purpose of this research was to assess whether socioeconomic disparities in adolescent depression and anxiety in Finland increased among middle adolescents during the COVID-19 pandemic. Repeated cross-sectional surveys (the School Health Promotion Study) from spring 2019 and spring 2021 were compared. The respondents were 87,283 eighth and ninth graders (14-16-year-olds) in 2019 and 91,560 in 2021, corresponding respectively to 73% and 75% of the age groups. Depression was measured by Patient Health Questionnaire-2 (PHQ-2), and anxiety with GAD-7, and adverse socioeconomic background using low parental education, not living with both parents, and family's poor financial situation. Associations of socioeconomic adversities with depression and generalised anxiety, and the effect of COVID-19 (2021 vs 2019), were analysed using logistic regression. Depression and anxiety were more common in both sexes the more sociodemographic adversities there were in the adolescent's background. However, increases in the prevalence of anxiety and depression from pre- to in-pandemic time did not differ with accumulating sociodemographic adversities. Depression and anxiety increased in prevalence among Finnish adolescents during the pandemic. Sociodemographic disparities in depression and anxiety show no increase. Emotional symptoms are nevertheless more common in adolescents from lower socioeconomic status families.

Food practices adaptation: Exploring the coping strategies of low-socioeconomic status families in times of disruption

COVID-19 impact on global and national food systems, along with associated physical restrictions, lockdowns, and school closures, have led to dramatic changes in families' everyday food practices. Our research explored the way food practices adapted and emerged, allowing families to cope with the disruption caused by COVID-19. We recruited 18 low socio-economic status families with primary school children across the United Kingdom and New Zealand to partake in two interviews, a survey, and the use of an ethnographic app. Analysis illuminates that this disruption triggered the emergence of three practices that were necessary to carry on and mitigate the impact of disrupted food practices; ‘asking for help’, ‘planning’ and ‘research and experimentation’. As a way to deal with disruption to their food practices, many participants called on the support of the community, including the use of food banks and the sharing of food. Participants discussed the way they had to plan their food, which often involved the expansion of practices formerly enacted to a small degree, such as curation of online shopping lists and stockpiling. Food research and experimentation also emerged as largely new practices, such as freezing foods, learning new recipes online (YouTube), experimenting with new ingredients and recipes. As such, for some participants, experimentation and research transformed cooking practices into leisure practices. The findings have practical implications for policy makers and non-governmental organisations, such as providing formal support that is accessible while reducing any associated stigma. Designing interventions that integrate planning routines within food practices can help build skills (e.g., bulk cooking and freezing) which can be vital during disruptions, aiding families to cope with the difficulties and aftermath of sudden and large-scale disruption, such as a pandemic.

The Current Youth Sport Culture and its Impact on Sport Participation Experiences of Low Socioeconomic Status Families

Purpose: The rise of sport specialization can jeopardize the opportunities for families of low socioeconomic status (SES) to participate in organized sport. However, obtaining an athletic scholarship may be a motivating factor for low SES youth to sport specialize. Yet, the experiences of low SES athletes in sport participation are not well known. Method: We used an Interpretative phenomenological analysis (IPA) to explore experiences of low SES families with children participating in sport and how this may be impacted by the current youth sport culture that promotes sport specialization. We engaged in semi-structured interviews with 12 low SES parents. Results: The following 4 interrelated themes emerged: (a) Benefits of youth sport participation, (b) Negatives and/or barriers to youth sport participation, (c) Strategies to get involved in youth sport, and (d) Facilitators for youth sport participation. Conclusions: Findings indicate that while low SES youth sport parents are motivated to involve their children in sports, there are many barriers that hinder their opportunities for their child to participate in organized sports. These issues are exacerbated by the current youth sport culture which emphasizes sport specialization with very few existing facilitators to involve their child in organize sport.

Und täglich grüßt das Murmeltier: Die frühe Bildung muss endlich stärker in den Fokus rücken!

Abstract Given the high benefits of early education, it is particularly noteworthy that new studies of child development during and shortly after the coronavirus pandemic show negative effects on children. This is true for cognitive and non-cognitive skills as well as mental health. Children from low SES families are particularly affected. Although there are fewer studies for preschool children, the few studies that do exist show similar effects; in particular, the closure of daycare centers had a negative impact on children. Last but not least, parental well-being was affected during the pandemic, which will further impact children’s development. The article briefly discusses policy responses in light of these findings. Overall, it argues that education policy should place a much greater emphasis on early education and be more targeted.

Association between adolescents' socioeconomic status and working memory updating functioning: Role of parental educational involvement.

Family socioeconomic status (SES) is positively associated with executive functioning. This study tested whether parental educational involvement mediates this association. Two hundred and sixty, 12-15-year-old adolescents completed working memory updating (WMU) and general intelligence tasks, and questionnaires on SES and parental educational involvement. SES and WMU ability were positively associated; there was no difference between the fathers and mothers for three types of educational involvement. The mothers' behavioural involvement positively mediated the SES-WM updating association, whereas a negative mediation was observed for the mothers' intellectual involvement. The fathers' educational involvement did not play a significant mediating role. These results might inform interventions targeting educational involvement for enhancing the cognitive development of children from low SES families.

Barriers to Exclusive Breastfeeding in Mothers Belonging to Low, Middle, and High Socio-Economic Families in Pakistan

Introduction: Exclusive breastfeeding (EBF) for the first six months of life improves health and increases infant survival. In Asia, Pakistan ranks second in child mortality. Socioeconomic status (SES) is an important predictor of healthy behaviors. The study aims to understand the barriers to exclusive breastfeeding faced by mothers from different socioeconomic classes in Pakistan.&#x0D; Method: The cross-sectional study was done in the Pediatric outpatient department (OPD) of Shifa International hospital and community health center from November 2020 to 1 March 2021. Mothers and their children 1 to 3 years of age were included in the study.&#x0D; Results: A total of 175 mothers and their children were included. EBF for the first six months was done by 120 (68.6%). However, by one year of age, only 99 (56%) continued breastfeeding. Out of these 175 mothers, 79 (45%) were from the lower class, 69 (39.4%) were from the middle class, and 27 (15.4%) were from upper SES. Among the lower, middle, and high socioeconomic classes frequency of EBF practiced by mothers was 51, 54, and 15 (p 0.03), respectively. Pre-lacteals were given to 102 (58.2%). This practice was more frequent in lower SES families (0.03). The majority of working women belonged to upper SES (0.04). Mothers in the upper class are least likely to EBF their children (OR 0.5 CI 0.2-1.3). The adjusted odds ratio for EBF is highest for lower SES mothers, followed by the middle class.&#x0D; Conclusion: Support from family, place and mode of delivery, working mothers, and high socioeconomic class are important factors affecting exclusive breastfeeding in Pakistan.