Financial Insecurity Research Articles

Evaluating associations between social risks and health care utilization in patients with chronic low back pain.

Care and outcomes for patients with chronic low back pain (cLBP) are influenced by the social risk factors that they experience. Social risk factors such as food insecurity and housing instability have detrimental effects on patient health and wellness, healthcare outcomes, and health disparities. This retrospective cross-sectional study examined how social risk factors identified in unstructured and structured electronic health record (EHR) data for 1,295 patients with cLBP were associated with health care utilization. We also studied the impact of social risk factors, controlling for back pain-related disability on health care utilization. Included patients who received outpatient spine and/or physical therapy services at an urban academic medical center between 2018 and 2020. Five identified social risks were financial insecurity, housing instability, food insecurity, transportation barriers, and social isolation. Outcomes included 4 categories of health care utilization: emergency department (ED) visits/hospitalizations, imaging, outpatient specialty visits related to spine care, and physical therapy (PT) visits. Poisson regression models tested associations between the presence of identified social risks and each outcome measure. Identified social risks in 12.8% of the study population (N = 166/1,295). In multivariate models, social isolation was positively associated with imaging, specialty visits, and PT visits; housing instability was positively associated with ED visits/hospitalizations and imaging; food insecurity was positively associated with ED visits/hospitalizations and specialty visits but negatively associated with PT visits; and financial strain was positively associated with PT visits but negatively associated with ED visits/hospitalization. These associations were seen above and beyond other factors used as markers of socioeconomic marginalization, including neighborhood-level social determinants of health, race/ethnicity, and insurance type. Identifying and intervening on social risk factors that patients with cLBP experience may improve outcomes and be cost-saving.

The Symphony of Consumer Partnering and Clinical Governance: An Organizational Review Using the RE-AIM Framework.

Partnering with Consumers in healthcare systems is now widely accepted and mandated in many countries. Despite this acceptance, there is minimal information regarding the best practice of how to successfully establish systems to embed this practice into healthcare systems. This evaluation used the RE-AIM implementation framework to retrospectively analyse data from a 3-year timeline to review the events relating to the transition of Consumer Partnering into a Clinical Governance Unit. Data was sourced via Phase 1 - a focus group to establish a 3-year timeline of events, enablers and barriers, and Phase 2 - a quantitative and qualitative semi-structured interview to review systems that had been developed to support embedding partnering with consumers into Clinical Governance. Five primary enablers and five barriers to successfully embedding a Consumer Partnering Team into a Clinical Governance Unit were identified. Enablers included Executive sponsorship and ownership of the value of partnering with consumers, Executive leadership influence on local area uptake, an organization-wide network, valuing via remuneration, and a centralized orientation and onboarding programme for Consumer Partners. Barriers included skills and attitudes of committee chairs, the size of the Directorate (smaller local areas can be easier to influence change), patient feedback data requires interpretation to be useful, staff turnover can reduce the relationships with Consumer Partners, and financial insecurity is a barrier to implementation and maintenance. This article described how an Australian Health Service embedded a Consumer Partnering Team into a Clinical Governance Unit to ensure that partnering became business as usual practice. Enablers, barriers, and unintended consequences can be used as learnings for other organizations to develop a similar approach. Two Consumer Partners with lived experience of the health service, and members of the organizations committee structures are part of the evaluation team. As team members, the consumers participated as equal contributors in evaluation design, analysis of the focus group and interview data, and contribution to the writing and review of the manuscript. Two Consumer Partners with lived experience of the health service, and members of the committee structures participated in the focus groups and the interviews.

Caregiving Intensity, Duration, and Subjective Financial Well-Being Among Rural Informal Caregivers of Older Adults with Chronic Illnesses or Disabilities

Introduction: Rural informal caregivers (IC) experience major financial and economic constraints in caring for their older family members. Rurality combined with increased caregiving demands and intensity, poor economic opportunities, and limited financial resources and policies create multiple financial stressors and can lead to poor financial well-being. A cross-sectional survey was conducted to understand how caregiving demands, intensity, and duration impact the subjective financial well-being of rural caregivers of older adults. Methods: Informal caregivers (N = 196) residing in 12 rural counties in the central North Region of the Midwestern US participated in the survey. Ordinary Least Squares and Linear Probability Model regressions were conducted to measure the association among the study variables. Results: Our findings showed a moderate level of subjective financial well-being among informal caregivers (average = 51.62; SD 14.52). Caregiving intensity negatively affected financial well-being (β = −1.470, p < 0.05). More than half of informal caregivers (58%) were not satisfied with their household income, and 30% found it difficult to meet their family’s needs with their current income status. Discussion and Conclusions: Longer hours of care are associated with financial burden and insecurity and can significantly influence the financial health and well-being of rural informal caregivers of older adults. Older caregivers were found to manage their financial constraints more effectively. Future comparative and longitudinal studies with a more diverse sample are required to infer long-term interactions among the different variables in this study.

Providing financial security to workers pays off: On the risks of employee financial insecurity for organisations and how to control them

Providing financial security to workers pays off: On the risks of employee financial insecurity for organisations and how to control them

COVID-19 and Female Genital Mutilation/Cutting and child marriage: An online multi-country cross sectional survey.

Female Genital Mutilation/Cutting (FGM/C) and child marriage are prevalent in many countries in Asia and Africa. These practices are a violation of human rights and have significant impacts on the physical and mental well-being of those affected. COVID-19 restrictions such as lockdowns and closure of schools may have influenced the occurrence of FGM/C and child marriage. This analysis reported on the impact of these restrictions on FGM/C and child marriage. The International Sexual Health And REproductive Health (I-SHARE) research team organised a multi-country online survey. Sampling methods included convenience samples, online panels, and population-representative samples. Data collected included the impact of COVID-19 restrictions on the occurrence, intention to practice and change in plans to organise FGM/C and child marriage. Data were analysed from 14 countries that reported on FGM/C and child marriage using basic descriptive statistics. Given it was an online survey, we had more responses from urban areas. Among the 22,724 overall participants, 8,829 participants (38.9%) responded to the survey items on FGM/C and child marriage and were included in this analysis. 249 (3.4%) participants stated that FGM/C occurred in their community during COVID-19. Out of this, COVID-19 affected the plans of 26 (20%) participants intending to organise circumcision and 15% of participants planned to organise FGM/C earlier. People with a worry about finances during COVID-19 were more likely to have an earlier plan to organise FGM/C during COVID-19. In total, 1,429 (13%) participants reported that child marriage occurred in their community. The pandemic affected plans of 52 (13%) participants intending to arrange child marriage and 7.7% (29/384) participants expressed intent to arrange the marriage sooner than planned. People with financial insecurities during COVID-19 were more likely to arrange a child marriage earlier. Thus, our study found that the pandemic impacted plans related to FGM/C and child marriage practices, resulting in many carrying out the practices sooner or later than initially planned.

Financial insecurity and mental well-being: experiences of parents amid the lebanese economic crisis

BackgroundThis study investigates the impact of financial insecurity on the mental well-being and stress levels of parents in Lebanon amid the country’s severe economic crisis. The context of Lebanon’s economic collapse, coupled with the effects of the COVID-19 pandemic and the Beirut port explosion, has exacerbated financial and psychological distress among the population. This research aims to understand the correlation between financial instability and parental stress, identifying key factors contributing to mental health challenges in this demographic.MethodsEmploying a quantitative research approach, data was collected through an online survey from 785 parents from different backgrounds in Lebanon. The survey incorporated sociodemographic questions, the InCharge Financial Distress/Financial Well-Being Scale (IFDFW), and the Arabic version of the Parental Stress Scale (PSS). Data analysis was conducted using SPSS version 25.ResultsFindings showed significant correlations between high levels of parental stress and factors such as age (r = 0.071, p = 0.047) and lower education levels. Notably, refugees residing in Lebanon exhibited higher stress levels compared to Lebanese parents (mean stress score: 51.73 vs. 45.71, p < 0.001). Similarly, employed participants exhibited higher stress levels compared to the nonworking (mean stress score: 46.75 vs. 44.60, p = 0.003). A significant inverse association was found between financial well-being and parental stress (r=-0.216, p < 0.001), emphasizing the profound impact of economic instability on mental health.ConclusionsThis study highlights the adverse effects of financial insecurity on parents’ mental health, primarily during a period of economic instability, emphasizing the urgent need for targeted support interventions. These findings contribute to the literature on economic crises and mental health, providing a basis for future research and policy development in similar contexts.

Complex emotion processing and early life adversity in the Healthy Brain Network sample

ObjectiveEarly life adversity (ELA) has shown to have negative impacts on mental health. One possible mechanism is through alterations in neural emotion processing. We sought to characterize how multiple indices of ELA were related to naturalistic neural socio-emotional processing. MethodIn 521 5–15-year-old participants from the Healthy Brain Network Biobank, we identified scenes that elicited activation of the Default Mode Network (DMN), Ventral Attention Network (VAN), Cingulo-Opercular Network (CON) and amygdala, all of which are networks shown to be associated with ELA. We used linear regression to examine associations between activation and ELA: negative parenting, social status, financial insecurity, neighborhood disadvantage, negative experiences, and parent psychopathology. ResultsWe found DMN, VAN, CON and amygdala activation during sad/emotional, bonding, action, conflict, sad, or fearful scenes. Greater inconsistent discipline was associated with greater VAN activation during sad or emotional scenes. ConclusionFindings suggest that the DMN, VAN, CON networks and the amygdala support socio-emotional processing consistent with prior literature. Individuals who experienced inconsistent discipline may have greater sensitivity to parent–child separation signals. Since no other ELA–activation associations were found, it is possible that unpredictability may be more strongly associated with complex neural emotion processing than socio-economic status or negative life events.

Representing the Needs of Rural Caregivers of People Living with Alzheimer’s Disease and Related Dementias through User Personas

Abstract Background and Objectives Rural caregivers of people living with Alzheimer’s disease and related dementias (ADRD) face unique caregiving challenges. Current interventions do not address many of the systemic barriers experienced by rural ADRD caregivers, including barriers related to geography, healthcare services access, and financial insecurity. The objective of this study was to gain a deeper understanding of rural ADRD caregivers’ needs, strengths, and strategies in obtaining caregiving support, and to represent these attributes in the form of personas that can be used to design interventions for rural ADRD caregivers. Research Design and Methods In this qualitative user-centered design study, we conducted semi-structured interviews with self-identified caregivers of people living with ADRD in rural areas. Interview data was copied to a virtual whiteboard, and affinity diagramming was used to confirm a priori attributes and yield inductive attributes relevant to rural ADRD caregivers. Attributes were assigned to personas, which were then validated through team-based discussion, consultation with a study advisory board, and review by rural caregivers and community partners. Results Analyses of N=19 interviews yielded seven inductive attributes relevant to rural ADRD caregivers of persons living with ADRD and five distinct personas: Capable Christine, Connected Connie, Isolated Irene, Learning Larry, and Discerning Dan. Personas differed on inductive attributes including financial security, subjective rurality, attitudes, connectedness, and information behavior, including preferences for traditional versus technology-based information seeking. Discussion and Implications The personas identified in the present study can be used as tools to represent and efficiently communicate the intersection and interaction of attributes relevant to designing interventions and technologies to meet the support needs of rural ADRD caregivers.

A Machine Learning Approach to Identifying Risk Factors for Long COVID-19

Long-term sequelae of coronavirus disease 2019 (COVID-19) infection are common and can have debilitating consequences. There is a need to understand risk factors for Long COVID-19 to give impetus to the development of targeted yet holistic clinical and public health interventions to reduce its associated healthcare and economic burden. Given the large number and variety of predictors implicated spanning health-related and sociodemographic factors, machine learning becomes a valuable tool. As such, this study aims to employ machine learning to produce an algorithm to predict Long COVID-19 risk, and thereby identify key predisposing factors. Longitudinal cohort data were sourced from the UK’s “Understanding Society: COVID-19 Study” (n = 601 participants with past symptomatic COVID-19 infection confirmed by serology testing). The random forest classification algorithm demonstrated good overall performance with 97.4% sensitivity and modest specificity (65.4%). Significant risk factors included early timing of acute COVID-19 infection in the pandemic, greater number of hours worked per week, older age and financial insecurity. Loneliness and having uncommon health conditions were associated with lower risk. Sensitivity analysis suggested that COVID-19 vaccination is also associated with lower risk, and asthma with an increased risk. The results are discussed with emphasis on evaluating the value of machine learning; potential clinical utility; and some benefits and limitations of machine learning for health science researchers given its availability in commonly used statistical software.

Exploring the Complex Relationship between Psychological Stress and Fertility: Implications for Population Growth in Developing Countries

Uncontrolled population growth has raised serious concerns among future policymakers. Although fertility rate has declined substantially over time, in developing countries the rate is still very high. Most of these countries face serious issues such as; severe poverty, malnutrition, unemployment, homelessness, financial insecurity, and medical insufficiency, leading to psychological distress. This article explores the mechanisms of psychological stress and its potential effects on human fertility. An attempt is made to differ from the existing claim that stress is anti-steroidogenic. This counter was based on earlier studies on adaptation of acute stress and overcoming stress stimuli. Which have asserted that individual adaptive abilities can alter the negative outcome of psychological stress depending on genetic, environmental, and behavioural factors. One of such adaptations comes from mitochondrial efficiency. An extensive energy demand during stress is achieved through competitive mitochondrial biogenesis. Earlier studies have noted that psychological stress triggers mitochondrial biogenesis. Thus, theoretically, mitochondrial biogenesis may also contribute in augmenting quality of sperm. In conclusion, stress induced biogenesis of mitochondria may contribute in enhancing fertility. Future studies on the degree of psychological stress and its possible retaliation through mitochondrial biogenesis, and subsequent responses to metabolic, and mechanical pathways, would open new avenues in understanding human fertility.

Financial Insecurity in Ageing Population

Financial Insecurity in Ageing Population

How Do Persons With Disabilities and/or Complex Health Conditions Perceive Oral Health? A Qualitative Study.

This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions. Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi-structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken. Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter-relationships between the mouth, oral health and the socio-medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions. This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population. This study was registered into ClinicalTrials.gov (NCT04815434).

Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

IntroductionSocial health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals’ social risks such as food, housing, transportation, and financial insecurity, and their interest in receiving assistance from the healthcare system (social needs), can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions. MethodsWe conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation). and by intersectional strata based on a combination of age, income, gender, and race and ethnicity. ResultsOf 10,274 who completed the survey, 52% reported any social risk and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). Our intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher income (>$50,000/year) or older age (>60) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black and Multiracial adults had the highest estimates of social risk and need. ConclusionsHigher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.

Institutional Trust and Economic Coping Strategies in Response to Sanctions: The Case of Russia and Iran

Sanctions have become an established feature of the economic landscape in Russia and Iran and may lead to economic insecurity and distrust of political bodies among citizens. However, few studies have investigated the way individuals adapt to these sanctions and whether their coping strategies are linked to their trust in institutions. To address this gap, we conducted a comparative study between Russians and Iranians, examining their economic coping strategies (ECS), including traditional ways of storing value, modern investments, cost-cutting measures, extra work, and resorting to social and material resources in response to sanctions and their relationship with institutional trust. Utilizing a cross-sectional research design, we administered surveys and obtained sample sizes of 364 and 311 in Russia and Iran, respectively. Our findings revealed that Russians exhibit higher institutional trust and lower levels of employing ECS compared to Iranians. Furthermore, we observed that lower institutional trust is associated with a greater overall use of ECS among Russians but not Iranians. When analyzing each coping strategy individually, we found that Russians with lower institutional trust tend to rely more on extra work, cost-cutting measures, and social and material resources, while in Iran, we observed this relationship for cost-cutting measures and modern investments. We concluded that in Russia, the financial insecurity induced by sanctions may have impacted institutional trust of those low-income individuals that were pressed to use certain strategies, while in Iran, the link between cutting expenses, modern investments, and institutional trust may be better explained by reduced life satisfaction and cultural factors. Given the role of institutional trust in well-being, it is crucial to protect at-risk segments of society from the adverse effects of financial challenges on their institutional trust.

" Operationalizing Jitegemea Philosophy As A Model To Sustainable Development To Retirement Plan Among The Pulpit Workers

Purpose of the Study: This study aimed to investigate the operationalization of Jitegemea Philosophy as a model for the sustainable development of retirement plans among pulpit workers. Statement of the Problem Despite the importance of retirement planning, these workers face challenges such as low salaries, irregular income, and limited access to pension schemes, leading to financial insecurity in later life. The Jitegemea (self-reliance) philosophy, rooted in principles of self-sufficiency and sustainability, offers a potential model for addressing this gap. However, there is limited research and practical application of Jitegemea as a structured retirement planning model tailored to the specific needs of pulpit workers. Addressing these challenges is crucial to ensuring the financial security and well-being of PCEA pulpit workers in retirement. Therefore, this study explores how operationalizing the Jitegemea philosophy could provide a sustainable solution for enhancing financial security and well-being for clergy during retirement. Methodology: This study employed a qualitative research approach, utilizing semi-structured interviews with PCEA pulpit workers to explore their perceptions, experiences, and challenges related to retirement planning. A purposive sampling technique was used to select participants from various PCEA churches in Nairobi. Data were analyzed thematically to identify key themes and patterns related to retirement planning among PCEA pulpit workers. Key Findings: The study revealed that while many clergy face socio-economic barriers, religious beliefs, community support, and proactive planning can foster resilience. Participants expressed mixed emotions about retirement, some feeling apprehensive and others viewing it as a period of spiritual renewal. The study highlights the need for tailored support mechanisms, including financial literacy programs, fair compensation, and expanded pension schemes. Conclusion: The study emphasizes the importance of collaborative efforts among religious institutions, policymakers, and community organizations to improve retirement planning. Recommendation: Recommendations include financial education, compensation reform, and community support to ensure better retirement preparedness. Further research is suggested to evaluate the long-term effects of these interventions on clergy retirement outcomes.

Coping with COVID-19: a prospective cohort study on young Australians' anxiety and depression symptoms from 2020–2021

BackgroundStudies have shown that the coronavirus (COVID-19) pandemic negatively impacted the mental health of young Australians. However, there is limited longitudinal research exploring how individual factors and COVID-19 related public-health restrictions influenced mental health in young people over the acute phase of the COVID-19 pandemic. This study aimed to identify risk and protective factors associated with changes in individual symptoms of anxiety and depression among young Australians during the COVID-19 pandemic.MethodsThis prospective cohort study collected data on anxiety and depression symptoms of young Australians aged 15–29 years old using the Depression, Anxiety and Stress Scale short form (DASS-21). We delivered four online questionnaires from April 2020 to August 2021 at intervals of 3, 6, and 12 months after the initial survey. We implemented linear mixed-effects regression models to determine the association among demographic, socioeconomic, lifestyle and COVID–19 public health restrictions related factors and the severity of anxiety and depression symptoms over time.ResultsAnalyses included 1936 young Australians eligible at baseline. There was a slight increase in DASS-21 anxiety mean scores from timepoint 3 to timepoint 4. DASS-21 depression scores showed slight fluctuations across timepoints with the highest mean score observed in timepoint 2. Factors associated with increases in anxiety and depression severity symptoms included LGBTQIA + identity, financial insecurity both before and during the pandemic, higher levels of loneliness, withdrawal or deferral of studies, spending more time on social media, and difficulties to sleep. Risk factors for only depression symptoms include unemployment during COVID-19 pandemic and being in lockdown. Living with someone was a protective factor for both anxiety and depression symptoms, pre-COVID-19 unemployment for depression symptoms, and older age and unemployment during the pandemic for anxiety symptoms.ConclusionThese findings indicate that during the first year of the pandemic in Australia, there were significant changes in young people’s mental health which were associated with multiple demographic, socioeconomic, lifestyle, and lockdown factors. Hence, in future public health crises, we suggest more inclusive guidelines that involve young people in their development and implementation ensuring that their unique perspectives and needs are adequately considered.

Investigating the impact of COVID-19 on international student wellbeing in Australia.

International students are at a heightened risk of experiencing negative health and wellbeing outcomes, which was further exacerbated during the COVID-19 lockdowns. This research sought to explore the impact of the COVID-19 pandemic on the health and wellbeing of international students in Australia. Thirty-one international students participated in qualitative in-depth interviews between March and April 2022 to explore their experiences of health and wellbeing during 2020-2021 while they lived and studied in Australia. Interviews were coded and analysed thematically using NVivo software. Findings highlight the impact of the pandemic on international students' mental, social and financial wellbeing, including worry about loved ones, social isolation, financial and employment insecurity and challenges related to online learning. The pandemic exacerbated and brought more attention to existing issues and placed students in unequal positions in relation to domestic students and each other. The COVID-19 pandemic has increased students' vulnerability to poor mental health and to a range of social and financial issues. SO WHAT?: The findings of this study highlight the need for support strategies to improve international students' mental health and social wellbeing outcomes in Australia.

Understanding the diversity of private conservation in the Peruvian Amazon

AbstractGlobal awareness about the threats of ecosystem degradation in the Amazon is growing. While state‐managed protected areas remain key instruments for forest conservation, private actors are increasingly funding and implementing a broad range of conservation initiatives. Private actors are transforming the Amazonian conservation landscape and its governance, however, many aspects of private conservation, especially the diversity of local practitioners and the challenges they face, remain understudied. Drawing on a case study of Madre de Dios in the Peruvian Amazon, we aim to generate a better understanding of private conservation practitioners and their various approaches to conservation on private and public land. We used an extensive review of literature and databases, in addition to 13 semi‐structured interviews with various private conservation practitioners, to map privately conserved areas, and to gather perceptions about challenges, opportunities, and future pathways for private conservation. A total of 590 privately conserved areas, covering over one million hectares, were identified and mapped in Madre de Dios. We find that, while most initiatives are managed by individuals and families, for‐profit companies manage half of the total area privately protected. Furthermore, we find that private conservation initiatives face significant barriers and pressures. These barriers include complex bureaucratic processes, legal contradictions and incoherencies, corruption, weak law enforcement, and financial insecurity. Conservation policies largely favor national and international actors and less so local, grassroots initiatives run by individuals and communities. Finally, we highlight the need for more accessible and inclusive policies that recognize the contribution of less powerful actors, to foster more effective conservation efforts for the future of the Amazon.

Social Adversities Associate with Worse Disease Control in Pediatric Celiac Disease

To characterize how social adversities influence disease control in children with celiac disease (CeD). We conducted a cross-sectional analysis of data from 325 eligible children ≤18years old with CeD enrolled between 2015 through 2023 into iCureCeliac, a patient-centered US registry for CeD. We evaluated the associations between financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity with 2 validated patient-reported outcomes on disease activity and gluten-free diet adherence: celiac symptom index and CeD adherence test, respectively. We used multivariable logistic and linear regression analysis to adjust for race, primary spoken language, and socioeconomic status. Among 325 children with available financial insecurity data, the median age was 11years (IQR 8, 15), 67% were female, and 88% were White. In multivariable logistic regression, the odds of elevated disease activity among children with financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity were 2.6 (95% CI 0.9, 8.0; P=.09), 2.8 (95% CI 1.6, 5.1; P<.001), 4.8 (95% CI 2.4, 9.8; P<.001), and 1.9 (95% CI 1.1, 3.3; P=.03), respectively. For insufficient dietary adherence, the respective odds were 1.6 (95% CI 0.5, 4.7; P=.43), 3.3 (95% CI 1.7, 6.5; P<.001), 2.9 (95% CI 1.5, 5.7; P=.002), and 2.3 (95% CI 1.2, 4.2; P=.01). Statistically significant associations in logistic regression aligned with results of linear models. Social stigmatization, decreased health knowledge, and mental health comorbidity were associated with worse disease control in pediatric CeD. Targeted interventions aimed at addressing these social adversities may improve disease activity and dietary adherence.

Mixed evidence concerning the effects of the hopeful mindset among mother and child in low-income families in Singapore

Having a hopeful mindset is believed to enable adaptation but much of the pertinent research was cross-sectional, focused on convenient samples, and examined normal circumstances. It is unclear whether hope can predict beneficial outcomes over time among people living in challenging life conditions, such as those in low-income families with protracted financial insecurity. We report a longitudinal study where hope and several psychological outcomes – reported health, self-esteem, and emotional distress – were measured three times across 12 months in mothers and their children in families on financial assistance in Singapore. The results were mixed as to hope’s adaptation effectiveness. Hope positively predicted reported health and self-esteem but not emotional distress over time among the children. It did not predict any outcome among the mothers. Hence, hope can be a resource that could enable children in these families to thrive, but its longer-term benefits for mothers appear less straightforward.