Financial Insecurity Research Articles

Individual and neighborhood-level factors associated with disruptions in patients with gynecologic cancers undergoing radiation treatment.

e13713 Background: Disparities in cancer health outcomes are driven in part by social determinants of health (SDOH). Health-related social needs (HSRN) are downstream modifiable manifestations of SDOH. It is critical to identify patients with HRSN who may benefit from early intervention to improve health outcomes. Methods: We identified all patients who received radiation treatment (RT) for gynecologic cancer at an urban, academic center from January 2021-August 2023 and completed HRSN screening. HRSN screening queries patients on food, housing, transportation, and financial insecurity as well as help reading hospital materials. We extracted demographic and clinical data, self-reported HRSNs, and separately screened each chart for additional evidence of transportation insecurity. We extracted area deprivation index (ADI), a measure of neighborhood level socioeconomic disadvantage, based on home address. Any RT disruption was the primary outcome. We compared patients with and without any RT disruption using Fisher’s exact tests. Univariate Poisson regression was used to examine the magnitudes of association between individual and neighborhood level factors and RT disruption. Results: A total of 127 patients met inclusion criteria. Median age was 62 (interquartile range 25%-75%: 53-71). Most (54%, n=69) patients were White, 32% were Black (n=41), and 14% were another race (n=17). Sixteen percent (n=20) reported at least one HRSN. Six percent of patients (n=8) resided in neighborhoods in the 81st-100th percentile ADI. A total of 26% (n=33) of patients had any RT disruption, and these patients differed on individual and neighborhood factors (Table). Patients with public insurance were 2.4 times as likely to have RT disruption compared to those with private insurance (95% confidence interval [CI]: 1.4-4.2). Self-reporting at least one HRSN was associated with a 2.3 times higher risk of RT disruption (95% CI: 1.31-4.11). Chart-derived evidence of transportation insecurity was associated with a 2.6 times higher risk (95%CI: 1.5-5.6) of RT disruption. Residing in a neighborhood with an ADI above the 80%ile was associated with a 3.3 times higher risk (95% CI: 2.0-5.5) of disruption. Conclusions: A variety of measures of SDOH both at the individual and neighborhood-level were associated with RT disruptions. While we did not have the power to perform multivariate analyses, our results suggest the ADI – which can be readily obtained from a patient’s home address – could help identify those patients most at risk of disruption to care. [Table: see text]

Die US-Variante des Kapitalismus erzeugt gesundheitsgefährenden chronischen Stress

Abstract Maximising output creates psychological stress as a negative externality. Focusing on bellweather indicators of economic performance while disregarding its effect on work-life balance, on income distribution, on insecurity, or the quality of life creates stress-ors that harm the human biological system. Stress in the US has been generated by debilitating poverty, financial insecurity, the highest level of inequality among rich countries, meager social safety nets that might have mitigated the turbulence of adjusting to the new knowledge economy, and the downward social mobility of millions disadvantaged by globalisation.

Sexual Orientation and Financial Well-Being in the United States

We study the relationship between financial well-being and sexual orientation in the United States using Survey of Household Economics and Decisionmaking (SHED) data for 2019-2022. We document that people who are lesbian, gay, and bisexual (or LGB) have significantly more difficulty managing financially than similarly situated heterosexual individuals—and this pre-dated the COVID-19 pandemic. Differences are found across a broad array of current and future financial well-being outcomes, including retirement savings, rainy-day funds, credit card and schooling debts, and the use of alternative financial services such as payday loans. Differences in partnership, financial assistance from parents, financial knowledge, and risk preferences cannot explain these differences. Instead, we document that some social vulnerabilities such as exposure to discriminatory behavior and violence are differentially experienced by LGB people, which may play a role. Our results demonstrate that people who are lesbian, gay, and bisexual experience significantly more financial insecurity than previously understood.

BUILDING PEOPLE’S RESILIENCE: SUPPORT MECHANISMS AND POST-RETIREMENT WELL-BEING OF RETIREES IN LAGOS STATE

This study examined the support mechanisms that are available to enhance the post-retirement well-being of Lagos State Civil Service retirees. Using the descriptive survey research design and the purposive/snowball sampling technique, 671 retirees were selected as respondents for this study. Collected and collated data were analyzed using descriptive statistical techniques such as tables, frequencies, and bar charts. Four research questions were stated and findings from research question one revealed that the challenges faced by Lagos State Civil Service retirees encompass financial insecurity, health deterioration, loss of routine, emotional adjustment, lack of purpose, and social isolation. Equally, research question two found that most retirees rely strongly on pensions for financial security. Research question three brought to the fore that 98.4% of the respondents observed that the existing support mechanisms during the transition to retirement are not adequate at all, and research question four indicated that retirees want assistance in financial planning, improved healthcare, lifelong learning opportunities, a centralized information portal, active feedback mechanisms, and housing assistance. Based on these findings, this study concludes that the current support mechanisms are grossly inadequate underscores a critical gap between provided services and the actual needs of the retired populace. Thus, the study recommends amongst others that the Lagos State Civil Service should implement a multi-faceted approach that addresses the diverse needs (i.e., financial education, healthcare accessibility, mental health and social reintegration services, lifelong learning, and volunteer programmes and centralized information portal) of its retirees.

Classifying Individuals With Rheumatic Conditions as Financially Insecure Using Electronic Health Record Data and Natural Language Processing: Algorithm Derivation and Validation.

We aimed to examine the feasibility of applying natural language processing (NLP) to unstructured electronic health record (EHR) documents to detect the presence of financial insecurity among patients with rheumatologic disease enrolled in an integrated care management program (iCMP). We incorporated supervised, rule-based NLP and statistical methods to identify financial insecurity among patients with rheumatic conditions enrolled in an iCMP (n = 20,395) in a multihospital EHR system. We constructed a lexicon for financial insecurity using data from available knowledge sources and then reviewed EHR notes from 538 randomly selected individuals (training cohort n = 366, validation cohort n = 172). We manually categorized records as having "definite," "possible," or "no" mention of financial insecurity. All available notes were processed using Narrative Information Linear Extraction, a rule-based version of NLP. Models were trained using the NLP features for financial insecurity using logistic, least absolute shrinkage operator (LASSO), and random forest performance characteristic and were compared with the reference standard. A total of 245,142 notes were processed from 538 individual patient records. Financial insecurity was present among 100 (27%) individuals in the training cohort and 63 (37%) in the validation cohort. The LASSO and random forest models performed identically and slightly better than logistic regression, with positive predictive values of 0.90, sensitivities of 0.29, and specificities of 0.98. The development of a context-driven lexicon used with rule-based NLP to extract data that identify financial insecurity is feasible for use and improved the capture for presence of financial insecurity with high accuracy. In the absence of a standard lexicon and construct definition for financial insecurity status, additional studies are needed to optimize the sensitivity of algorithms to categorize financial insecurity with construct validity.

Family Stress Processes Underlying COVID‐19–Related Economic Insecurity for Mothers and Fathers and Children's Internalizing Behaviour Problems

ABSTRACTCOVID‐19 and its economic fallout have resulted in unprecedented financial insecurity and material hardship for many American families, with a disproportionately negative impact on children and families from socioeconomically disadvantaged contexts. The current study applied the family stress model to examine the family processes underlying pandemic‐related economic insecurity and children's internalizing behaviours. Online survey data from an economically diverse sample of mothers and fathers, who experienced at least one type of pandemic‐related economic insecurity in the United States (N = 259), were collected across two longitudinal time points in the early weeks of COVID‐19: (1) 14 April and (2) 30 April of 2020. Parental depressive symptoms, negative partner relationship quality and harsh parenting were tested as mediators. Results from the path model showed that pandemic‐related economic insecurity was associated with higher levels of parental depressive symptoms, which were then associated with higher levels of negative partner relationship quality. Negative partner relationship quality was subsequently associated with more harsh parenting, which was then associated with increased child internalizing behaviours. Indirect effects were found for all hypothesized mediators. The family stress model can be applied and extended to the early COVID‐19 period. Child and family social work implications include targeting parents' mental health, relationship quality and parenting behaviours, as well as directly addressing financial and material hardship, to mitigate the adverse effects of pandemic‐related economic insecurity on children's mental health.

Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania.

More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.

Pediatric psychoSocial Risk Index: Factor Analysis and Item Reduction Study.

The Pediatric psychoSocial Risk Index (PSRI) is psychosocial risk screening instrument for health practitioners. The objective of this study was to confirm validity evidence of a truncated version of PSRI. PSRI was completed initially by 100 parents of children aged 0 to 18 years admitted to a tertiary hospital; 50 parents repeated the PSRI 3 days later. Analysis includes principal component analysis (PCA) to include the least number of items that explain the most variance in a shortened version of PSRI as well as confirming test-retest reliability and internal consistency of the shortened instrument. PSRI originally had 86 items, 85 close-ended items were analyzed. Three items were excluded because of missing test-retest data. Item reduction resulted in truncation of 16 items; 66 items remained. A Kaiser-Mayer-Orkin test of sampling adequacy resulted in reduction of 14 items; 52 items remained. Initial PCA led to reduction of 26 items. The PCA was rerun on remaining items, resulting in reduction of 6 further items; 18 items remained. Two items with >10% missingness were removed leaving 16 items in the final PSRI. Test-retest reliability was 0.98 and mean within-person across-item reliability was 0.95. Cronbach α was 0.9. Remaining items represented 9 social risk themes: food insecurity, medical complexity, home environment, behavioral issues, financial insecurity, parenting confidence, parental mental health, social support, and unmet medical needs. PSRI was reduced from 86 to 16 items with high internal consistency and reliability. PSRI demonstrates adequate validity supporting practitioners to screen families about their psychosocial risk.

Food insecurity and epigenetic aging in middle-aged and older adults

BackgroundFood insecurity is recognized as a key social determinant of health for older adults. While food insecurity has been associated with morbidity and mortality, few studies have examined how it may contribute to accelerated biological aging. A potential mechanism by which food insecurity may contribute to aging is via epigenetic alterations. We examined the relationship between food insecurity and epigenetic aging, a novel measure of biological aging, in a nationally representative sample of middle-aged and older adults in the United States. MethodsCross-sectional analysis of adults 50 years of age and older from the 2016 Health and Retirement Study (HRS). Financial food insecurity was self-reported via two questions that ascertained having enough money for food or eating less than they felt they should. Epigenetic aging was measured via epigenetic clocks based on DNA methylation patterns that predict aging correlates of morbidity and mortality. Linear regressions were performed to test for differences in the epigenetic clocks, adjusting for biological, socioeconomic, and behavioral factors. ResultsThe analysis consisted of 3875 adults with mean age of 68.5 years. A total of 8.1% reported food insecurity. Food insecurity was associated with several characteristics, including younger age, race/ethnic minority, lower income, total wealth, and educational attainment, higher BMI, and less physical activity. Food insecurity was associated with accelerated epigenetic aging compared to food security, as measured via second (Zhang, PhenoAge, GrimAge) and third (DunedinPoAm) generation epigenetic clocks. In particular, food insecurity remained significantly associated with accelerated Zhang (B = 0.09, SE = 0.03, p = 0.011) and GrimAge (B = 0.57, SE = 0.24, p = 0.022) in the fully adjusted models. ConclusionsFood insecurity is associated with accelerated epigenetic aging among middle-aged and older adults in the United States. Food insecurity may contribute to DNA methylation alterations across the genome and biological age acceleration. These findings add to a growing understanding of the influence of socioeconomic status on the epigenome and health in aging.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Visualising the 2020s UK cost‐of‐living crisis

Visualising the 2020s <scp>UK</scp> cost‐of‐living crisis

The good manager in TV: tales for the Twenty-first century

The UK Creative Industries provide meaningful employment to more than two million people (Creative Industries Council, 2022) with opportunities for self-actualisation and satisfaction beyond what many jobs can provide. This is so particularly within the television industry where, since 2015, new streaming services have massively expanded demand for content and consequently employment. Such opportunities, however, have been heavily dependent upon a freelance workforce, whose experience is often characterised by financial insecurity, poor work-life balance, and lack of coherent career structure or support, within a system that predicates against diversity. This article sets out to address some of these issues and their solutions by offering, and problematising, the concept of ‘The Good Manager in TV’. In 2021 the authors followed-up an earlier survey of management practices in unscripted TV production across the UK with a series of in-depth interviews with individuals who, in another context, would be characterised as ‘middle managers’. Our data suggests that the challenges faced by the would-be good manager in TV can seem overwhelming, evoking the predicament of Brecht’s Good Person of Szechwan. Yet it also points to solutions to those challenges. This article reviews our findings in order to answer the following questions: What does it mean to be a good manager in the volatile, project-based, context of TV production? What are the challenges faced by those who aspire to fill the role? How can such challenges be addressed across this evolving creative industry?

Wellbeing and collective grievances among farmers: The case of Flanders, Belgium

Media coverage and policy at both national and EU level is increasingly paying attention to how farming populations in multiple countries in Europe are facing problems in terms of wellbeing. Similar attention is also being paid to this issue in Flanders (Belgium), although research data on this problem is lacking. The present study fills this gap by investigating what type of stressors farmers are experiencing in their daily activities. Through qualitative interviews (15) and focus group discussions (9), reaching 81 Flemish farmers, 2 categories of stressors are identified as negatively impacting on farmers wellbeing. The first category encompasses regulations and administrative burdens which are understood to be increasingly strict and complex, adding to workload and reducing the autonomy of the farmer. A second category relates to financial insecurity, including points such as anxieties as to the overall future of the farm enterprise and price volatility. These stressors and their direct impact can also be retrieved in other countries.In addition to these findings, this article will argue that these stressors are inextricably tied to perceptions by Flemish farmers about a changing socio-political climate that is understood to be increasingly anti-farming. Throughout the individual and group interviews on stress and wellbeing, a discourse emerges about a lack of societal respect towards farming in which farmers express increasingly feeling alienated from society. Hence, these individual stress factors cannot be detached from a set of collective grievances about the place of farmers as a professional group in the larger societal fabric. The point on regulations and administrative burdens is put in a framework wherein farmers indicate increasingly being misunderstood and disrespected. A specific symbol of contention in this regard are so-called ‘green regulations’ centred around biodiversity, animal welfare, climate … The issue of financial insecurity is tied to a larger moral critique wherein society supposedly no longer wishes to pay a fair price for honest labour and healthy food products.

Exploring the Socio-economic Realities of Shatranji Workers in Rangpur

The Shatranji industry in Rangpur, Bangladesh, is a vital traditional craft and a Geographical Indication (GI) product, supporting around 50,000 families. This study examines the socio-economic conditions of Shatranji workers based on a qualitative survey of 115 workers, all of whom are women. The findings reveal that most workers are 30–40 years old, have limited education, and belong to low-income families. They earn modest wages, with the majority earning less than 100 takas daily, and live in poor housing conditions. Financial insecurity is widespread, with 67% of workers lacking savings or loans. Despite these challenges, there is a strong emphasis on education for their children. Unemployment rates within families are high, yet workers generally perceive their workplaces as safe. However, improvements in living conditions have been minimal, and nutritional intake remains inadequate. The study highlights the need for targeted interventions, including wage increases, job security, improved healthcare, and financial literacy programs. These recommendations aim to enhance the socio-economic status of Shatranji workers and ensure the sustainability of this culturally significant industry.

Microglial function interacts with the environment to affect sex-specific depression risk

There is a two-fold higher incidence of depression in females compared to men with recent studies suggesting a role for microglia in conferring this sex-dependent depression risk. In this study we investigated the nature of this relation. Using GWAS enrichment, gene-set enrichment analysis and Mendelian randomization, we found minimal evidence for a direct relation between genes functionally related to microglia and sex-dependent genetic risk for depression. We then used expression quantitative trait loci and single nucleus RNA-sequencing resources to generate polygenic scores (PGS) representative of individual variation in microglial function in the adult (UK Biobank; N = 54753–72682) and fetal (ALSPAC; N = 1452) periods. The adult microglial PGS moderated the association between BMI (UK Biobank; beta = 0.001, 95 %CI 0.0009 to 0.003, P = 7.74E-6) and financial insecurity (UK Biobank; beta = 0.001, 95 %CI 0.005 to 0.015, P = 2E-4) with depressive symptoms in females. The fetal microglia PGS moderated the association between maternal prenatal depressive symptoms and offspring depressive symptoms at 24 years in females (ALSPAC; beta = 0.04, 95 %CI 0.004 to 0.07, P = 0.03). We found no evidence for an interaction between the microglial PGS and depression risk factors in males. Our results illustrate a role for microglial function in the conferral of sex-dependent depression risk following exposure to a depression risk factor.

The Psychosocial, Organizational, and Environmental Stressors Experienced by Food Service Workers in a Hospital Setting During the COVID-19 Pandemic.

To identify stressors faced by hospital food service workers amid the COVID-19 pandemic and effective interventions mitigating these stressors. Methods: In this cross-sectional study, we conducted surveys ( n = 305) and interviews ( n = 9) in the summer and fall of 2022 with employees in hospital settings to determine the psychosocial, organizational, and environmental stressors they faced during the COVID-19 pandemic and interventions that improved health and well-being. Findings: The main stressors reported were fear of infection, increased work demands and schedule unpredictability, and financial insecurity. Employee well-being was bolstered by regular, clear, bidirectional communication; a sense of community and purpose; benefits like paid sick leave and health insurance coverage; and organizational policies that included masking and vaccine requirements demonstrating commitment to protecting worker health. Conclusion: Organizations can play a critical role in guarding the health, well-being, and resilience of frontline workers.

A Constitutional Right to a Universal Basic Income

This article explains how a legal argument for a constitutional right to a universal basic income (UBI) in the United States could be constructed. My aim is to move the idea of a constitutionally-required UBI from the implausible to the plausible, suggesting that it is less far-fetched than it may initially appear to be. In Dworkinian terminology, everyone is entitled to equal concern and respect under the Constitution. Judges can read its abstract language morally when they decide real constitutional cases to make the country more just. In egalitarian liberalism, the quality of a person’s life must not depend on financial circumstances that are mostly beyond her control and the government must protect the most vulnerable members of society from financial insecurity to enhance their personal autonomy. I reduce the sharp distinction between positive and negative rights in contemporary constitutional doctrine by elaborating on how the U.S. Constitution, and the case law that has glossed it over time, can establish a constitutional right to a UBI. A constitutional right to a UBI is morally justified and constitutionally possible; it is only implausible inasmuch as the timing is far from ideal.

Was there a way out?: Nexus among domestic violence, stressors, and resources During COVID-19 among the urban middle-class families in Bangladesh

This article examines how different stressors created and aggravated by COVID-19 put urban middle-class families in a situation that leads to domestic violence, particularly in the unavailability of resources to deal with the stressors. A mixedmethod approach with an online questionnaire survey, in-depth interviews, and key informant interviews has been applied for a detailed understanding of the experiences of pandemic-induced stressors and the risk of domestic violence. Based on the Exosystem Factor Theory, the findings resonate that the pandemic created several stressors in urban middle-class families, including fear and anxiety, financial insecurity, gender role stress, disturbed interpersonal relationships, and disrupted support systems. This study further demonstrates that these stressors lead to domestic violence, where external and internal resources, such as alternative financial support, personal traits, women’s agency, rehabilitation support, and government and community support, do not appear to mediate the stressors.&#x0D; Social Science Review, Vol. 40(2), December 2023 Page 1-22

The Fragile Home of a Precarious Girl: A Butlerian Study of Tennessee Williams’s The Glass Menagerie. Part One

The present article aims to explore Butler’s notion of precarity in Williams’s The Glass Menagerie. Agencies that induce precarity in characters of the play, Laura in particular, reaction to the repercussions of precariousness and the ways it leads to a new identity are also put under scrutiny. In the last decades, feminist and gender studies, with all their subcategories and subdivisions, have been one of the main concerns and interests in literary criticism as well as in social and cultural studies. A highly influential scholar in feminist and gender studies is Judith Butler. Normative power and gender related issues are sustained motifs throughout the study, which addresses the following questions: What are the roots of Laura’s feeling of precarity? How does her precarity affect and inflict those around her? How does she cope with or respond to her sense of precarity? To answer these questions, the researcher will draw upon Butler’s conception of precarity and precariousness and will focus on such key terms as femininity, patriarchy, pipe dreams, physical impairment, regulative system, and financial insecurity. This section of the article is divided into three main parts, namely, “Introduction,” “Theoretical Framework,” and “Analysis,” which comprises “Femininity” and “Disability.”

The association between allostatic load and guaranteed annual income using the Canadian Longitudinal Study on Aging: A cross-sectional analysis of the benefits of guaranteed public pensions

BackgroundOld Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians. MethodsUsing data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load. ResultsReceiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95 % CI: 0.227, 0.696; ORF: 0.677, 95 % CI: 0.483, 0.949). DiscussionWhile longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.