Greater Household Income Research Articles

The absence of formal work experience may affect the rate of cognitive decline in older adult women: findings from the health and retirement study.

This study investigated the relationship between years of employment and cognitive health among older non-Latinx Black, Latinx, and non-Latinx White women. We hypothesized that women who had never been formally employed (i.e., zero years of formal work experience) would exhibit a pronounced cognitive decline. Our study included 5,664 older adult women from the Health and Retirement Study (2010-2016) aged 65-101 (M = 75.41). Out of 5,664 participants, 850 identified as non-Latinx Black, 475 identified as Latinx, and 4,339 identified as non-Latinx White. Furthermore, 5,292 women indicated having a professional employment history of at least one year, whereas 372 women reported no formal work experience. The Telephone Interview for Cognitive Status-27 (TICS-27) was used to assess cognitive performance. Linear mixed effects models were conducted to assess whether employment history was associated with the rate of cognitive decline. In all three racial and ethnic groups, lower age, higher education, greater number of years worked, fewer chronic conditions, and greater household income were associated with better cognitive performance at baseline (p < .05). Additionally, women who had not worked in any formal capacity had a lower baseline cognitive performance (p < .001) and a more extreme decline in cognitive performance over time (p = .04). In conclusion, we found that women without any formal work experience performed lower at baseline and experienced a steeper cognitive decline over time. These findings underscore the need to further explore the complex interrelationships between employment duration and cognitive trajectories, especially among older women and those from different racial and ethnic backgrounds.

Problematic Alcohol Use Trajectories in U.S. Military Veterans during a Public Health Crisis: Results from a 3-year, Nationally Representative, Longitudinal Study.

A growing number of studies have examined alcohol use during the COVID-19 pandemic. However, few longitudinal studies evaluated the prevalence and correlates of different trajectories of problematic alcohol use in vulnerable segments of the population, such as US veterans, over the 3-year course of the COVID-19 pandemic.Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 2,441 US veterans. Latent growth mixture modeling was used to identify the trajectories and correlates of problematic alcohol use.Four trajectories were identified: consistent (N = 170, weighted 7.2%), decreasing (N = 38, weighted 2.2%), increasing (N = 22, weighted 1.2%), and low (N = 2,211, weighted 89.4%) problematic alcohol use. Greater household income, pre-pandemic drug use disorder (DUD), lower social support, and COVID-19 infection to self or non-household members were associated with an increasing relative to decreasing problematic alcohol use trajectory. Greater household income, adverse childhood experiences (ACEs), pre-pandemic DUD, lower social support, and greater COVID-related social restriction stress were associated with an increasing relative to a low problematic alcohol use trajectory. Younger age, male sex, ACEs, pre-pandemic DUD, lower pre-pandemic and greater decline in protective psychosocial characteristics, COVID-19 infection to non-household member, and lower COVID-related financial stress were associated with a consistent relative to a low problematic alcohol use trajectory. Overall, pre-pandemic greater income, DUD, and lower social support were associated with an increase in problematic alcohol use among US veterans during the COVID-19 pandemic. Results may help inform prevention efforts to mitigate problematic alcohol use during prolonged crises in this population.

RELATIONSHIP BETWEEN LEISURE CONSTRAINTS AND WELL-BEING IN MIDDLE TO OLDER ADULTS

Abstract Leisure activity engagement is correlated with several health outcomes, such as depression, a lower risk of dementia and better physical health. However, older adults report experiencing leisure constraints in daily lives due to intrapersonal (e.g., stress), interpersonal (e.g., interaction with friends) and structural factors (e.g., availability of opportunity). Since relatively few research investigated the impact of leisure constraints on middle and older adults’ eudaimonic well-being, the major aim of this study was to explore whether perceived leisure constraints are uniquely associated with eudaimonic well-being after adjusting for sociodemographic, loneliness, health and neighborhood covariates. This study accessed leisure constraints using Leisure Barriers and Interest Questionnaire, and accessed eudaimonic well-being by 4 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire among 378 adults (age range: 40-92, M = 58.4). Correlation results indicated that better well-being was correlated with less perceived leisure constraints (r = -.40, p &amp;lt; .01), greater household income (r = .14, p = .01), less reported loneliness (r = -.53, p &amp;lt; .01), greater reported neighborhood safety (r = -.18, p &amp;lt; .01), and better reported neighborhood quality (r = .23, p &amp;lt; .01). Linear regressions revealed that individuals who perceived a lower level of leisure constraints associated with better well-being (β = -0.20, p &amp;lt; .01) after adjusting for age, sex, income, health conditions, loneliness, and neighborhood quality and safety. Our results highlight the importance of reducing leisure constraints in intrapersonal, interpersonal and structural levels to help older adults live a meaningful and happy life.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors.

To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years. Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership. Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (β estimate, 3.437; P = 0.001) and quality of life (β estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (β estimate, 1.970; P = 0.035), greater household income (β estimate, 94.615; P < 0.001), and greater parental total PA (β estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group. These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Associations between socioeconomic gradients and racial disparities in preadolescent brain outcomes.

The aim of this study was to determine the extent to which socioeconomic characteristics of the home and neighborhood are associated with racial inequalities in brain outcomes. We performed a cross-sectional analysis of the baseline dataset (v.2.0.1) from the Adolescent Brain and Cognitive Development (ABCD) Study. Cognitive performance was assessed using the National Institutes of Health Toolbox (NIH-TB) cognitive battery. Standard socioeconomic indicators of the family and neighborhood were derived from census-related statistics. Cortical morphometric measures included MRI-derived thickness, area, and volume. 9638 children were included. Each NIH-TB cognitive measure was negatively associated with household and neighborhood socioeconomic characteristics. Differences in cognitive scores between Black or Hispanic children and other racial groups were mitigated by higher household income. Most children from lowest-income families or residents in impoverished neighborhoods were BlackorHispanic. These disparities were associated with racial differences in NIH-TB measures and mediated by smaller cortical brain volumes. Neighborhood socioeconomic characteristics are associated with racial differences in preadolescent brain outcomes and mitigated by greater household income. Household income mediates racial differences more strongly than neighborhood-level socioeconomic indicators in brain outcomes. Highlighting these socioeconomic risks may direct focused policy-based interventions such as allocation of community resources to ensure equitable brain outcomes in children. Neighborhood socioeconomic characteristics are associated with racial differences in preadolescent brain outcomes and mitigated by greater household income. Household income mediates racial differences more strongly than neighborhood-level socioeconomic indicators in brain outcomes. Highlighting these disparities related to socioeconomic risks may direct focused policy-based interventions such as allocation of community resources to ensure equitable brain outcomes in children.

Wealthy, educated, and… non-millennial? Variable patterns of distributional inequity in 31 Canadian cities

This article assesses the distribution of urban vegetation in 31 Canadian cities to determine whether certain social-economic/demographic factors are associated with increased proximity to greenness. Using spatial lag models, Canadian census data, and urban ‘greenness fractions’ derived from Landsat imagery, we find diversity between cities in the factors associated with increased urban vegetation. This makes it difficult to establish a single overarching narrative about the state of environmental justice and green equity as it pertains to proximity to vegetation in Canadian cities. Factors such as greater household income and educational attainment were positively associated with proximity to vegetation in numerous cities, while the proportion of millennials was often negatively associated. Variables including the proportion of visible minorities, Indigenous people, and recent immigrants infrequently had significant associations with urban vegetation. These results highlight the need for planning and management actions tailored to individual Canadian cities to improve green equity for marginalized and underserved groups. We discuss the need for funding for greening initiatives and maintenance; democratic participation, engagement, and education opportunities for residents; urban planning that considers the challenge of greening dense environments; and consideration of potential negative outcomes of greening, such as gentrification, to improve green equity in Canadian cities.

Inflated lives and a clean tech privilege in Washington State: Policy amidst spatialized affluence

In this study, we analyze policy and the socio-spatial distribution of clean technology privilege—electric vehicles (EVs)—in Washington State. We examine EV penetration in relation to zip code variables like social demographics and population density. Data was acquired from the US Census and Washington State’s vehicle registry (N = 576). After regression and geographic analyses, we find that median income, an Inflated Life Proxy (ILP), and education have the highest associations with EV concentrations. The ILP was constructed by dividing zip code median home values by median incomes. We also find associations between EV penetration and the distribution of broadband internet. As the highest EV adoption shares are found in areas of the highly educated and affluent—a clean tech privilege—we argue that, despite years of state and federal incentives, EV diffusion in Washington State has not progressed beyond early adoption. As the association between greater household income and greenhouse gas emissions is well established, we urge decision makers toward more progressive economic policies—consumption, wealth, and income taxes—in order to direct civil society towards greater economic moderation and equality, generally. If only consumers with a clean tech privilege are adopting EVs, then current emission reduction strategies may be annulled by the otherwise high carbon lifestyles of the affluent.

Assessment of Neighborhood Poverty, Cognitive Function, and Prefrontal and Hippocampal Volumes in Children

The association between poverty and unfavorable cognitive outcomes is robust, but most research has focused on individual household socioeconomic status (SES). There is increasing evidence that neighborhood context explains unique variance not accounted for by household SES. To evaluate whether neighborhood poverty (NP) is associated with cognitive function and prefrontal and hippocampal brain structure in ways that are dissociable from household SES. This cross-sectional study used a baseline sample of the ongoing longitudinal Adolescent Brain Cognitive Development (ABCD) Study. The ABCD Study will follow participants for assessments each year for 10 years. Data were collected at 21 US sites, mostly within urban and suburban areas, between September 2019 and October 2018. School-based recruitment was used to create a participant sample reflecting the US population. Data analysis was conducted from March to June 2019. NP and household SES were included as factors potentially associated with National Institutes of Health Toolbox Cognitive Battery subtests and hippocampal and prefrontal (dorsolateral prefrontal cortex [DLPFC], dorsomedial PFC [DMPFC], superior frontal gyrus [SFG]) volumes. Independent variables were first considered individually and then together in mixed-effects models with age, sex, and intracranial volume as covariates. Structural equation modeling (SEM) was used to assess shared variance in NP to brain structure and cognitive task associations. The tested hypotheses were formulated after data collection. A total of 11 875 children aged 9 and 10 years (5678 [47.8%] girls) were analyzed. Greater NP was associated with lower scores across all cognitive domains (eg, total composite: β = -0.18; 95% CI, -0.21 to -0.15; P < .001) and with decreased brain volume in the DLPFC (eg, right DLPFC: β = -0.09; 95% CI, -0.12 to -0.07; P < .001), DMPFC (eg, right DMPC: β = -0.07; 95% CI, -0.09 to -0.05; P < .001), SFG (eg, right SFG: β = -0.05; 95% CI, -0.08 to -0.03; P < .001), and right hippocampus (β = -0.04; 95% CI, -0.06 to -0.01; P = .01), even when accounting for household income. Greater household income was associated with higher scores across all cognitive domains (eg, total composite: β = 0.30; 95% CI, 0.28 to 0.33; P < .001) and larger volume in all prefrontal and hippocampal brain regions (eg, right hippocampus: β = 0.04; 95% CI, 0.02 to 0.07; P < .001) even when accounting for NP. The SEM model was a good fit across all cognitive domains, with prefrontal regions being associated with NP relations to language (picture vocabulary: estimate [SE], -0.03 [0.01]; P < .001; oral reading: estimate [SE], -0.02 [0.01]; P < .001), episodic memory (picture sequence: estimate [SE], -0.02 [0.01]; P = .008), and working memory (dimensional card sort: estimate [SE], -0.02 [0.01]; P = .001; flanker inhibitory control: estimate [SE], -0.01 [0.01]; P = .01; list sorting: estimate [SE], -0.03 [0.01]; P < .001) and hippocampal regions being associated with NP associations with language (picture vocabulary: estimate [SE], -0.01 [0.004]; P < .001) and episodic memory (picture sequence: estimate [SE], -0.01 [0.004]; P < 0.001). In this study, NP accounted for unique variance in cognitive function and prefrontal and right hippocampal brain volume. These findings demonstrate the importance of including broader environmental influences when conceptualizing early life adversity.

A-026 Older Adults’ Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Age, Geographic Location, and Income

Abstract Objective Recent implementations of teleneuropsychological services allow cognitive assessment to take place within the individual’s home. Geographic location and financial resources may influence older adults’ decision to access these services. Additionally, the likelihood of older adults’ participation in home-based cognitive assessment (HBCA) is unknown. We aimed to examine the relationship between age, geographic location, income, and likelihood of participation in HBCA. Method A nation-wide sample of 483 adults ages 50–79 completed an online survey via the crowdsourcing website Amazon Mechanical Turk. Respondents were asked about age, income and geographic location (e.g. rural, urban, suburban). Income was categorically measured in $20,000 increments. Likelihood of participation in HBCA was measured using 4 likert-scale items. Total likelihood was calculated by summing items. Results Perceived likelihood of participating in HBCA increased with greater household income, B = .087, p = .001 (0-20 K: M = 13.08 ± 4.19; 20-40 K: M = 14.76 ± 3.39; 40-60 K: M = 14.55 ± 3.49; 60–80 K: M = 14.55 ± 3.38; 80-100 K: M = 15.11 ± 2.83 and &amp;gt; 100 K: M = 15.48 ± 2.55). Likelihood decreased with age, B = −.061 p = .025 (50–59: M = 15.03 ± 3.56; 60–69: M = 14.31 ± 3.52, 70–79 M = 14.29 ± 3.27). Likelihood was not related to geographic location B = −.005, p = .933 (rural: M = 14.52 ± 3.84; suburban: M = 14.48 ± 3.31; urban: M = 14.48 ± 3.56). Conclusion Adults aged 50–59 with high income were the group most likely to participate in HBCA. Geographic location does not appear to play a role in acceptance of HBCA. However, this survey was conducted with online respondents. Different results may be obtained with in-person samples.

756-P: Socioeconomic and Self-Management Factors Do Not Explain Racial/Ethnic Disparities in Advanced Diabetes Technology Use among Young Adults (YA) with Type 1 Diabetes (T1D)

Recent studies demonstrate wide racial/ethnic disparity in insulin pump and continuous glucose monitor (CGM) use in people with T1D. It remains unknown whether socioeconomic status (SES) or other factors drive disparities. We recruited 300 diverse YA with T1D from 6 diabetes centers across the U.S. (ages 18-28; 33% non-Hispanic White, 32% non-Hispanic Black, 34% Hispanic; 52% public/no insurance; median A1c 9.2%). We used logistic regression to examine how patient-reported and chart-extracted variables, including multiple socioeconomic and individual-level factors, accounted for racial/ethnic disparity in current pump or ever CGM use. Compared with White YA (71/72%), both Black (18/28%) and Hispanic (37/39%) YA had significantly lower pump and CGM use, respectively (p&amp;lt;0.001). Pump and CGM users were more likely to have lower A1c levels, higher attained education, greater household income, lower neighborhood poverty, private insurance, higher diabetes numeracy and literacy, and receive care in a pediatric or combined pediatric-adult center (p&amp;lt;0.001). They were also more likely to report frequent self-monitoring of blood glucose and diabetes medical visit attendance (p&amp;lt;0.001). Full adjustment for these multiple SES, self-management, and care factors did little to explain racial/ethnic disparity. Compared with White YA, Black and Hispanic YA had persistent 50-80% lower odds of insulin pump use and Black YA had 70% lower odds of CGM use (OR (95% CI) Pump: Black 0.125 (0.050, 0.313), Hispanic 0.427 (0.176, 1.035); CGM: Black 0.291 (0.121, 0.702)). In contrast, these variables accounted for more of the CGM disparity between White and Hispanic YA (OR (95% CI) 1.007 (0.409, 2.483)). Exploration of factors other than SES and self-management is needed to examine disparity in diabetes technology use, especially in Black YA. Black and Hispanic YA preferences for technology and provider factors should be considered. Disclosure S. Agarwal: None. C. Schechter: None. J.S. Gonzalez: None. J.A. Long: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)

PINJAMAN TUNDA TEBANG HUTAN RAKYAT: SIAPA YANG MENGAKSES? (Studi Kasus: Hutan Rakyat di Bojonegoro)

Trees are important for rural people livelihood, because of its function as savings for urgent need. The recognition function of trees has increase by using it as collateral to access loan. The aim of this study is to discover the household and smallholder private forest characteristic that acces delaying timber harvesting loan for smallholder private forest (PTT-HR) in Bojonegoro, Indonesia as one of the loan scheme using trees as collateral initiate by Public Service Agency of Ministry of Environment and Forestry (BLU KLHK). About 170 farmers were involved in this study which is devided into two groups; debtors and non-debtors Result of this studies indicate that farmers accessing this loan are from prosperous farmer, which characterized by young aged, high education level, have the main job not as farmers, have greater household income, wider total area owned, forest relatively far from house, and do not having experience of logging. This condition also supported by the result of poverty level determination from World Bank which indicate only 27% farmer with poor condition who access this scheme. According to the perspective of formal lending institution, giving loan to prosperous farmer is not risky, but according to the program perspective this condition is less suited to poverty alleviation missions

Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health

ABSTRACT Background: Prenatal health disparities exist for African Americans and low socioeconomic status (SES) individuals when compared to non-Hispanic Whites and people of higher SES, particularly in cardio-metabolic diseases. Furthermore, having had a pregnancy-specific cardio-metabolic disease, e.g. preeclampsia, increases risk for future cardio-metabolic disease. Although these factors (race, SES and pregnancy cardio-metabolic disease) are interrelated, studies have rarely considered their combined effect on postpartum cardio-metabolic risk. The purpose of this study was to assess whether SES, race/ethnicity, and prenatal cardio-metabolic disease interact in the prediction of postpartum cardio-metabolic risk. Methods: A sample of 1,753 low-income women of African American, Latina, non-Hispanic White race/ethnicity was recruited after a birth in 5 US sites. Household income was used to categorize poverty status as Poor (< Federal Poverty Level; FPL), near poor (100–200% FPL), or low/middle income (> 200% FPL). Three prenatal cardio-metabolic disease diagnoses (preeclampsia, gestational hypertension, gestational diabetes) were identified from medical records. Four biomarkers (mean arterial pressure, glycosylated haemoglobin, total cholesterol:HDL ratio, and waist-hip ratio) were collected at 6 and 12 months postpartum, and combined into an average postpartum cardio-metabolic risk index. Maternal age, pre-pregnancy body mass index, parity, health behaviors and employment status were covariates. Results: Analyses revealed interactions of race/ethnicity, poverty status, and prenatal cardio-metabolic diseases in the prediction of postpartum cardio-metabolic risk. African American women had higher postpartum cardio-metabolic risk, which was exacerbated following a prenatal cardio-metabolic disease. Low/middle income African American women had higher cardio-metabolic risk compared to poor African American, and all Latina and White women. Conclusions: African American women, and especially those who experienced pregnancy complications, emerged as vulnerable, and greater household income did not appear to confer protection against worse postpartum cardio-metabolic risk for this group. These results highlight the complex interplay between socioeconomic status and race/ethnicity with respect to understanding health disparities.

Family Needs on an Inpatient Brain Injury Rehabilitation Unit: A Quantitative Assessment.

To examine the needs of family members in an inpatient setting and factors predicting extent to which needs are perceived as met. University health system inpatient rehabilitation unit. Adult survivors of traumatic brain injury and family members (n = 85). Prospective, cross-sectional. Family Needs Questionnaire-Revised (FNQ-R). Needs related to the Health Information subscale were most frequently rated as met, whereas needs related to the Instrumental Support and Emotional Support subscales were most frequently rated as unmet. Predictors related to the FNQ-R included family income, gender, and ethnicity. For 4 of 6 subscales, white family members were more likely to rate needs as unmet than minority members. For 3 subscales, females were more likely to rate needs as unmet than males. Greater household income was associated with fewer met needs for 2 subscales. The ranking of met and unmet needs in the present study was remarkably similar to previous studies within and outside the United States. Clinicians should not assume that families with relatively higher incomes will experience fewer unmet needs. Through structured assessment, clinicians can reveal perceived needs that might have otherwise been unrecognized and facilitate appropriate supports. Findings provide direction for inpatient program development.

Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study.

To identify sociodemographic and military characteristics of combat-exposed and non-combat-exposed veterans in the United States and to compare rates of mental and physical health conditions in these populations. Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative survey of 1,480 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured included lifetime and current psychiatric disorders and physical health conditions. A total 38% of US veterans reported being exposed to combat. Compared to noncombat veterans, combat veterans were younger, had greater household income, and served a greater number of years in the military; were more likely to be male, to have served in the Marine Corps, and to use the Veterans Affairs Healthcare System as their main source of health care; and reported a greater number of lifetime potentially traumatic events. After adjustment for these sociodemographic and military differences, combat veterans were more than 3 times as likely as noncombat veterans to screen positive for lifetime posttraumatic stress disorder (PTSD) and more than twice as likely for current PTSD and had 82% greater odds of screening positive for current generalized anxiety disorder. After additionally controlling for lifetime diagnoses of PTSD and depression, alcohol or drug use disorder, and nicotine dependence, combat veterans had 68% greater odds of having attempted suicide and 85% and 38% greater odds of being diagnosed with a stroke and chronic pain, respectively. Younger combat veterans were more likely than older combat veterans to screen positive for lifetime (30.6% vs 10.1%) and current PTSD (19.2% vs 4.9%) and suicidal ideation (18.6% vs 6.9%) and to have been diagnosed with migraine headaches (12.8% vs 2.1%), while older combat veterans were more likely than younger combat veterans to report having been diagnosed with heart disease (19.2% vs 2.6%) and heart attack (13.9% vs 2.5%). Compared to noncombat veterans in the United States, combat veterans have elevated rates of PTSD, suicide attempt, stroke, and chronic pain independent of other sociodemographic, military, and mental health factors. Younger combat veterans have elevated rates of PTSD, suicidal ideation, and migraine headaches, while older combat veterans have elevated rates of heart disease and heart attack. These results characterize the population-based burden of mental and physical health conditions in combat veterans. They further underscore the importance of age- and condition-sensitive screening, monitoring, and treatment efforts in this population.

The financial impact and drivers of hospital charges in contralateral prophylactic mastectomy and reconstruction: a Nationwide Inpatient Sample hospital analysis.

Rates of contralateral prophylactic mastectomy (CPM) have increased over the last decade; it is important for surgeons and hospital systems to understand the economic drivers of increased costs in these patients. This study aims to identify factors affecting charges in those undergoing CPM and reconstruction. Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample was undertaken (2009-2012), identifying women aged ≥18 with unilateral breast cancer undergoing unilateral mastectomy with CPM and immediate breast reconstruction (IBR) (CPM group), in addition to unilateral mastectomy and IBR alone (UM group). Generalized linear modeling with gamma regression and a log-link function provided mean marginal hospital charge (MMHC) estimates associated with the presence or absence of patient, hospital and operative characteristics, postoperative complications, and length of stay (LOS). Overall, 70,695 women underwent mastectomy and reconstruction for unilateral breast cancer; 36,691 (51.9%) in the CPM group, incurring additional MMHCs of $20,775 compared to those in the UM group (p<0.001). In the CPM group, MMHCs were reduced in those aged >60years (p<0.001), while African American or Hispanic origin increased MMHCs (p<0.001). Diabetes, depression, and obesity increased MMHCs (p<0.001). MMHCs increased with larger (p<0.001) hospitals, Western location (p<0.001), greater household income (p<0.001), complications (p<0.001), and increasing LOS (p<0.001). MMHCs decreased in urban teaching hospitals and Midwest or Southern regions (p<0.001). There are many patient and hospital factors affecting charges; this study provides surgeons and hospital systems with transparent, quantitative charge data in patients undergoing contralateral prophylactic mastectomy and immediate breast reconstruction.

Public Attitudes on Funding Oil Pollution Cleanup in the Chinese Bohai Sea

ABSTRACT Liu, X.; Pan, G. C.; Wang, Y. B.; Yu, X.; Hu, X. K.; Zhang, H., and Tang, C., 2016. Public attitudes on funding oil pollution cleanup in the Chinese Bohai Sea. The loss in value of coastal resources due to oil spills is difficult to determine as the degraded areas are typically neither bought nor sold and have no transaction history. We used a questionnaire by Liu et al. (2009) and Choice Experiments (CEs) methodology to place values on coastal resources including coastal water, beaches, and sea birds in the Chinese Bohai Sea. Survey results showed that during spill response actions, coastal water, and beaches were of equal concern to Chinese households while sea birds were of somewhat less concern. Respondents with higher education and fewer children and those with relatively greater household income were more likely to state they were willing to pay for oil spill cleanup costs. Age of respondent was negatively correlated to willingness to pay for cleanup. We also compared valuations of coastal ...

Urban Latino Families' Food Built Environment and Young Children's Produce Consumption.

This study explored the association between objective and subjective ratings of the food environment and child produce consumption for Latino preschoolers at-risk for obesity. Parental surveys (N = 115) assessed perceptions of food availability, affordability, and acceptability. Comparable factors were objectively rated by a trained observer, using the Nutrition Environment Measures Survey for Stores (NEMS-S), in commonly frequented grocery stores cited by participants. There were no significant correlations between objective and subjective measures of food availability, affordability, and acceptability. Greater household income was associated with higher participant perceptions of food acceptability (r = .33, p = .003) and affordability (r = .22, p = .04). Participant-perceived affordability of food was correlated with more frequent child fruit and vegetable consumption (r = .21, p = .03). These findings support that parental subjective ratings of the food environment affects their child's eating behaviors more than objective ratings.

The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents.

The use of dietary supplements (DSs) by children and adolescents is increasing. The aim of this study was to identify the characteristics of DS users and examine the nutritional contributions of DSs to total nutrient intakes in children and adolescents, using data obtained from a national survey. In total, 3134 subjects aged 9-18 years who participated in the 4th Korea National Health and Nutrition Examination Survey (2007-2009) were selected; the survey included 24-h recall questions on food intake and questions on DS use over the past year. Nutrient intakes from DSs were calculated using the aid of a label-based database on such supplements, and individual total nutrient intakes were derived by combining information on the foods and DSs consumed by each subject. There were 895 DS users (28.5%), 85.2% of whom (n=577) had complete DS nutrient information and were therefore defined as identified-DS users. Identified-DS users were slightly younger and had a greater household income and better nutritional knowledge than did non-users. The most frequently consumed type of supplement was a 'multivitamin and minerals' complex. For total nutrient intake, identified-DS users had a significantly higher intake of most of the nutrients, except for macronutrient and sodium than non-users. In all identified-DS users, the contribution of vitamins and minerals from DSs to total nutrient intake was higher than energy and macronutrients. DS use by children and adolescents can improve micronutrient status, but it also increases the risk of excessive intake of certain vitamins and minerals.

Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia.

BackgroundStudies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.MethodsAll new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients’ perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).ResultsDuring the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.ConclusionIn relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.

Determinants of household participation in the management of rural water supply systems: A case from Ethiopia

Access to safe drinking water supply in Ethiopia is among the lowest in sub-Saharan Africa. While both governmental and non-governmental organizations have implemented water supply projects in recent years, many fail shortly after construction due to improper management. In this paper, we examine socio-economic, institutional and exogenous factors affecting household participation in the management of water supply systems for drinking purposes. A survey was carried out involving 16 water supply systems and 160 households within the Achefer area, in the Amhara region, Ethiopia. The results show that household contributions to water supply system management are positively and significantly affected by user participation during the project design and implementation, by advocacy provided by the project and by greater household income. Thus, for drinking water systems in rural areas to be sustainable, these factors should be included when planning water supply projects.