Greater Poverty Research Articles

Forest Management Assessment Using LASSO and the Critical List of Variables for Sustaining the Commons: Four Cases in the Monarch Reserve

In the Monarch Reserve, four cases were selected for exploratory analysis using the critical list of variables for sustaining the commons and LASSO regression to determine which of these are most influential in the successful maintenance of forest cover over a decade. Forest recovery from degraded to dense forest is found to be inversely related to resource size, consistent with theory. However, in four other categories of forest change, the size of the resource is less influential, though it is still a significant, variable with a positive relationship to forest cover change which is inconsistent with theory. The analysis also showed that less overlap, greater poverty and lower dependence on the resource are associated both with forest gain and with mitigation of forest loss, which is contrary to theory and most research. Also associated with poverty in the LASSO regression are homogeneity of identity and ease of enforcement of rules. These show a negative relation to transitions from non-forest to dense forest, with low coefficients. This is inconsistent with theory. Possible reasons for the divergence from theory are discussed in detail, as is the utility of this approach for assessment and monitoring.

Association between mammographic screening history and stage at diagnosis among women with screen-detected breast cancer.

145 Background: Although screening mammography is an effective means of detecting breast cancer at earlier stages, some women are still diagnosed with later stage disease despite screening mammography. We hypothesized that screening history prior to diagnosis may impact stage at diagnosis and breast cancer mortality among women with screen-detected breast cancer. Methods: Retrospective cohort study of women aged 70+ in the SEER-Medicare database, diagnosed with ER+/HER2- breast cancer from 2010-2017, and enrolled in fee-for service Medicare Parts A and B from 5-years prior to diagnosis through 1 year after. We used validated claims-based algorithms to identify cancers that were detected by screening mammogram. We quantified 5-year screening history by number of prior screens. Stage at diagnosis was dichotomized into very early (T1N0) vs. later stage (T2+ or N+) disease. Multivariable logistic regression was used to assess the association between screening history and stage at diagnosis and Cox proportional hazards used to examine breast cancer mortality. Models were adjusted for demographic and clinical covariates associated with later stage disease in bivariate analyses. Results: We included 13,029 women with screen-detected breast cancer; 3,813 (29.27%) women had later stage disease at diagnosis, and 10,095 (77.48%) had at least one prior negative screening mammogram within the past five years. During this time, 2,359 (18.11%) women had only one prior mammogram, 3,132 (24.03%) had two, and 4,604 (35.34%) had three or four. Having at least one prior mammogram was associated with 56% lower odds of being diagnosed with later stage disease (OR: 0.44, 95% CI=0.40-0.48). Sociodemographic factors associated with increased odds of later stage disease included living in an area with greater poverty (20-100% vs. 0-5% of residents, OR: 1.19, 1.00-1.40), non-Hispanic Black race (OR: 1.18, 1.00-1.38), and Medicare/Medicaid dual eligibility (OR: 1.20, 1.06-1.36). Factors associated with later stage disease included living in an area with a more people with a high-school education (30-40% vs. 0-30% of residents, OR: 0.87, 0.77-0.97). At total of 696 deaths from breast cancer were observed, including 273 deaths among 2,935 women with no prior screening (9.3%) and 423 deaths among 10,097 women who had undergone screening within the past five years (4.2%, P < 0.001). Receiving at least one negative screening prior to diagnosis was associated with decreased breast cancer-specific Mortality in adjusted analysis (HR: 0.48, 0.40-0.57). Conclusions: The use of prior routine screening mammography was associated with lower risk of being diagnosed with later stage disease and dying from breast cancer in elderly women with screen-detected breast cancer. Future research is warranted regarding the impact of routine vs. sporadic screening on potential morbidity and mortality in this age group.

Abstract C021: Racial and socioeconomic disparities in molecular diagnostics for NSCLC patients

Abstract Background: Targeted therapies have substantially changed the landscape of non-small cell lung cancer (NSCLC) outcomes. These drugs work by inhibiting specific molecular pathways, such as the epidermal growth factor receptor (EGFR) tyrosine kinase, the anaplastic lymphoma kinase (ALK), KRAS, and BRAF oncogenic pathways. Approximately 30% of NSCLC patients will have tumors with eligible targetable mutations, but a molecular test must be conducted to assess eligibility to these treatments. Disparities in molecular testing could be partially responsible for the disproportionate utilization of targeted therapy across race and socioeconomic status (SES). Methods: Surveillance, Epidemiology and End Results (SEER)-Medicare linked data was queried for NSCLC patients diagnosed from 2013 (the first year that standard guidelines for molecular testing in lung cancer were available) to 2016. Patients were limited to age over 66 years at diagnosis with continuous Part A and B coverage and no Part C coverage, for 1 year prior and 90 days post-diagnosis. The primary outcome was receipt of a molecular test based on claims data. Race, defined as white, Black or other, was the primary predictor variable. Demographic and clinical characteristics of those receiving vs not receiving a molecular test were compared using χ2 tests for categorical variables and t-tests for continuous variables. We also performed multivariable logistic regression to assess the association of molecular testing with race adjusting for sex, age, marital status, Charlson comorbidity index, histology, tumor site, stage, and census-level poverty indicator. Results: There were 28,511 NSCLC patients, of which 9,639 (33.8%) received some type of molecular testing. Black patients were significantly less likely than white patients to have received a molecular test (p<0.0001). Only 23.9% of Black patients underwent any molecular testing, compared to 34.6% of white patients. Patients living in census tracts with at least 10% of residents living in poverty were also less likely to receive a molecular test (p<0.0001). Patients who were female (p<0.0001), married (p<0.0001), with fewer comorbidities (p<0.0001), adenocarcinoma histology (p<0.0001), tumors located in the lower lobe (p<0.0001), diagnosed at a later stage (p=0.0001) were more likely to have molecular testing. After adjustment, Black patients (ORadj [odds ratio]: 0.65; 95% CI [confidence interval]: 0.59-0.72) and those living in areas with greater poverty (ORadj: 0.87; 95% CI: 0.82-0.91) were statistically significantly less likely to have received molecular testing. Conclusions: Disparities exist in comprehensive molecular diagnostics, and could explain, at least in part, the high mortality observed among Black NSCLC patients. Addressing barriers to molecular testing could increase uptake of targeted therapy treatment, decreasing disparities and improving patient outcomes. Citation Format: Stephanie Tuminello, Wiley Turner, Matthew Untalan, Raja Flores, Emaneula Taioli. Racial and socioeconomic disparities in molecular diagnostics for NSCLC patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C021.

Racial and socioeconomic disparities in NSCLC molecular diagnostics uptake.

Precision therapies, such as targeted and immunotherapies, have substantially changed the landscape of late-stage non-small cell lung cancer (NSCLC). Yet utilization of these therapies is disproportionate across strata defined by race and socioeconomic status (SES), possibly due to disparities in molecular diagnostic testing (or "biomarker testing"), which is a prerequisite to treatment. We extracted a cohort of NSCLC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. The primary outcome was receipt of a molecular diagnostic test, based on claims data. The primary predictors were race and SES. Likelihood of receiving a molecular diagnostic test, and overall survival (OS), were investigated using logistic and Cox proportional hazards regression, adjusted for sex, age, residence, histology, marital status, and comorbidity. Of the 28,511 NSCLC patients, 11,209 (39.3%) received molecular diagnostic testing. Compared to White patients, fewer Black patients received a molecular diagnostic test (40.4% vs 27.9%; p < .001). After adjustment, Black patients (ORadj [odds ratio]: 0.64; 95% CI [confidence interval]: 0.58-0.71) and those living in areas with greater poverty (ORadj: 0.85; 95% CI: 0.80-0.89) had statistically significant decreased likelihood of molecular diagnostic testing. Patients who did receive testing had a statistically significant decreased risk of death (HRadj [hazards ratio]: 0.74; 95% CI: 0.72-0.76). These results held in the stratified analysis of stage IV NSCLC patients. Disparities exist in comprehensive molecular diagnostics, which is critical for clinical decision making. Addressing barriers to molecular testing could help close gaps in cancer care and improve patient outcomes.

Characteristics Associated With Homebound Vaccination Against COVID-19

ObjectivesHomebound patients are older and suffer from multiple comorbidities, and many experienced difficulties getting vaccinated because of their inability to routinely leave the home due to health and function. Home-based primary care (HBPC) programs offer vaccination at home to reach this high-risk population. We evaluated an urban HBPC program's COVID-19 vaccination campaign to explore whether home-based vaccination can reduce inequity in vaccine administration or improve vaccine efforts. DesignWe conducted a cross-sectional study to examine characteristics of homebound patients who were vaccinated through an HBPC program or were vaccinated elsewhere. Setting and ParticipantsWe analyzed 795 patients enrolled in the HBPC program who were eligible for vaccination at home in 2021. MethodsWe collected vaccination data from patients, demographic data from the electronic medical record, and neighborhood-level characteristics for each patient based on census tract. ResultsHomebound patients vaccinated by HBPC were significantly more likely than homebound patients vaccinated outside of the program to have a history of dementia (P = .003), live in public housing (P < .001), have Medicaid (P = .005), be enrolled in HBPC for longer (P = .03), and live in neighborhoods with higher proportions of immigrants (P = .022), lower English proficiency (P = .007), lower computer usage (P = .001), and greater poverty (P < .001). Conclusion and ImplicationsHome-based vaccination campaigns may help lower-resourced patients get vaccinated by mitigating logistic barriers and using the influence of trusted patient-provider relationships established through HBPCs.

United States Healthcare System

United States Healthcare System

Looking at maternal health of Asháninka communities from the conceptual framework of the accessibility of care

BackgroundPeru is one of the 20 countries that has significantly reduced maternal mortality before the pandemic due to implementing policies to strengthen maternal health care, mainly in rural areas with greater poverty. However, the implementation of these policies has been different across the territory; such is the case of the indigenous communities of the Peruvian Amazon that are characterized by the inaccessibility of their territory and continue to face severe problems in accessing maternity care in health services.ObjectiveAnalyze the main dimensions of accessibility for maternal care in public health services for women of the Asháninka community of Peru between 2016 and 2018.MethodsQualitative research was carried out in the Asháninka community of the Tambo River. Key informants involved in maternal health care were selected, and 60 in-depth interviews were conducted that explored geographical, financial, cultural, and organizational accessibility. The interviews were recorded and transcribed into a word processor; then, a content analysis was performed to classify the texts according to the dimensions of specified accessibility.ResultsGeographical accessibility: health units in the territory do not have the resolution capacity to attend maternal health problems. Financial accessibility: the programs implemented by the government have not been able to finance the indirect costs of care, such as transportation, which has high costs that a family cannot afford, given their subsistence economy. Cultural: there are efforts for cultural adaptation of maternal care, but its implementation needs to be improved, and the community cannot recognize it due to the lack of continuity of the model and the high personnel turnover. Organizational: health units are characterized by insufficient human resources, supplies, and medicines that fail to offer continuous and quality care.ConclusionsThe poor geographical, financial, cultural, and organizational accessibility that women from the Asháninka community face for maternal care in public health services are evident. So, the Peruvian government must review the implementation processes of its models of care and maternal health programs in these communities and propose strategies to improve the coverage, quality and continuity of maternal care.

FEATURES OF LATIN AMERICAN SOCIALISM ON THE EXAMPLE OF CHILE, BOLIVIA, VENEZUELA AND NICARAGUA

The article discusses the theoretical issues of the development of socialist ideology in Latin America, from the 60s of the twentieth century to the present. At the height of the Cold War, most of the states of this region belonged to the countries of the “third world” and found themselves in the sphere of strategic interests of the world superpowers. The example of Cuba and the support of the Soviet Union played an important role in the attempts to build a socialist society in Chile, Bolivia, Venezuela and Nicaragua. The article explores aspects similar for all these countries in the implementation of approaches to building an ideal model of socialism: the growth of social programs for the population, reliance on the poorest segments of the population and promotion among them of the idea of equality and struggle against external and internal enemies. Differences in approaches to the distribution of wealth among the population are also considered, starting from the nationalization of enterprises and latifundia in Chile, indigenism in Bolivia, Chavism in Venezuela and the redistribution of the wealth of the Somoza family in favor of the Sandinista Ortega in Nicaragua. Also, the Bolivarian Union plays a certain position in maintaining socialist sentiments. Radical left and moderate left governments currently operate in thirteen states of South America. Common to the countries considered in the article is the fact that even in the face of an attempt to build socialism in the 21st century, all left-wing radical governments leave behind the cult of “caudillos” and even greater poverty.

Lung Cancer Screening Among Mammography Patients: Knowledge, Eligibility, Participation, and Interest.

To determine lung cancer screening eligibility, knowledge, and interest and to quantify the effect of the expanded 2021 lung cancer screening eligibility criteria among women presenting for screening mammography, a group with demonstrable interest in cancer screening. A single-page survey was distributed to patients presenting for screening mammography, from January-March 2020 and June 2020-January 2021, at 2 academic medical centers on the East and West Coasts. The population served by the East Coast institution has greater poverty, greater ethnic/racial diversity, and lower education levels. Survey questions included age, smoking history, lung cancer screening knowledge, participation, and interest. Lung cancer screening eligibility was determined for both 2013 and 2021 USPSTF guidelines. Descriptive statistics were calculated, and data were compared between groups using the Chi-square test, Mann-Whitney nonparametric test, and the 2-sample t test. 5512 surveys were completed; 33% (1824) of women reported a history of smoking-30% (1656) former smokers and 3% (156) current smokers. Among women with a smoking history, 7% (127/1824) were eligible for lung cancer screening using 2013% and 11% (207/1824) using the 2021 USPSTF criteria. Interest in lung cancer screening was high (73%; 151/207) among eligible women using 2021 USPSTF criteria, but only 42% (87/207) had heard of lung cancer screening and only 28% (57/207) had received prior LDCT screening. Eligible screening mammography patients reported high levels of interest in lung cancer screening but low levels of knowledge and participation. Linking mammography and LDCT appointments may improve lung cancer screening participation.

The EU and the Western Balkans’ response during the migrant crisis

BackgroundThe European Green Deal does not consider the issue of migrant inclusion, nor are there specific data on the risk of migrants falling into energy poverty, social exclusion, and other data that could help create an effective policy that would be applied in this area. The main objective of this study is to assess the current status of the migrant population when it comes to risk from poverty (including energy poverty) and social exclusion in four (4) EU countries with the most significant influx of migrants.ResultsAn analysis included two main indicators aimed to describe level of risk of migrants to fall into energy poverty: (a) persons at risk of poverty or social exclusion by group of citizenship (population aged 18 and over, male and female); and (b) Migrant Integration Policy Index. The results revealed that foreign-born citizens have greater poverty or social exclusion risk. In 2020, citizens of Sweden that were not born in the EU28 had more than 360% greater chance than national citizens of being at risk of poverty (including energy poverty) or social exclusion. In France, foreign citizens were 340% more likely to be exposed to poverty than national citizens, while Germany records the highest rate: 250% in 2020. The United Kingdom rates demonstrate an increased 10% (2014–2018) difference in the risk of poverty (including energy poverty) or social exclusion for foreign citizens. In addition, results obtained by using the Migrant Integration Policy Index showed highest level of Anti-discrimination score is highest in Sweden, and lowest in Albania. On the other hand, Labor market mobility score is highest in Sweden, and lowest in Slovenia.ConclusionsBearing in mind the results of the research, the primary recommendations elaborated in the paper are as follows: (a) up-to-date collection and innovation of data for the migrant population (including data on energy poverty); (b) creation of conditions for more efficient employment of migrants; (c) adoption of special measures to protect migrants from energy poverty, and (d) strengthening of cooperation between the EU and to non-EU countries on the migrant route.

Understanding geographic and racial/ethnic disparities in mortality from four major cancers in the state of Georgia: a spatial epidemiologic analysis, 1999–2019

We examined geographic and racial variation in cancer mortality within the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. We analyzed county-level cancer mortality data collected by the Centers for Disease Control and Prevention on breast, colorectal, lung, and prostate cancer mortality among adults (aged ≥ 18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic white (NH-white) and NH-black race/ethnicity. Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: (1) eastern Piedmont to Coastal Plain regions, (2) southwestern rural Georgia area, or (3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-black adults, older adult population, greater poverty, and more rurality. In Georgia, targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-black race/ethnicity, low-income, and rural residents.

THEORETICAL AND METHODOLOGICAL FOUNDATIONS OF THE CONCEPT OF POVERTY

Special attention is being paid to adaptation of citizens to social, economic, and legal norms through communication with the people, which is the basis of reforms in our country. President Shavkat Mirziyoev said, "The greatest wealth is intelligence and knowledge, the greatest inheritance is good education, and the greatest poverty is ignorance. Therefore, for all of us, mastering modern knowledge, becoming the owner of true enlightenment and high culture should become a continuous vital need. Studying and reducing poverty in Uzbekistan requires specific measures. It is very important to study the experience of developed countries, analyze it, analyze factors such as the national mentality of our people, national education, social goals, natural conditions, climate, religious beliefs, and periodic changes.

Inequality in Peruvian neonatal mortality generated by poverty and education, 2011-2019.

This study aimed to analyze inequality in the neonatal mortality rate (NMR) between departments in Peru, generated by poverty and education, in the years 2011 and 2019. Ecological study based on the analysis of social inequalities in health, recommended by the World Health Organization. The health indicator was the NMR. Poverty, measured as the existence of at least one unmet basic need per department, and education, average years of study of women of childbearing age per department, were selected to stratify equity. We calculated the absolute inequality gap (AG), the relative inequality gap (RG) and the health concentration index (HCI). A higher NMR was found in departments with greater poverty and less education. In the NMR generated by poverty, the AG decreased from 8.13 to 2.24 between 2011-2019 and the RG from 2.08 to 1.31. The AG of the NMR according to education dropped from 4.50 to 2.31 and the RG from 1.62 to 1.28. The HCI registered values close to zero and with a decreasing trend; in 2019 it was 0.07 for poverty and 0.06 for education. There is inequality in neonatal mortality between departments in Peru according to poverty and education, which decreased between 2011 and 2019 mainly in the poor or less educated population. The Ministry of Health should continue to reduce neonatal mortality by promoting interventions with a greater population focus.

Abstract 5908: Understanding geographic and racial disparities in mortality from four major cancers in the state of Georgia: A spatial epidemiologic analysis, 1999 - 2019

Abstract Purpose of the study: Progress in cancer outcomes in the general population are not equitable among all populations, leaving some, such as rural and non-Hispanic Blacks (NH-Black) behind. We examined geographic and racial variation in cancer mortality in the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. Methods: We analyzed data on breast, colorectal, lung, and prostate cancer mortality among adults (aged &amp;gt;18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic White (NH-White) and NH-Black races. We assessed differences in county-level characteristics between hot spot and non-hot spot counties using Wilcoxon rank-sum test and Spearman correlation and stratified all analyses by race/ethnicity. Results: Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Among NH-Whites, 5.7% (9 of 159), 4.4% (7 of 159), 4.4% (7 of 159) counties, and 5.0% (8 of 159) of counties were identified as hot spots for breast, colorectal, lung, and prostate cancer mortality, respectively. Among NH-Blacks, 5.7% (9 of 159), 3.8% (6 of 159), 7.4% (11 of 159), and 5.7% (9 of 159) counties were identified as hot spots for breast, colorectal, lung, prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: 1) eastern Piedmont to Coastal Plain regions, 2) southwestern rural Georgia area, or 3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-Blacks, older adult population, greater poverty, and more rurality. Conclusions: We observed distinct geographic and racial/ethnic disparities in mortality from breast, colorectal, lung, and prostate cancer in Georgia. Targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-Black, low-income, and rural residents. Citation Format: Justin Xavier Moore, Martha S. Tingen, Steven S. Coughlin, Christine O'Meara, Lorriane Odhiambo, Marlo Vernon, Samantha Jones, Robert Petcu, Ryan Johnson, K.M. Monirul Islam, Darryl Nettles, Ghadeer Albashir, Jorge Cortes. Understanding geographic and racial disparities in mortality from four major cancers in the state of Georgia: A spatial epidemiologic analysis, 1999 - 2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5908.

MP42-18 SOCIAL AND ENVIRONMENTAL RISK FACTORS FOR UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA IN RHODE ISLAND: 2000-2020

You have accessJournal of UrologyCME1 May 2022MP42-18 SOCIAL AND ENVIRONMENTAL RISK FACTORS FOR UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA IN RHODE ISLAND: 2000-2020 Borivoj Golijanin, Sarah Andrea, Justin Bessette, Rebecca Ortiz, Philip Caffery, Timothy O'Rourke, Christopher Tucci, Ali Amin, and Dragan Golijanin Borivoj GolijaninBorivoj Golijanin More articles by this author , Sarah AndreaSarah Andrea More articles by this author , Justin BessetteJustin Bessette More articles by this author , Rebecca OrtizRebecca Ortiz More articles by this author , Philip CafferyPhilip Caffery More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , Christopher TucciChristopher Tucci More articles by this author , Ali AminAli Amin More articles by this author , and Dragan GolijaninDragan Golijanin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002608.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Development of urothelial carcinoma (UC) has well documented risk factors including tobacco smoking and occupational exposure. Potentially upstream neighborhood-level factors are underexplored. We examined the association between sociodemographic and pollution composition and incidence of UC treated by radical cystectomy (RC) and overall survival (OS) in Rhode Island. METHODS: 484 patients underwent RC from 1/2000 to 12/2020 at Brown University affiliated hospitals. Patient addresses were linked to census tract level data on neighborhood sociodemographic composition and locations of leaking underground storage tanks, superfund sites, sanitary waste sites, and active solid waste facilities. Using Poisson and Cox proportional hazards models, we assessed incidence of RC and OS as a function of neighborhood pollution, area deprivation index (ADI), poverty, and racial composition quartiles in separate models adjusted for year and age at time of RC. RESULTS: Average age was 68 years, 73% men, and 90% white, with clinical stage T2 in 32%, Tis in 5%, Tx in 8%, and 3% had no information. Likelihood of RC positively correlated with greater neighborhood pollution (RR for 4th vs 1st quartile:1.39, 95% CI:1.08,1.79), predominance of white population (RR for 4th vs. 1st quartile:1.94, 95% CI:1.41,2.66) and negatively with greater poverty (RR for 4th vs. 1st quartile: 0.44, 95% CI:0.33, 0.58). Five-year OS rate was 56%, in neighborhoods with highest poverty rates (Q4) was 45%, and in neighborhoods with lowest rates of poverty (Q1) was 62%. Compared with Q1, the hazard ratio for those in Q4 poverty neighborhoods was 1.72 (95% CI:1.16,2.55). CONCLUSIONS: Inequalities in social determinants of health influence incidence and outcomes of UC patients undergoing RC. Patients undergoing RC were more likely to be white and living in affluent neighborhoods, however, this could be an artifact of selective survival. Those living in neighborhoods with greater number of pollutants underwent RC at greater rates. Risk of death in the first five years following RC was greatest for those living in neighborhoods with low socioeconomic status. Further research is needed to study contextual factors defining the differences in RC use and OS of patients with UC. Health policies and screening programs can target these high-risk UC hot-spots in order to improve earlier detection and patient outcomes. Source of Funding: Funded in part by DG and the Rhode Island Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e739 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Borivoj Golijanin More articles by this author Sarah Andrea More articles by this author Justin Bessette More articles by this author Rebecca Ortiz More articles by this author Philip Caffery More articles by this author Timothy O'Rourke More articles by this author Christopher Tucci More articles by this author Ali Amin More articles by this author Dragan Golijanin More articles by this author Expand All Advertisement PDF DownloadLoading ...

Monitoring Menstrual Health Knowledge: Awareness of Menstruation at Menarche as an Indicator.

As initiatives to support menstrual health are implemented globally, monitoring progress through a set of comprehensive indicators provides important feedback to direct policies and programs. One proposed core indicator is awareness of menstruation at menarche. That is, at the time of menarche an adolescent girl knowing that menstrual bleeding is something she will experience. In this investigation, we undertook secondary analysis of data collected across four studies to support interpretation of this indicator. We (1) describe the proportion of each sample aware of menstruation at menarche, (2) test variations in awareness according to sociodemographic characteristics, and (3) describe the associations between this indicator and self-reported experience at menarche, social support, and confidence to manage menstruation. Studies included cross-sectional survey data from 421 schoolgirls in Magway, Myanmar, 537 schoolgirls in Soroti, Uganda, 1,359 schoolgirls in Netrokona, Bangladesh, and 599 adult women working in Mukono, Uganda. Awareness of menstruation at menarche varied from 84% in Myanmar to 34% in Bangladesh. Older age at menarche was associated with awareness. Awareness at menarche was not associated with household poverty in the adolescent samples, but greater poverty was associated with lower levels of awareness among adult women. In Myanmar, girls aware of menstruation had significantly higher odds of reporting that they felt prepared (2.85 95% CI 1.34–6.08), happy (OR = 3.81 95% CI 1.74–8.37) and knew what was happening at menarche (OR = 2.37 95% CI 1.34–4.19). However, they also reported higher levels of embarrassment (OR = 1.76 95% CI 1.04–2.97) and did not report significantly less fear (OR = 1.24 95% CI 0.82–1.85). Awareness of menstruation at menarche was associated with higher scores on a menstrual knowledge quiz in both Myanmar (b = 9.51 95% CI 3.99–15.04) and Bangladesh (b = 4.78 95% CI 1.70–7.87). In these studies girls aware of menstruation at menarche also had higher odds of reporting they felt confident discussing menstruation with support sources and managing menstruation at school, while these differences were not significant among schoolgirls in Uganda. Findings support the usefulness of awareness of menstruation at menarche as an indicator to describe minimal knowledge of menstruation and suggest that awareness may signal greater knowledge, social support, and confidence in some settings.

Concept of Public Education System Development in the Republic of Uzbekistan

President of the Republic of Uzbekistan Shavkat Mirziyoyev in his Address to the Oliy Majlis stressed: "The greatest wealth is mind and knowledge, the greatest inheritance is good upbringing, the greatest poverty is ignorance! Therefore, for all of us, obtaining modern knowledge, true education and a high culture should become a constant vital need ". Indeed, Uzbekistan is laying the foundation for a new renaissance ˗ the Third Renaissance. This foundation is laid in the school, since the threshold of the new Uzbekistan begins with the school. To this end, Presidential Decree No. PF-5712 "On the Approval of the Concept for the Development of the Public Education System of the Republic of Uzbekistan until 2030" and Decree No. PF-6108 "On Measures for the Development of Education and Science in the New Period of Development of Uzbekistan" have been adopted.

Differences in the prevalence of mental health disorders among Black American adults with sickle cell disease compared to those with non-heritable medical conditions or no medical conditions.

Our aim was to determine differences in the prevalence of mental health disorders between Black Americans living with sickle cell disease (SCD) and Black Americans with other, non-heritable medical conditions, or no medical conditions. We examined the prevalence of mental health disorders among a non-institutionalized, community sample of Black adults in the US from the National Survey of American Life. We compared the odds of mental health disorders between Black American adults with SCD and those with other medical conditions, or no medical condition. Among the SCD group, 38·8% reported at least one mental health disorder: 17·6% endorsed a mood disorder, 24·7% an anxiety disorder, 2·4% an eating disorder, and 11·8% a childhood disorder. Compared to those with other medical conditions, Black Americans with SCD had greater poverty, more children in the household, and were less likely to be married/cohabitating (all P < 0·05). Yet, Black Americans with SCD were not at greater odds of having a mental health disorder compared to those with other medical conditions. When compared to the group with no conditions, however, individuals with SCD had 2·57 greater odds of mood disorder (95% confidence interval: 1·43-4·65; P = 0·002). The effect remained when controlling for socioeconomic status, marital status, and perceived physical health. In this study, almost 40% of Black American adults with SCD presented with a mental health disorder. Prevalence of mental health disorders was similar among those with non-heritable medical conditions, but those without a medical condition had a lower prevalence than in SCD. Among Black Americans, there appear to be unmeasured factors, common across medical conditions, that are linked to mental health disorders.

A Mixed Methods Case Study of Food Shopping in a Community with High Infant Mortality.

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores’ nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.

Environmental Cadmium Exposure and Odds of Residing in a Breast Cancer Hotspot in Kentucky

BACKGROUND AND AIM: Breast cancer is the most common invasive cancer diagnosed in US women. Cadmium is a carcinogenic heavy metal pollutant found in cigarettes and as an agricultural and industrial byproduct. Studies of cadmium exposure and breast cancer risk have produced mixed results depending upon methodology. We examined environmental cadmium exposure and risk of residing in a breast cancer hotspot in Kentucky. METHODS: Invasive breast cancer cases diagnosed between 1995-2018 were identified from the Kentucky Cancer Registry (n=66,413) and 68 of the 1,114 KY census-tracts were identified as breast cancer clusters using Getis-Ord Gi* for age-standardized rates. Census-tract cadmium concentrations from the 2014 National Air Toxics Assessment interpolated estimations were linked to cases’ residential addresses. Logistic regression was performed to assess the odds of residing in a hotspot across quartiles of cadmium exposure adjusted for individual-level (demographic, reproductive factors, Appalachian residence, insurance, tobacco use) and neighborhood factors (population density, poverty, and physical inactivity). Effect modification by smoking was assessed. RESULTS:4,134 women with breast cancer resided in hotspots (6.2%), which were located in major cities and southeast Kentucky. The mean age was 61 years. Hotspot cases were more likely than other cases to be black, single, uninsured or have public insurance, live in Appalachia, and reside in more densely populated neighborhoods with greater poverty. The odds of living in a hotspot were 4.2-times higher for those who resided in areas with the highest quartile of cadmium exposure compared to those in the lowest (95% CI: 3.6, 4.8; p-trend 0.0001). Results were similar (Q4 vs Q1: OR=4.4 95% CI 3.6, 5.4) among non-smokers. CONCLUSIONS:The observed associations of environmental cadmium exposure and residing in breast cancer hotspots in Kentucky warrant further research with more appropriate epidemiologic study designs. KEYWORDS: heavy metals, cancer and cancer precursors, environmental epidemiology, female, hotspot, air pollution